A 70-year-old male with metastatic uveal melanoma following systemic treatment (immunotherapy) presented for evaluation of anemia. A complete blood count revealed decreased red blood cells and hemoglobin (3.39 M/uL and 9.1 g/dL, respectively) in addition to thrombocytopenia (79 K/uL). Peripheral blood smear showed no significant findings, with absence of a leukoerythroblastic reaction. Bone marrow aspiration and biopsy were performed. The biopsy was slightly hypercellular but without evidence of myeloid or plasma cell neoplasm or metastatic tumor.
What is the diagnosis?
Plasmablastic myeloma
Acute monoblastic leukemia
Metastatic melanoma
Metastatic carcinoma
![Bone marrow aspirate smears and clot section showed a predominance of dyscohesive, large epithelioid cells with plasmacytoid appearance, prominent nucleoli, binucleation, and variably prominent cytoplasmic vacuoles (A and B, Wright stain of aspirate smears, 500X and 1000X respectively, and C, hematoxylin and eosin stain of clot section, 400X). The cells were positive for SOX10 (D, clot section immunohistochemistry [IHC], 400X) and negative for CD138 (E, clot section IHC, 400X). The cells were additionally positive for CD10 and CD117 (F, left side, clot section IHC, 400X). On flow cytometry, a distinct population was seen in the CD45 negative/high side scatter area; these cells were positive for CD117 and CD10 (F, right side, flow cytometry plots). A flow cytometry panel for plasma cells revealed polytypic plasma cells without immunophenotypic aberrancies.](https://ash.silverchair-cdn.com/ash/content_public/journal/thehematologist/21/5/10.1182_hem.v21.5.202453/4/m_hem210503f1.jpeg?Expires=1737543004&Signature=ronHP2WCl8oUEgmYlOgccp8rU9cT6T1dh7ia3QU-q8WvX~OzFmXx~Oqu4xCQzWYvKfgt9798q1bPabs7gbIWjKrrTCj8wtC-KVYmqkTXsQFXVN7N0OE-cg5zLY2iTwlJAxc5y3GnjGo43lsoomQbYAP5yjHQl1~njBfLVPClaeqLsBEMamadHEBjAIxYfbELdF6vZFUShOqxSE4QAAx3n24sPzUJvBoQOQxhK3D7uUlCmmYjfxsY4ojBjXVyJBHd1KamooF8c~1rcVycSIDfRlWvJN9iR4QS6UVXeu2m9iCKV5A7C3rLrhg-cNq~wDFGbE0qCzeuiWL-PS-MPRMF9g__&Key-Pair-Id=APKAIE5G5CRDK6RD3PGA)
Bone marrow aspirate smears and clot section showed a predominance of dyscohesive, large epithelioid cells with plasmacytoid appearance, prominent nucleoli, binucleation, and variably prominent cytoplasmic vacuoles (A and B, Wright stain of aspirate smears, 500X and 1000X respectively, and C, hematoxylin and eosin stain of clot section, 400X). The cells were positive for SOX10 (D, clot section immunohistochemistry [IHC], 400X) and negative for CD138 (E, clot section IHC, 400X). The cells were additionally positive for CD10 and CD117 (F, left side, clot section IHC, 400X). On flow cytometry, a distinct population was seen in the CD45 negative/high side scatter area; these cells were positive for CD117 and CD10 (F, right side, flow cytometry plots). A flow cytometry panel for plasma cells revealed polytypic plasma cells without immunophenotypic aberrancies.
Bone marrow aspirate smears and clot section showed a predominance of dyscohesive, large epithelioid cells with plasmacytoid appearance, prominent nucleoli, binucleation, and variably prominent cytoplasmic vacuoles (A and B, Wright stain of aspirate smears, 500X and 1000X respectively, and C, hematoxylin and eosin stain of clot section, 400X). The cells were positive for SOX10 (D, clot section immunohistochemistry [IHC], 400X) and negative for CD138 (E, clot section IHC, 400X). The cells were additionally positive for CD10 and CD117 (F, left side, clot section IHC, 400X). On flow cytometry, a distinct population was seen in the CD45 negative/high side scatter area; these cells were positive for CD117 and CD10 (F, right side, flow cytometry plots). A flow cytometry panel for plasma cells revealed polytypic plasma cells without immunophenotypic aberrancies.
For the solution to the quiz, visit The Hematologist online at www.hematology.org/TheHematologist/Image-Challenge.
Competing Interests
The authors indicated no relevant conflicts of interest.
