Lymphoplasmacytic lymphoma - Peripheral blood
Peripheral blood smear shows prominent rouleaux formation. Atypical lymphocytes, including plasmacytoid forms, are present.
Lymphoplasmacytic lymphoma - Bone marrow aspirate
Bone marrow aspirate smear shows increased small lymphocytes with clumped chromatin and scant cytoplasm (green arrow). Plasmacytoid lymphocytes (red arrow) and atypical plasma cells (black arrow) are seen. Mast cells are also increased (A, black circles).
Lymphoplasmacytic lymphoma - Bone core biopsy
A bone core biopsy shows diffuse infiltration by small lymphocytes and plasma cells (A). Dutcher bodies (intra-nuclear pseudo-inclusions comprised of immunoglobulin) are readily identified (B).
Lymphoplasmacytic lymphoma - IHC
Immunohistochemical stains show diffuse proliferation of CD20-positive B-cells (A). Clusters of CD138-positive plasma cells are also present (B). These were kappa-restricted (C) with only occasional lambda-positive cells (D).
Lymphoplasmacytic lymphoma - Flow cytometry
Flow cytometry shows a monotypic B-cell population with bright CD20, negativity for CD5 and CD10, and bright kappa light-chain restriction.
Lymphoplasmacytic lymphoma - MYD88 mutation
Next-generation sequencing analysis on the bone marrow aspirate smear shows a T>C missense mutation at 30% of the reads in MYD88 L265, leading to the L265P mutation. The image is visualization of the NGS analysis using Integrated Genomics Viewer (IGV) software.