Hematology and Clinical Microscopy Glossary - College of American ...

Plasma Cell With Inclusion (Dutcher Body,
Russell Body, etc)
Plasma cells normally produce and secrete
immunoglobulins. This protein product may appear in
different forms within the cytoplasm. When production
within a particular plasma cell is increased or when
there is a blockage in secretion, accumulation of
immunoglobulin occurs. This finding can occur in
mature, immature, or malignant plasma cells.
These plasma cells range from 10 to 25 μm and the
N:C ratio varies from 1:2 to 1:3. Accumulations of
immunoglobulin sometimes appear as intranuclear
inclusions called Dutcher bodies. While Dutcher bodies
appear to be within the nucleus, they are actually
pseudoinclusions that occur when a cytoplasmic
globule invaginates through the nucleus or is
surrounded by the nucleus. The immunoglobulin
globules may also appear as large cytoplasmic
eosinophilic globules called Russell bodies. When
multiple Russell bodies are present, the cell is called
a Mott cell.
Occasionally, immunoglobulin inclusions in plasma cells
may form crystalline structures in the cytoplasm.
Megakaryocytic Cells
Megakaryocyte Nucleus
After discharging their cytoplasm to form platelets,
megakaryocyte nuclei or nuclear fragments may
enter the peripheral blood stream, particularly in
conditions associated with marrow myelofibrosis. The
cell nucleus is single-lobed or less commonly,
multilobated. The chromatin is smudged or “puddled”
and is surrounded by a very scant amount of basophilic
cytoplasm or no cytoplasm at all. If a small amount of
cytoplasm is present, it is often wispy, frilly, or
fragmented. Rarely, there may be a few localized areas
of cytoplasmic blebs or adherent platelets. Small cells
with more abundant cytoplasm are best termed
micromegakaryocytes. If the nuclear characteristics are
not appreciated, megakaryocyte nuclei may be
mistakenly identified as lymphocytes. Finding
megakaryocyte cytoplasmic fragments and giant
platelets in the field are helpful clues to the origin of the
nucleus. It is important to remember that these cells are
not degenerating cells and therefore, the chromatin
pattern does not have the characteristics of basket
cells. For CAP proficiency testing purposes, megakaryocyte
nuclei are almost always seen in the blood,
whereas micromegakaryocytes may be seen in blood
or marrow.
Bone Marrow Cell Identification
Megakaryocyte or Precursor, Normal
Megakaryocytes are the largest bone marrow
hematopoietic cell. They are derived from bone
marrow stem cells and are responsible for platelet
production. During development, the cell does not
divide, but instead the nucleus undergoes nuclear
replication without cell division (endomitoisis or
endoreduplication) giving rise to a hyperdiploid nucleus
with several lobes and each lobe roughly containing a
normal complement of chromosomes. The cytoplasm
becomes granular and eventually fragments into
platelets. The nucleus is left behind to be phagocytized
by marrow histiocytes. For proficiency testing purposes,
the term normal megakaryocyte almost always refers to
a mature cell rather than one of the maturation stages.
Typically, the mature megakaryocyte measures at least
25 to 50 μm in diameter. The numerous nuclear lobes
are of various sizes, connected by large bands or
fine chromatin threads. The chromatin is coarse and
clumped to pyknotic. The abundant cytoplasm stains
pink or wine-red and contains fine azurophilic granules
that may be clustered, producing a checkered pattern.
Megakaryocyte or Precursor, Abnormal
Megakaryocytic dysplasia may manifest as
abnormalities in cell size, nuclear shape, and cell
location. Micromegakaryocytes, also known as dwarf
megakaryocytes, are abnormally small megakaryocytes
that usually measure 20 μm or less in diameter. The N:C
ratio is 1:1 or 1:2. The nucleus may be hypolobated or
may have multiple small lobes reminiscent of the PMNs
in megaloblastic anemia. The cytoplasm is pale blue
and may contain pink granules. Micromegakaryocytes
may be found in the marrow or circulating in the
peripheral blood. Larger abnormal megakaryocytes are
highly variable in morphology. Some show increased
nuclear lobation, while others are hypolobated or
mononuclear. Normal megakaryocyte nuclei are
connected in series. Dysplastic nuclei may be separated
or form masses of chromatin and nuclei. The finding
of triple nuclei may be a particularly useful marker
of dysplasia. Pyknotic megakaryocytes are also
abnormal. The naked or near-naked nuclei are
composed of dark masses of chromatin. These cells are
undergoing apoptosis (programmed cell death). On
biopsy specimens, abnormal megakaryocytes may
cluster together, sometimes close to bony trabeculae.
Normal megakaryocytes are usually well separated
from each other and located away from the
trabeculae.
800-323-4040 | 847-832-7000 Option 1 | cap.org
31