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Lymphoplasmacytic Lymphoma in the Marrow

If, as in the illustrated case, the neoplastic lymphoid cells secrete IgM, the name "Waldenstrom's Macroglobulinemia" is appropriate ("macroglobulin" because IgM is the largest immunoglobulin). Patients with this entity almost always have lesions in the marrow, which may be nodular (paratrabecular or not), interstitial, or diffuse.
        The lymphoid cells are frequently morphologically diverse, including small lymphocytes, plasmacytoid lymphocytes, plasma cell, and larger forms. Also often seen are intranuclear inclusions in the malignant plasma cells called "Dutcher bodies," increased mast cells, and reticulin fibrosis associated with the infiltrates.


At low power, several nodules are seen in the patient's hypocellular marrow.

 


At higher power, the heterogeneous composition of the nodule is evident. Two little arrows point to plasma cells (somewhat hard to perceive).

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