Peripheral blood and BM features of pPCL. (A) May-Grünwald-Giemsa staining of peripheral blood smears from 3 different patients with pPCL. (i) The peripheral blood smear of patient 1 is characterized by the presence of circulating plasma cells, including binucleated cells. Some plasma cells have a lymphoplasmacytoid appearance. There is also rouleaux formation and leuko-erythroblastosis (myelocyte in Ai). Cytogenetic analysis demonstrated the presence of an IgH translocation with an unknown partner chromosome as well as deletion of the Y chromosome. (ii) Peripheral blood of patient 2 contains circulating plasma cells, some of which have 2 nuclei or a lymphoplasmacytoid aspect. FISH analysis showed the presence of t(14;16) and ampl(1q21). (iii) The staining of patient 3 shows very atypical circulating plasma cells often with a monocytic appearance. Numerous cells contain cytoplasmic (Russell bodies) and intranuclear inclusions (Dutcher bodies). Cytogenetic analysis revealed multiple deletions, including chromosomes 6q, 12p, 13, 16, and 20, and the presence of t(14;20). (B) May-Grünwald-Giemsa-stained BM smears from the same 3 pPCL (i-iii) patients. (C) Immunophenotypic analysis of the leukemic plasma cells from the patient shown in subpanels Aii and Bii. The tumor cells are positive for CD138 and CD27, weakly positive for CD38 and CD45, and negative for CD56 and CD19. Cells were also negative for CD20 (not shown).