This slide was made from a bone marrow preparation obtained from a patient with Waldenstrom's macroglobulinemia. WM is a malignant monoclonal IgM disease. It is about 1/20th as common as MM. Classically the cell that produces IgM paraprotein is a lymphoid-appearing plasma cell. The diagnosis of WM is difficult to make on the basis of morphology alone since the bone marrow appearance can vary from that of myeloma to that of chronic lymphocytic leukemia. It is impossible solely on the basis of morphology to identify the cell that produces IgM paraprotein. The large cell with basophilic granules in the lower part of the center of the slide is a tissue basophil or mast cell. This kind of cell increases in number in WM and is helpful in making the diagnosis.
Course Section: 10. Plasma Cell Dyscrasias
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