title: Primary plasma cell leukemia mimicking an adult T-cell leukemia-lymphoma: a case report.
abstract: BACKGROUND
  Malignant plasma cells ofmultiple myeloma (MM), or plasma cell leukemia (PCL), may present highly variable morphologic aspects. Adult T-cell leukemia-lymphoma (ATLL) is a peripheral T-cell neoplasm composed of highly pleomorphic lymphoid cells. We report an unusual case ofprimary PCL with misleading cellular morphology and some clinical and biologic similarities simulating ATLL.
  
  
  METHODS
  A 40-year-old Caribbean man presented with asthenia, epistaxis and diffuse bone pain. Blood cell count showed anemia and thrombocytopenia and a hyperleukocytosis composed of deeply basophilic cells with a polylobulated nucleus resembling flower cells. An ATLL diagnosis was given at first, without ruling out the possibility of a PCL diagnosis. Hypercalcemia and lytic bone lesions were compatible with both diagnoses. Immunophenotyping was key to the diagnosis of primary PCL.
  
  
  CONCLUSIONS
  Some clinical and biological overlap may exist between PCL and ATLL, leading to a false diagnosis or delaying a correct one. An accurate cytologic analysis leading to a rapid detection of plasma cell markers is essential for an early diagnosis.
authors.affiliation: Department of Biological Immunology and Haematology, Hôpital Saint-Antoine, France. fdelhom@yahoo.com
authors.forename: François
authors.initials: F
authors.lastname: Delhommeau
authors.forename: Stéphanie
authors.initials: S
authors.lastname: Huguet
authors.forename: Julie
authors.initials: J
authors.lastname: Gachet
authors.forename: Jacqueline
authors.initials: J
authors.lastname: van den Akker
authors.forename: Monique
authors.initials: M
authors.lastname: Lagrange
mesh_terms: D051997:ADP-ribosyl Cyclase 1 / Q000032:analysis; D000328:Adult; D003937:Diagnosis, Differential; D006801:Humans; D007952:Leukemia, Plasma Cell / Q000175:diagnosis* / Q000276:immunology; D015459:Leukemia-Lymphoma, Adult T-Cell / Q000175:diagnosis* / Q000276:immunology; D008297:Male; D010950:Plasma Cells / Q000276:immunology / Q000473:pathology*; D053668:Syndecan-1 / Q000032:analysis
chemical_list: D053668:Syndecan-1; D051997:ADP-ribosyl Cyclase 1