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Mejia Saldarriaga M, Alhomoud M, Roboz G, Allan JN, Ruan J, Ouseph MM, Simonson PD, Bustoros M, Niesvizky R. Angioimmunoblastic T-cell lymphoma presenting with severe plasmacytosis mimicking plasma cell leukemia. Am J Hematol 2023. [PMID: 36785525 DOI: 10.1002/ajh.26878] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 01/30/2023] [Accepted: 02/01/2023] [Indexed: 02/15/2023]
Abstract
Peripheral blood smear (A) demonstrates increased numbers of plasma cells (representative cells indicated by arrows), (B) demonstrates polytypic nature of plasma cells.
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Affiliation(s)
| | - Mohammad Alhomoud
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Gail Roboz
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - John N Allan
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Jia Ruan
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Madhu M Ouseph
- Division of Pathology & Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Paul D Simonson
- Division of Pathology & Laboratory Medicine, Weill Cornell Medicine, New York, New York, USA
| | - Mark Bustoros
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
| | - Ruben Niesvizky
- Division of Oncology & Hematology, Weill Cornell Medicine, New York, New York, USA
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2
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Li B, Nong L, Zhang J, Wang W, Wang Q, Zhang Y, Ren S, Wang M. Plasmacytic Pleural Effusion as a Major Presentation of Angioimmunoblastic T-Cell Lymphoma: A Case Report. Curr Oncol 2022; 29:7637-7644. [PMID: 36290880 PMCID: PMC9600574 DOI: 10.3390/curroncol29100603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2022] [Revised: 09/26/2022] [Accepted: 10/11/2022] [Indexed: 11/05/2022] Open
Abstract
Angioimmunoblastic T-cell lymphoma is one of the peripheral T-cell lymphomas. Reactive plasma cells can occasionally be observed in AITL patients' peripheral blood and bone marrow. Plasmacytic pleural effusion as the presentation of AITL has not been reported before. The mechanisms of plasmacytic pleural effusion are not fully understood. Here we present an 82-year-old male with exuberant plasma cells in his pleural effusion in addition to his peripheral blood and bone marrow aspiration. By presenting this case, we would like to expand the spectrum of disease presentations in AITL and discuss the significance of flow cytometry in the differential diagnosis of pleural effusion. To our knowledge, this is the first case report in the literature, which will be crucial to assist the hematopathologist in accurate diagnosis and treatment.
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Affiliation(s)
- Borui Li
- Department of Hematology, Peking University First Hospital, Beijing 100034, China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing 100034, China
| | - Jianhua Zhang
- Department of Nuclear Medicine, Peking University First Hospital, Beijing 100034, China
| | - Wensheng Wang
- Department of Hematology, Peking University First Hospital, Beijing 100034, China
| | - Qian Wang
- Department of Hematology, Peking University First Hospital, Beijing 100034, China
| | - Yang Zhang
- Department of Hematology, Peking University First Hospital, Beijing 100034, China
| | - Shaomin Ren
- Department of Hematology, Peking University First Hospital, Beijing 100034, China
| | - Mangju Wang
- Department of Hematology, Peking University First Hospital, Beijing 100034, China
- Correspondence:
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Kalmuk J, Matar S, Feng G, Kilb E, Lim MY. Parvovirus B19-induced hemophagocytic lymphohistiocytosis: Case report and review of the literature. Clin Case Rep 2019; 7:2076-2081. [PMID: 31788255 PMCID: PMC6878072 DOI: 10.1002/ccr3.2401] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2019] [Revised: 05/27/2019] [Accepted: 05/28/2019] [Indexed: 12/21/2022] Open
Abstract
HLH is a catastrophic and likely underdiagnosed pathology with multiple triggers including infection. PVB19 can cause persistent marrow infection leading to HLH despite negative acute serologic markers making timely diagnosis difficult. Increased awareness of PVB19-HLH is warranted given its potentially lethal nature and the careful interpretation required with serologic markers.
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Affiliation(s)
- James Kalmuk
- Department of Internal MedicineMedical University of South CarolinaCharlestonSCUSA
| | - Sara Matar
- Department of Hematology/OncologyMedical University of South CarolinaCharlestonSCUSA
| | - Gong Feng
- Department of Pathology and Laboratory MedicineMedical University of South CarolinaCharlestonSCUSA
| | - Edward Kilb
- Department of Pulmonary and Critical Care MedicineMedical University of South CarolinaCharlestonSCUSA
| | - Ming Y. Lim
- Department of Hematology/OncologyMedical University of South CarolinaCharlestonSCUSA
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Zhang J, Yan X, Li Y, Gao R, Wang P, Mo W. Reactive plasmacytosis mimicking multiple myeloma associated with SFTS virus infection: a report of two cases and literature review. BMC Infect Dis 2018; 18:528. [PMID: 30348099 PMCID: PMC6198377 DOI: 10.1186/s12879-018-3431-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2018] [Accepted: 10/02/2018] [Indexed: 01/01/2023] Open
Abstract
Background Severe fever with thrombocytopenia syndrome (SFTS) is an emerging infectious disease caused by a novel bunyavirus named SFTS virus (SFTSV), which is classified into the genus Phlebovirus and family Phenuiviridae. Reactive plasmacytosis mimicking multiple myeloma is a very rare condition in association with SFTS. Here, we describe two SFTS cases who presented with hyperimmunoglobulinemia, as well as extensive bone marrow and peripheral blood plasmacytosis, which mimicked multiple myeloma (MM). Case presentation We report two cases who presented with fever and blood routine abnormity which were conformed as SFTS eventually. They were performed bone marrow aspiration and were admitted to the department of hematology with a preliminary diagnosis of MM. They all had hyperimmunoglobulinemia, extensive bone marrow and peripheral blood plasma cells, prolonged activated partial thromboplastin time (APTT), elevated hepatic enzyme. The two patients recovered with treatment of doxycycline, human immunoglobulins, plasma transfusion, and other supporting treatments. But case 1 occurred lymphoma 8 months later and died. Conclusion SFTS might be one of differential diagnosis of MM in certain endemic area. We also conclude that SFTSV is a pantropic virus that could injure most tissues and cells of the human body.
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Affiliation(s)
- Jinjing Zhang
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Xiaojing Yan
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China.
| | - Yan Li
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Ran Gao
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Pingping Wang
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
| | - Wenbin Mo
- Department of Hematology, The First Affiliated Hospital of China Medical University, Shenyang, 110001, Liaoning, China
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Adachi Y, Hino T, Ohsawa M, Ueki K, Murao T, Li M, Cui Y, Okigaki M, Ito M, Ikehara S. A case of CD10-negative angioimmunoblastic T cell lymphoma with leukemic change and increased plasma cells mimicking plasma cell leukemia: A case report. Oncol Lett 2015; 10:1555-1560. [PMID: 26622708 DOI: 10.3892/ol.2015.3490] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 05/22/2015] [Indexed: 11/06/2022] Open
Abstract
Angioimmunoblastic T cell lymphoma (AITL) is a peripheral T cell lymphoma, known to express CD3 and CD4, and, frequently, also CD10 and c-Maf-1. Hypergammaglobulinemia is not particularly rare in patients with AITL. However, AITL in conjunction with plasmacytosis in the peripheral blood is rare. The current report presents a case of CD10-negative AITL demonstrating leukemic change and plasmacytosis in the peripheral blood mimicking plasma cell leukemia. A 78-year-old male was admitted to hospital due to systemic lymph node enlargement, high serum IgG and IgA, and increased counts of plasmacytoid cells and lymphoid cells with atypical nuclei in the peripheral blood. Initially, plasma cell leukemia was suspected, due to the extreme increase in the number of plasma cells in the peripheral blood. However, the plasma cells did not show clonal expansion on examination by flow cytometry. Based on histological analyses, following a biopsy of an enlarged lymph node, the patient was diagnosed with AITL. This case suggests that when hypergammaglobulinemia and increases in B-lineage cells are observed, AITL should be considered in addition to disorders of B-lineage cells.
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Affiliation(s)
- Yasushi Adachi
- Division of Surgical Pathology, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan ; Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan
| | - Takuya Hino
- Department of Internal General Medicine, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Masahiko Ohsawa
- Department of Diagnostic Pathology, Osaka City University Graduate School of Medicine, Osaka City, Osaka 545-0051, Japan
| | - Kazuhito Ueki
- Department of Internal General Medicine, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Tomoko Murao
- Department of Clinical Laboratory, Toyooka Hospital, Toyooka City, Hyogo 668-8501, Japan
| | - Ming Li
- Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan
| | - Yunze Cui
- Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan ; Japan Immunoresearch Laboratories Co. Ltd., Takasaki City, Gunma 370-0021, Japan
| | - Mitsuhiko Okigaki
- Department of Internal Medicine, Otokoyama Hospital, Yawata City, Kyoto 614-8366, Japan
| | - Mitsuhiro Ito
- Division of Medical Biophysics, Kobe University Graduate School of Health Sciences, Kobe City, Hyogo 650-0017, Japan
| | - Susumu Ikehara
- Department of Stem Cell Disorders, Kansai Medical University, Hirakata City, Osaka 573-1010, Japan
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Papadi B, Polski JM, Clarkson DR, Liu-Dumlao TO. Atypical angioimmunoblastic T-cell lymphomas masquerading as systemic polyclonal B-immunoblastic proliferation. Virchows Arch 2012; 461:323-31. [PMID: 22790664 DOI: 10.1007/s00428-012-1280-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2012] [Revised: 06/21/2012] [Accepted: 06/27/2012] [Indexed: 12/20/2022]
Abstract
Angioimmunoblastic T cell lymphoma (AITL) is a relatively rare peripheral T cell lymphoma derived from follicular T helper cells. AITL has a varied presentation, both clinically and morphologically. AITL can pose a diagnostic challenge as it may be difficult to identify and characterize the neoplastic cells among the polymorphous infiltrates composed of polyclonal B immunoblasts and plasma cells. In AITL, the reactive B cell and plasma cell proliferation is secondary to dysregulated secretion of cytokines such as interleukin-6 by the neoplastic follicular T helper cells. SPBIP is a condition of unknown etiopathogenesis characterized by systemic involvement by polyclonal B immunoblasts and plasma cells. We report two cases of AITL, which are presented with atypical findings making it difficult to diagnose. The cases had features similar to SPBIP. Our cases highlight the importance of screening cases of polyclonal plasmacytosis and SPBIP like cases for underlying AITL.
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Affiliation(s)
- Bhavesh Papadi
- Department of Pathology, University of South Alabama, Mobile, AL 36617, USA
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Gérôme P, Foucher B, Otto MP, Crevon L, Rabar D, Pasquet F, Tolou H. [Plasmacytosis and dengue fever: an underestimated abnormality?]. Rev Med Interne 2012; 33:343-5. [PMID: 22578590 DOI: 10.1016/j.revmed.2012.03.357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2011] [Revised: 02/10/2012] [Accepted: 03/31/2012] [Indexed: 11/29/2022]
Abstract
INTRODUCTION A significant peripheral blood plasmacytosis is a rare finding associated with viral infections. We reported five consecutive cases of dengue virus infection, with circulating plasma cells. CASE REPORTS Three women and two men, aged 26 to 75 years, had returned from French West Indies less than one week before the onset of the symptoms (mean: 2.5 days). The transient blood plasmacytosis was variable in intensity (0.1 to 0.8 G/L) with a maximal level between the fourth and the seventh day following the onset of the symptoms, and was associated in four patients, with activated lymphocytes and lympho-plasma cells. CONCLUSION Reactive plasmacytosis during dengue fever is common and probably underestimated because it is transient and only identified by careful microscopic examination of a blood smear. Plasmacytosis could be explained by the intensity of the immunological response and the production of large amount of interleukins.
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Affiliation(s)
- P Gérôme
- Service de biologie médicale, HIA Desgenettes, 108, boulevard Pinel, 69275 Lyon cedex 03, France
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Slavov SN, Kashima S, Pinto ACS, Covas DT. Human parvovirus B19: general considerations and impact on patients with sickle-cell disease and thalassemia and on blood transfusions. ACTA ACUST UNITED AC 2011; 62:247-62. [DOI: 10.1111/j.1574-695x.2011.00819.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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9
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Thai KTD, Wismeijer JA, Zumpolle C, de Jong MD, Kersten MJ, de Vries PJ. High incidence of peripheral blood plasmacytosis in patients with dengue virus infection. Clin Microbiol Infect 2010; 17:1823-8. [PMID: 21091833 DOI: 10.1111/j.1469-0691.2010.03434.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Little is known about polyclonal peripheral blood plasmacytosis in dengue virus (DENV)-infected patients. We initiated this prospective observational study to quantify and describe the kinetics and phenotype of peripheral blood plasma cells (PCs) in these patients. Morphological examination and flow cytometric (FC) analysis for the characterization and immunophenotyping of lymphocyte subsets and PCs were performed in 35 and 31 patients suspected of DENV infection, respectively. Our results show that blood plasmacytosis is a very common haematological finding. Depending on the days of illness at presentation, blood plasmacytosis was observed in 64% to 73% of patients. Blood plasmacytosis was most pronounced before 7 days of illness and declined rapidly thereafter, to completely disappear after 14 days of illness. Blood plasmacytosis was higher in secondary DENV infection. The majority of CD138(+) PCs (89%) had a shared immunophenotype (CD45(+)/CD19(-)/CD56(-)) and in all cases the PCs were polyclonal. Blood plasmacytosis, characterized by a transient presence of polyclonal PCs in the circulation, is a common event in DENV infection.
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Affiliation(s)
- K T D Thai
- Division of Infectious Diseases, Tropical Medicine and AIDS, Academic Medical Centre, Amsterdam, The Netherlands.
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Wada T, Maeba H, Ikawa Y, Hashida Y, Okumura A, Shibata F, Tone Y, Inoue M, Koizumi S, Takatori H, Sakai Y, Kaneko S, Yachie A. Reactive peripheral blood plasmacytosis in a patient with acute hepatitis A. Int J Hematol 2007; 85:191-4. [PMID: 17483053 DOI: 10.1532/ijh97.06200] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Reactive plasmacytosis is a transient expansion of plasma cell progenitors and precursors. This rare condition has been reported to occur mainly in infections and tumors. We describe a case of acute hepatitis A presenting with marked peripheral blood plasmacytosis. Plasma cells made up 27.5% of the mononuclear cells and had the immunophenotype CD10-CD19+CD20-CD21-CD23-CD34-CD38++HLA-DR+. Although the level of interleukin 6 was not increased, the presence of activated T-cells with an inverted CD4/CD8 ratio and high levels of soluble interleukin 2 receptor and neopterin indicated a marked immune response to acute hepatitis A. The patient's plasma cells had almost disappeared from the blood by hospital day 16. This report may represent the first described case of reactive peripheral blood plasmacytosis in acute hepatitis A.
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Affiliation(s)
- Taizo Wada
- Department of Pediatrics, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan.
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Bai LY, Chiu CF, Chiang IP, Lin CY, Liao YM. Acalculous cholecystitis mimicking plasma cell leukemia. Ann Hematol 2006; 85:487-8. [PMID: 16570151 DOI: 10.1007/s00277-006-0105-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2006] [Accepted: 02/17/2006] [Indexed: 10/24/2022]
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Abstract
Extreme plasmacytosis in peripheral blood is a rare finding most often associated with plasma cell leukemia but rarely with other malignancies, infectious diseases, or drug reactions. We report the case of a 40-year-old man who was a US expatriate working and traveling in East Asia. He presented with complaints of fever, myalgia, headache, vomiting, and diarrhea of 3 days' duration. An initial evaluation revealed elevated liver function tests, thrombocytopenia (68 x 10(3)/microL), and a white blood cell count of 5.8 x 10(3)/microL with 19% plasma cells (1100/microL), 9% abnormal plasmacytoid lymphocytes (520/microL), 37% polymorphonuclear leukocytes, 3% band forms, 27% lymphocytes, 4% monocytes, and 1% eosinophils. An extensive evaluation was performed, including infectious disease serologies, a bone marrow biopsy, and flow cytometry. During the course of 3 days, his symptoms and hematologic findings improved dramatically. Serologic results were reactive for dengue (immunoglobulin M [IgM] positive, reciprocal IgG titer, 655 360), consistent with a secondary infection of unknown serotype. He remains well 4 years later. To our knowledge, plasmacytosis to this degree has not been described in dengue fever, but atypical lymphocytosis is common. In patients from dengue-endemic areas, even extreme plasmacytosis should be assessed to determine whether it is transient and related to an acute illness before proceeding to an extensive evaluation.
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Affiliation(s)
- John M Gawoski
- Department of Laboratory Medicine, Lahey Clinic, Burlington, Mass 01805, USA.
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Lower FE, Menon S, Sanchez JA. Association of parvovirus B19 with plasma cell-rich myocardial infiltrates after heart transplantation. J Heart Lung Transplant 2001; 20:755-8. [PMID: 11448804 DOI: 10.1016/s1053-2498(01)00233-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
In this report we describe the development of plasma cell-rich myocardial infiltrates in association with a parvovirus B19 infection in a heart transplant patient. We hypothesize that the virus, either alone or in association with the cardiac allograft, may polarize the immune response in the direction of T helper 2 (Th2) cells rather than the expected Th1 cells. This favors the development of a humoral immune response and infiltration of the graft with plasma cells.
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Affiliation(s)
- F E Lower
- Department of Pathology and Laboratory Medicine, Lexington, Kentucky 40536-0293, USA
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Larroche C, Scieux C, Honderlick P, Piette AM, Blétry O. [Fever and polyarthralgia: a serology can obscure another...]. Rev Med Interne 1998; 19 Suppl 2:247s-250s. [PMID: 9775084 DOI: 10.1016/s0248-8663(98)80835-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- C Larroche
- Service de médecine interne, hôpital Saint-Louis, Paris
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Abstract
The morphology of the giant proerythroblasts (GPE) in air-dried and Wright-Giemsa-stained smears of bone marrow in 16 patients with pure red cell aplasia (PRCA) caused by parvovirus B19 infection is described. B19 infection was diagnosed by the presence of the virus or viral DNA and/or IgM antibodies. Twelve patients had chronic hemolytic anemia and aplastic crisis and 4 patients had AIDS with chronic PRCA. In patients with chronic hemolytic anemia and aplastic crisis, GPE were not detectable in bone marrow biopsies that showed any degree of recovery of erythropoiesis. The GPE morphology was quite variable. The early (basophilic) GPE measured 25 to 35 microm in diameter, had a narrow rim of intensely blue and often vacuolated cytoplasm with pseudopodia, round nuclei with compact uncondensed chromatin, and an indistinct and inclusion-like purple-colored tinctorial change. The "intermediate" and "late" GPE measured 25 to 45 microm in diameter and showed cytoplasmic swelling, gradual loss of cytoplasmic basophilia, and fraying of the cytoplasm with focal rupture; the nuclei showed an increase in volume, a highly uncondensed and coarse sieve-like chromatin, and 1 to 3 prominent, pale to moderate purple inclusion-like nucleoli or inclusions. Bare nuclei similar in size and chromatin pattern to those of the GPE were present in proximity to the GPE and may have arisen from the GPE by dissolution of the cytoplasm. The glassy intranuclear inclusions with central clearing, the so-called lantern cells described in formalin-fixed tissues of patients with B19 infection, were absent in all cases. These findings suggest that direct toxic cell injury rather than apoptosis may be involved in the pathogenesis of erythroid aplasia in B19 infection.
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Affiliation(s)
- P R Koduri
- Division of Hematology, Cook County Hospital, Chicago, Illinois, USA
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