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A young boy presenting with cervical lymph node enlargement and mediastinal mass. On examination sig…
Dr Hafsa Hanif, PG Year 4 Resident, Dr Zunaira Rafiq, Junior Consultant Clinical Haematology, Dr Fatima Meraj, Section Head Haematology - The Indus Hospital, Karachi-Pakistan
A 73-year-old man presented to our hospital with a two-week history of fatigue and anorexia. Laborat…
Jing Cheng, The First Affiliated Hospital of Sun Yat-sen University, China
Xueyan Chen, The People’s Hospital of Longhua Shenzhen,China
A 60-year-old woman with a history of human T-cell lymphotropic virus 1 infection presented with a l…
Keisuke Kidoguchi M.D., Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University,5-1-1 Nabeshima, Saga 849-8501, Japan
Male, 47 years old, with newly diagnosed multiple myeloma (MM) IgG kappa (top, left) ISS II. The kar…
Maria Gabriella Cordeiro(1,2); Gracia Aparecida Martinez (1); Vanderson Rocha (1), Elvira Deolinda Rodrigues Pereira Velloso (1,2)
1. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
2. Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
A case of neonatal hyperbilirubinaemia with bilirubin crystals in the peripheral blood.
A three-day…
Dr Pooja Singh, Senior Resident, Pathology (Government Medical College and Hospital, Chandigarh India)
Dr Anita Tahlan, Associate Professor, Pathology (Government Medical College and Hospital, Chandigarh, India)
A 79-year-old man with history of chronic lymphocytic leukaemia previously treated with lenalidamide…
Maansi Joshi and John Giannoutsos
Department of Haematology, Nepean Hospital, Sydney, Australia
A 80-year-old gentleman presented with pancytopenia - haemoglobin 86 g/l, total white cell count 10.…
Dr Teng Fong Ng
Dr Frank Cordingley
Prof Michael Leahy
Affiliate Institutions: Royal Perth Hospital and PathWest Laboratory Medicine WA, Perth, Australia.
MYC-amplified AML is a rare clinical entity. We report a case of MYC-amplified AML with the followin…
Dr Ashvind Prabahran
MBBS
Victorian Comprehensive Cancer Centre
Peter MacCallum Cancer Centre & Royal Melbourne Hospital.
Australia
A/Prof Surender Juneja
MD
Victorian Comprehensive Cancer Centre
Peter MacCallum Cancer Centre & Royal Melbourne Hospital.
Australia
A 60-year old male presented with a two-year history of increasing head size due to an extensive, ir…
Primary Author:
Dr David J M Routledge
Secondary Author:
Dr Daniel Wong, Dr David Kipp, Dr Sumi Ratnasingam, Dr Hannah Rose, A/Prof Philip Campbell
Institution:
University Hospital Geelong
70 Swanston Street
Geelong
Victoria
3220
Although symptomatic osteonecrosis is a rare complication it has been reported in patients with lymp…
Ferrari Angela1, Luminari Stefano1,2, Felaco Davide3, Dardani Lucia4, Merli Francesco1 1 Hematology, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Italy 2 Department of Clinical Diagnostic and Public Health Medicine, Università degli studi di Modena e Reggio Emilia, Modena, Italy 3 Radiology, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Italy 4 Rheumatology, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Italy
An 81-year-old woman with Alzheimer's disease was admitted to the emergency room of our hospital in …
Saray Anabitarte and Joan Cid
Blood grouping, microtitre plate; positive reactions show as sharp agglutinates; in negative reactio…
A. V. Hoffbrand
A young boy presenting with cervical lymph node enlargement and mediastinal mass. On examination signs of superior vena cava obstruction and pleural effusion were noted. Pleural fluid aspirate morphology demonstrated multiple mononuclear and classical Reed-Sternberg cells. Biopsy of lymph node is awaited.
Dr Hafsa Hanif, PG Year 4 Resident, Dr Zunaira Rafiq, Junior Consultant Clinical Haematology, Dr Fatima Meraj, Section Head Haematology - The Indus Hospital, Karachi-Pakistan
A 73-year-old man presented to our hospital with a two-week history of fatigue and anorexia. Laboratory tests revealed remarkable anaemia (haemoglobin 75g/L) with normal white cells and platelets. Immunoglobulin testing showed monoclonal IgG, κ in the serum (41.80 g/L). Urine protein electrophoresis showed free κ-type Bence-Jones proteinuria (3.87 g/L). Bone marrow aspiration showed 54.5% myeloma cells (CD38+ CD138+ IgG-κ+). A remarkable finding was phagocytosis of red blood cells, and platelets by approximately 4% of these myeloma cells in Wright-Giemsa-stained bone marrow. The immunohistochemistry of the bone marrow biopsy specimen revealed CD138-and-κ-positive plasma cells. This case indicates that the ability to phagocytose may represent the nature, acquired through a process of malignant transformation, of plasma cells, The possibility is discussed that phagocytising ability may be one of the markers for malignant plasma cells.
Jing Cheng, The First Affiliated Hospital of Sun Yat-sen University, China
Xueyan Chen, The People’s Hospital of Longhua Shenzhen,China
A 60-year-old woman with a history of human T-cell lymphotropic virus 1 infection presented with a left-hand dorsal swelling during the course of treatment for rheumatoid arthritis (left). Abnormal 'flower-like' nuclei comprised 37.5% of white blood cells, and showed positivity for CD3, DC4, CCR4, TSLC1 and CD25 by flow cytometric analysis.
Her rheumatoid arthritis was well-controlled without exacerbation. A biopsy of the thickened synovial membrane revealed proliferation of abnormal lymphocytes (right), which showed positive for CD3, CD4 and Ki-67. CD8 and CD20 were negative with immunohistochemistry. Adult T-cell leukaemia/lymphoma presenting with synovitis was diagnosed.
Adult T-cell leukaemia/lymphoma is a haematological malignancy with s poor prognosis. Clinical presentations are usually aggressive, but sometimes insidious. Clinicians must have awareness of various presentations if mimicking comorbidities exist.
Keisuke Kidoguchi M.D., Division of Haematology, Respiratory Medicine and Oncology, Department of Internal Medicine, Faculty of Medicine, Saga University,5-1-1 Nabeshima, Saga 849-8501, Japan
Male, 47 years old, with newly diagnosed multiple myeloma (MM) IgG kappa (top, left) ISS II. The karyotype demonstrated a hyperhaploid clone with structural abnormalities, including 17p deletion (below). Interphase fluorescence in situ hybridisation of CD138+ cells showed only one signal for CKS1B, FGFR3, RB1, IGH, MAF and TP53 in 90% of cells (top, right, multiple myeloma panel). The hyperhaploid subgroup MM defined by a range of 24-34 chromosomes clone is rare; corresponding to 0.25% of newly diagnosed MM. Hyperhaploidy and TP53 gene deletion is associated with early progression to triple therapy and poor survival, with a five-year survival rate of 25%.
Maria Gabriella Cordeiro(1,2); Gracia Aparecida Martinez (1); Vanderson Rocha (1), Elvira Deolinda Rodrigues Pereira Velloso (1,2)
1. Hospital das Clínicas, Faculdade de Medicina, Universidade de São Paulo, São Paulo, SP, Brasil
2. Hospital Israelita Albert Einstein, São Paulo, SP, Brasil
A case of neonatal hyperbilirubinaemia with bilirubin crystals in the peripheral blood.
A three-day-old term male baby born following emergency lower segment caesarian section (LSCS), developed neonatal hyperbilirubinaemia on D1 OL of life. The baby demonstrated bleeding from a needle prick site and neonatal hyperbilirubinaemia and so was transferred to the Neonatal Intensive Care Unit. The baby weighed 2.28 kg.
Routine blood investigations showed Hb- 17.3, TLC- 30.8, platelets-28000, total bilirubin- 28.9, conjugated-.8, plasma haemoglobin -51, DCT- negative. Blood group was B positive. Blood cultures were negative.
The baby was given one unit of random donor platelets, one unit of FFP and one unit of packed red blood cells (RBCs) along with intravenous amikacin and fluids. Gradually, the baby started taking breast feeds and was discharged after ten days. Blood films were made from EDTA anticoagulated blood. The blood film showed moderate aniso-poikilocytosis, microcytes, microspherocytes (transfused), normocytes, a few macrocytes, and occasional fragmented cells. RBCs were normochromic. There were approximately 4 nRBCs/100 White blood cells and platelets were reduced. In addition, gold coloured, refractile, rhomboid to rectangular bilirubin crystals were seen in many neutrophils.
Bilirubin crystals are seen peripheral smears from blood samples collected in EDTA in children with severe hyperbilirubinaemia. In neonates, bilirubin crystals are more commonly associated with septicaemia than with haemolytic disease of newborn.
Dr Pooja Singh, Senior Resident, Pathology (Government Medical College and Hospital, Chandigarh India)
Dr Anita Tahlan, Associate Professor, Pathology (Government Medical College and Hospital, Chandigarh, India)
A 79-year-old man with history of chronic lymphocytic leukaemia previously treated with lenalidamide, ibrutinib and venetoclax presented with pancytopenia. Bone marrow biopsy showed trilineage dysplasia, increased blasts (8%) and increased abnormal promyelocytes (37%) with single or multiple Auer rods (faggot cells). The promyelocytes were hypogranular and bilobed. The morphological features were highly suggestive of acute promyelocytic leukaemia, although the prominent trilineage dysplasia was unusual. Cytogenetic analysis showed complex karyotype with no detectable t(15;17). This was confirmed on FISH and PCR testing. The diagnosis was revised to AML with MDS-related changes, although therapy-related AML could not be ruled out.
Maansi Joshi and John Giannoutsos
Department of Haematology, Nepean Hospital, Sydney, Australia
A 80-year-old gentleman presented with pancytopenia - haemoglobin 86 g/l, total white cell count 10.4x109/l, neutrophil count 1.8x109/l and platelet count 69x109/l. Blood film examination identified atypical blastoid lymphocytes with pale basophilic cytoplasm and pearl-like cytoplasmic micro-vesicles. By flow cytometry, the population expressed CD4, CD38, CD43, CD56, CD61, CD117, CD123, CD303, CD304, HLADR with dim expression of CD2 and CD7 and CD45. The CD4+/CD56+/CD123+ immunophenotype is consistent with blastic plasmacytoid dendritic cell neoplasm (BPDCN). BPDCN is a rare haematological malignancy of type 2 dendritic cells, which usually presents initially with cutaneous lesions and later with a leukaemic phase.
Dr Teng Fong Ng
Dr Frank Cordingley
Prof Michael Leahy
Affiliate Institutions: Royal Perth Hospital and PathWest Laboratory Medicine WA, Perth, Australia.
MYC-amplified AML is a rare clinical entity. We report a case of MYC-amplified AML with the following karyotype: 46 XY with 1-17 double minutes. The double minutes demonstrated positive staining for MYC via FISH, hence resulting in amplification of the gene. The unusual associated cytoplasmic inclusions in blasts (A,B,C) represent micronuclei. There are also Auer rods seen (A,B). The blood film demonstrated botryoid nuclei , shown here in a neutrophil and monocyte (D,E). The botryoid changes are thought to be caused by contractile microtubules or microfilaments radiating from a centriole in amitotic cells and are normally associated with hyperthermia. The patient at the time of this examination was normothermic. The patient was receiving treatment with a BCL2 inhibitor as part of a trial and the nuclear changes may be related to this drug effect as BCL2 has many interactions with the mitotic spindle.
Dr Ashvind Prabahran
MBBS
Victorian Comprehensive Cancer Centre
Peter MacCallum Cancer Centre & Royal Melbourne Hospital.
Australia
A/Prof Surender Juneja
MD
Victorian Comprehensive Cancer Centre
Peter MacCallum Cancer Centre & Royal Melbourne Hospital.
Australia
True True
A 60-year old male presented with a two-year history of increasing head size due to an extensive, irregular scalp lesion. Physical examination revealed bilateral cervical lymph node enlargement in the absence of other lymphadenopathy or hepatosplenomegaly. A scalp biopsy confirmed diffuse large B-Cell lymphoma (DLBCL) of germinal centre origin. Staging Computed Tomography-Positron Emission Tomography (CT-PET) scanning and Magnetic Resonance Imaging (MRI) demonstrated extensive involvement of the scalp with extension into the extradural space, as well as bilateral cervical lymph node involvement. Primary DLBCL should always be considered in the differential diagnosis of scalp masses.
Primary Author:
Dr David J M Routledge
Secondary Author:
Dr Daniel Wong, Dr David Kipp, Dr Sumi Ratnasingam, Dr Hannah Rose, A/Prof Philip Campbell
Institution:
University Hospital Geelong
70 Swanston Street
Geelong
Victoria
3220
True True
Although symptomatic osteonecrosis is a rare complication it has been reported in patients with lymphoproliferative disorders during treatment. High dose corticosteroids combined with chemotherapy is a well known risk factor. In the case reported here a high daily prednisolone dose of 40 mg/m2 over 14 days received with escalated BEACOPP could have caused on the osteonecrosis. The diagnostic work-up in non-responding bone pain should include consideration of osteonecrosis. Conservative treatment can result in an excellent response and should be the initial approach once the diagnosis is confirmed.
Ferrari Angela1, Luminari Stefano1,2, Felaco Davide3, Dardani Lucia4, Merli Francesco1 1 Hematology, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Italy 2 Department of Clinical Diagnostic and Public Health Medicine, Università degli studi di Modena e Reggio Emilia, Modena, Italy 3 Radiology, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Italy 4 Rheumatology, Azienda Unità Sanitaria Locale IRCCS di Reggio Emilia, Italy
True True
An 81-year-old woman with Alzheimer's disease was admitted to the emergency room of our hospital in 2016 following development of a haematoma on the right thigh after a fall. The patient was taking acenocumarol because of two episodes of deep vein thrombosis in 2008 and 2014. Physical examination revealed pallor, hypotension and tachycardia. Laboratory data showed acute anaemia (drop of Hb from 110 to 69 g/l in 24 hours) and INR 1.5. Vitamin K was administered, and a transfusion of red cells (RBC) and fresh frozen plasma was ordered. After transfusing 1 unit of RBCs, the attendant nurse noted the development of a haematoma of the left arm. The nurse recognized that the cannula in the peripheral vein used for transfusing the RBC unit was not well inserted and an extravasation of RBCs had occurred causing the haematoma.
Extravasation is defined as the inadvertent extravenous administration of a medication or solution into the subcutaneous or subdermal tissue at the injection site. Although extravasation injuries are a major cause of iatrogenic morbidity to the hospitalized patient, the incidence of extravasation is not known given the lack of reporting and absence of a centralized registry. However, reported incidence ranges from 0.1% to 6% of adult patients and up to 11% of paediatric patients. Specific guidelines are available for extravasation of radiographic contrast, chemotherapy and noncytotoxic medications, but comprehensive evidence-based management recommendations for extravasation of blood components in transfusion are lacking.
Saray Anabitarte and Joan Cid
Blood grouping, microtitre plate; positive reactions show as sharp agglutinates; in negative reactions the red cells are dispersed
A. V. Hoffbrand
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