Primary plasma cell leukemia mimicking an adult T-cell leukemia-lymphoma: a case report.
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.
Delhommeau
François
F
Department of Biological Immunology and Haematology, Hôpital Saint-Antoine, France. fdelhom@yahoo.com
Huguet
Stéphanie
S
Gachet
Julie
J
van den Akker
Jacqueline
J
Lagrange
Monique
M
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
D053668:Syndecan-1; D051997:ADP-ribosyl Cyclase 1