PMC4546951_01
Axial postcontrast CT of the chest ((a) and (b)) shows minimally enlarged mediastinal lymph nodes; the largest one in the right pretracheal region measures about 12.3 x 11.1 mm. Coronal postcontrast CT of the abdomen (c) shows mildly enlarged spleen and liver measuring about 14.5 and 15.7 cm, respectively, without evidence of focal lesions or associated abdominal lymphadenopathy.
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fig1
A computerized tomography scan of the chest, abdomen, and pelvis revealed minimally enlarged mediastinal lymph nodes; the largest one in the right pretracheal region measured about 12.3 x 11.1 mm; mildly enlarged spleen and liver measured about 14.5 and 15.7 cm, respectively, without evidence of focal lesions or associated abdominal lymphadenopathy (Figure 1).
(a) Bone marrow aspirate showing necrotic cells with very rare intact cells. Note intense blue staining of necrotic cells. (b) Bone marrow trephine biopsy showing massive necrosis. Note the homogeneous staining of the necrotic marrow. (c) BM biopsy shows hypercellular marrow due to a diffuse abnormal malignant infiltrate with starry-sky appearance. Note that areas of necrosis are still present. (d) The neoplastic cells show atypical large lymphoid cells with round, slightly irregular, or indented nuclei, dispersed chromatin, abundant agranular cytoplasm, and prominent nucleoli (blast-like cells).
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fig2
The first BM smears and biopsy were stained with Wright-Giemsa stain and hematoxylin and eosin and revealed massive BM necrosis (Figures 2(a) and 2(b)). Morphologically, the neoplastic cells showed atypical large cells with regular or slightly indented nuclei, dispersed chromatin, abundant agranular cytoplasm, and prominent nucleoli (blast-like cells) with starry-sky appearance (Figures 2(c) and 2(d)).
Flow cytometry analysis using side scatter/CD45 gating strategy; the gated population of cells (red) show bright CD45 positivity with expression of CD19 and FMC7 (45%) monotypic lambda light chain. These cells were negative for CD10, CD5, CD23, and CD34.
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Immunophenotyping by flow cytometry revealed a discrete lymphoid population (bright CD45 and low side scatter) that expressed CD19, CD20, CD22, FMC-7 (45%), and monotypic lambda light chain but was negative for CD5, CD10, CD23, and CD34 (Figure 3; some data are not shown).
(a) Karyotypic analysis showing complex chromosomal abnormalities including translocation t(11;14). (b) FISH using IGH-CCND dual color dual fusion on interphases and metaphases cells showed the presence of the translocation t(11;14).
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fig4
In 60% of cells, cytogenetic analysis revealed complex chromosomal abnormalities and chromosomal rearrangements in addition to the t(11;14)(q13;q32) translocation (Figure 4(a)). FISH was performed on interphase cells using Vysis LSI IgH/CCND1 dual color, dual fusion probe (Abbott Laboratories, Abbott Park, IL), and confirmed IgH/CCND1 fusion in 44% of analyzed cells (Figure 4(b)).