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report a case of hairy cell leukemia (HCL) initially misdiagnosed as
plasma cell dyscrasia due to various clinical, morphological and
|Figure 1. (A) Larger lymphoid cells/hairy cells in bone marrow aspirate smear (May-Grunwald Giemsa stain, x1000); (B) Trephine biopsy showing interstitial infiltrate of hairy cell having a typical “fried egg” appearance (Hematoxylin and Eosin stain, x600); (C) Immunohistochemistry for DBA.44 highlights hairy cells (Hematoxylin counterstain, x600); (D) Immunohistochemistry for mast cell tryptase highlights mast cells (Hematoxylin counterstain, x600). (E) ARMS-PCR and agarose gel electrophoresis showing positivity for BRAF V600E mutation (lane 3); 100bp ladder (lane 1), positive control (lane 2), and negative control (lane 4).|
|Figure 2. Multiparametric flow cytometry shows two distinct clones (CD19pos and CD19neg) of cells both of which are positive for CD45, CD22, CD10, CD25, CD103, CD11c, CD123 and surface Igκ in similar intensities. The plasma cells do not show clonal restriction.|
AcknowledgementThe authors are thankful to Mrs. Jasbir Kaur Hira and Mrs Praveen Bose for the technical help in performing molecular and immunophenotypic studies respectively.