63 y-o male with low grade fever, malaiase, weakness and occasional gum bleeding. Lab: Pancytopenia, accelerated ESR, siginificant roulex formation of RBC and mild hyperglobulinemia are present . Protein electrophoresis / immunoelectrophoresis and immunphenotyping not done. Outer table of bone at the site of aspiration is very fragile indicative of osteolysis. BM Aspiration with depressed hematopoesis of three cell lines, replaced by atypical immature cells (65 - 70 %), about 15-20% of these are peroxidase positive, another 8-10% of cells are plasma cells, some of which appear atypical.

Images:
3-Hp (High power) and 2-oil: Both Giemsa
5 and 6 oil: Both MPO stain

Send your answers to Dr. G.D.Mody (Haematopathologist) at   gdmody@eth.net