The images belong to a patient who was a 64 yrs old male, coming to hematology OPD with complaints of bone pains. Bone marrow aspiration and biopsy was performed. Bone marrow aspirate smears were aparticulate and blood diluted and revealed 13 % plasma cells with the presence of immature plasma cells. Bone marrow biopsy also revealed patchy plasmacytosis. The plasma cells in the aspirate smears showed rod alike inclusions resembling Auer rods. Few plasma cells had clusters of these rods resembling faggot cells.

Correlation with clinic radiological and biochemical findings was suggested to confirm a plasma cell dyscrasia. The patient was lost for follow-up.

Plasma cells can have Auer-rod-like inclusions, which are crystalline deposits of lysosomal enzymes such as acid phosphatase, α-N-esterase or β-glucuronidase rather than myeloperoxidase or chloroacetate esterase of myeloid cells and are also completely different from intracytoplasmic immunoglobulin crystals.¹ This is a rare and interesting finding though it has not got any known diagnostic or prognostic significance and cytogenetic or immunophenotypic association.²

REFERENCES

1.Metzgeroth G, Back W, Maywald O, et al. Auer rod-like inclusions in multiple myeloma. Ann Hematol 2003;82:57–60.doi:10.1007/s00277-002-0574-0

2. Zhang J, Li M, He Y (2017) White rodlike crystals in multiple myeloma cells. Hematol Med Oncol 2: DOI: 10.15761/HMO.1000141