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22 Miscellaneous cells

Hematologic manifestations of systemic disorders

FIGURE 22-1A Gaucher cell (BM ×1000).

FIGURE 22-1B Niemann-Pick disease (BM ×1000).

Description:

The Gaucher cell is a macrophage 20 to 80 μm in diameter, with one or more small, round to oval eccentric nuclei; cytoplasm has crumpled tissue paper appearance; found in bone marrow, spleen, liver, and other affected tissue.

Description:

The Niemann-Pick cell is a macrophage, 20 to 90 μm in diameter, with a small eccentric nucleus and foamy cytoplasm. It is found in bone marrow and lymphoid tissue. The peripheral blood of patients with Niemann-Pick disease may exhibit vacuolated lymphocytes.

FIGURE 22-1C Lymphocyte from Sanfilippo Syndrome (PB ×1000).

Description:

Peripheral blood lymphocytes containing azurophilic granules occasionally surrounded by halos

Associated with:

Mucopolysaccharide storage disorders

FIGURE 22-1D Alder-Reilly anomaly (PB ×1000).

(Courtesy Dennis P. O’Malley, MD, Clarient, Inc., Aliso Viejo, CA.)

Description:

Deep purple to lilac granules difficult to distinguish from toxic granulation; occur in neutrophils and occasionally eosinophils and basophils

FIGURE 22–1E May-Hegglin Anomaly. Note Döhle-like body at arrow (PB ×1000).

Description:

Characterized by thrombocytopenia with large platelets and large basophilic inclusions resembling Döhle bodies in granulocytes and monocytes with the absence of toxic granulation

Note:

These inclusions are sporadically visible by light microscopy but always detectable by electron microscopy. The ultrastructure varies from that of Döhle bodies.

FIGURE 22–1F Chédiak-Higashi anomaly neutrophil with granules (PB ×1000).

FIGURE 22–1G Chédiak-Higashi anomaly eosinophil with granules (PB ×1000).

FIGURE 22–1H Chédiak-Higashi anomaly lymphocyte with granule (PB ×1000).

FIGURE 22–1I Chédiak-Higashi anomaly monocyte with granules (PB ×1000).

Description:

Large gray-blue granules in the cytoplasm of many granulocytes. Monocytes, lymphocytes, and eosinophils may contain large red-purple granules.

Cells occasionally seen in bone marrow

FIGURE 22–2A Fat/adipose cell (BM ×500).

FIGURE 22–2B Mast cell (BM ×1000).

Description:

Large, round cell, 50 to 80 μm; cytoplasm filled with one or several large fat vacuoles, colorless to pale blue; nucleus small, round to oval, and eccentric; chromatin coarse; nucleoli seldom seen

Description:

Large cell (12-25 μm) with round to oval nucleus; cytoplasm is colorless to lavender with many dark blue to black granules that may partially obscure the nucleus. Constitute <1% of bone marrow cells. Increased numbers may be seen in allergic inflammation and anaphylaxis.

FIGURE 22–2C Mitosis (BM ×1000).

FIGURE 22–2D Mitosis (BM ×1000).

Mitotic figure—a cell that is dividing. Increased numbers may be seen in neoplastic disorders.

FIGURE 22–3A Endothelial cells lining a blood vessel (BM original magnification ×500).

FIGURE 22–3B Endothelial cells (BM original magnification ×1000).

Description:

Large, elongated cells, 20 to 30 μm; one oval nucleus with dense chromatin; nucleoli not visible; function is to line blood vessels; may also be seen in peripheral blood

FIGURE 22–3C Osteoblasts (BM original magnification ×1000).

FIGURE 22–3D Osteoclast (BM original magnification ×1000).

Osteoblast

Size:

30 μm

Description:

Comet or tadpole shaped; single, round, eccentrically placed nucleus, may be partially extruded; abundant cytoplasm with chromophobic area located away from nucleus; often appear in groups; function in synthesis of bone

Note:

May be confused with plasma cells.

Osteoclast

Size:

Very large, >100 μm

Description:

Multinucleated with irregularly shaped ruffled border; nuclei are round to oval, separate and distinct with little variation in nuclear size; cytoplasm may vary from slightly basophilic to very acidophilic; coarse granules may be present; osteoclasts function in the resorption of bone

Note:

May be confused with megakaryocytes.

FIGURE 22–4A Metastatic tumor (BM ×100).

FIGURE 22–4B Metastatic tumor (BM ×500).

Description:

Tumor cell clusters may be recognized during the ×100 scan of bone marrow, especially at or near the edge of the coverslip or glass slide. Characteristics of the tumor cells are more easily observed at ×1000 magnification. Cells are variable in size and shape within the same tumor clump. Nuclei vary in size and staining characteristics. Nucleoli are usually visible. It is sometimes difficult to distinguish one cell from another because of “molding” of cells.

FIGURE 22–5A Sea blue histiocyte (BM ×1000).

Description:

Macrophage 20 to 60 μm in diameter with eccentric nucleus; cytoplasm contains varying numbers of prominent blue-green granules; may be seen in diseases with rapid cell turnover, such as myeloproliferative neoplasms

FIGURE 22–5B Erythrophagocytosis (BM ×1000).

Description:

Monocyte or macrophage with engulfed erythrocyte; may be seen in some transfusion reactions

Artifacts in peripheral blood smears

FIGURE 22–6A Precipitated stain (PB ×1000).

Description:

Precipitate is in focus, but the cells are not. If bacteria are present within a cell, both cell and bacteria should be in focus at the same time.

FIGURE 22–6D Necrotic cell (PB ×1000).

Description:

Highly refractile areas because of slow drying of blood film

FIGURE 22–6B Bacteria in peripheral blood for comparison with precipitated stain.

FIGURE 22–6C Drying artifact in RBCs (PB ×1000).

Description:

Nuclear degeneration; note lack of chromatin pattern and nuclear filaments

FIGURE 22–6E Platelet satellitism (PB ×1000).

Description:

Platelets adhering to neutrophils; in vitro phenomenon in blood collected in ethylenediaminetetraacetic acid in rare individuals which may cause falsely decreased platelet counts. May be resolved by collecting blood in sodium citrate.*

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22 Miscellaneous cells

Hematologic manifestations of systemic disorders

FIGURE 22-1A Gaucher cell (BM ×1000).

FIGURE 22-1B Niemann-Pick disease (BM ×1000).

Description:

The Gaucher cell is a macrophage 20 to 80 μm in diameter, with one or more small, round to oval eccentric nuclei; cytoplasm has crumpled tissue paper appearance; found in bone marrow, spleen, liver, and other affected tissue.

Description:

The Niemann-Pick cell is a macrophage, 20 to 90 μm in diameter, with a small eccentric nucleus and foamy cytoplasm. It is found in bone marrow and lymphoid tissue. The peripheral blood of patients with Niemann-Pick disease may exhibit vacuolated lymphocytes.

FIGURE 22-1C Lymphocyte from Sanfilippo Syndrome (PB ×1000).

Description:

Peripheral blood lymphocytes containing azurophilic granules occasionally surrounded by halos

Associated with:

Mucopolysaccharide storage disorders

FIGURE 22-1D Alder-Reilly anomaly (PB ×1000).

(Courtesy Dennis P. O’Malley, MD, Clarient, Inc., Aliso Viejo, CA.)

Description:

Deep purple to lilac granules difficult to distinguish from toxic granulation; occur in neutrophils and occasionally eosinophils and basophils

FIGURE 22–1E May-Hegglin Anomaly. Note Döhle-like body at arrow (PB ×1000).

Description:

Characterized by thrombocytopenia with large platelets and large basophilic inclusions resembling Döhle bodies in granulocytes and monocytes with the absence of toxic granulation

Note:

These inclusions are sporadically visible by light microscopy but always detectable by electron microscopy. The ultrastructure varies from that of Döhle bodies.

FIGURE 22–1F Chédiak-Higashi anomaly neutrophil with granules (PB ×1000).

FIGURE 22–1G Chédiak-Higashi anomaly eosinophil with granules (PB ×1000).

FIGURE 22–1H Chédiak-Higashi anomaly lymphocyte with granule (PB ×1000).

FIGURE 22–1I Chédiak-Higashi anomaly monocyte with granules (PB ×1000).

Description:

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Clinical Hematology Atlas