PMC8597805_01
CT imaging demonstrating splenomegaly with hemorrhage, splenic laceration, and perisplenic hematoma (red arrows). Lymphadenopathy was also noted on imaging (not shown).
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Peripheral blood smear (Wright Giemsa, 100X) demonstrating pleomorphic atypical lymphocytes (red arrows).
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Examination of the peripheral smear showed nucleated red blood cells and a population of atypical lymphocytic cells characterized by variable size, irregular nuclear contours, and high nuclear:cytoplasmic ratios (Figure 2).
Flow cytometric analysis showing a clonal population of kappa-restricted CD5+ B-cells that express FMC7 and bright CD20 and lack CD23 (Top row: black dots backgated on CD19+ events).
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Dual fusion FISH for CCND1 and IGH, demonstrating a variant abnormal signal pattern with three copies of CCND1-IGH fusion (yellow signals).
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This diagnosis was confirmed by fluorescence in situ hybridization (FISH) analysis which was positive for t(11;14)(q13;q32), demonstrating a variant abnormal pattern with three CCND1-IGH fusion signals (Figure 4).