Plasma cells with hairy projections and Auer rod-like inclusions in a patient with multiple myeloma

Description

A 38-year-old woman presented to the outpatient clinic with complaints of easy fatiguability and bone pains for 1 month. On investigating, she was found to have plasma cell (PC) neoplasm of IgA-kappa type with 91% PCs in bone marrow and 5% in peripheral blood (PB). Apart from PCs with classical morphology, there were PCs with distinct circumferential hairy cytoplasmic projections (figure 1) and a few others showing bulbous projections (figure 2). Bone marrow showed Auer rod-like inclusions in some of the PCs (figure 3) and rare histiocytes showing ingested Auer-rod like inclusions (figure 4). She was given two-drug combination chemotherapy (thalidomide and dexamethasone) because of financial limitation. During the second cycle of chemotherapy, she developed generalised weakness and shortness of breath. At this point, the PB smear revealed 27% PCs with cells having hairy projections. Flow cytometry revealed these cells to have...

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