#00062353

A 66 year old man presented with fever, loss of appetite and weight loss. There was no lymphadenopathy or hepatosplenomegaly. Systemic examination was normal. CBC showed Hb- 8.3g/dl, leukocytosis (TLC = 12,600/𝞵L) and normal platelet count (2,30,000/𝞵l). Peripheral smear examination showed leucoerythroblastic blood picture.  Bone marrow aspirate and imprint smear showed all hematopoietic elements and presence of abnormal lymphoid cells of large size having high N:C ratio and deep basophilic cytoplasm with vacuolization. The imprint smears were more cellular than aspirate smears and showed ~ 60% abnormal lymphoid cells as compared to ~ 7.2% seen in aspirate smears. Bone marrow biopsy showed marked crushing artifact and distorted morphology due to inadequate fixation.

IHC was attempted on imprint smears after destaining and the large lymphoid cells were positive for CD 20 and CD 10. MUM-1/ IRF4  were negative. Scattered CD 3 positive T lymphocytes were seen in the background. Together with morphology and IHC findings it was compatible with bone marrow involvement by a CD 10+ large B cell lymphoma.