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My impression is that this is either lymphoplasmacytic lymphoma (LPL) or B cell small lymphocytic lymphoma (SLL), which I believe are part of a continuous spectrum without a firm dividing line. The distinction depends on the degree of plasmacytic differentiation, which is hard for me to assess on these photos. On the whole I favor LPL. One photo shows a Russell body, which can be seen in either LPL or SLL. The presence of peripheral blood involvement, or chronic lymphocytic leukemia (CLL), would favor SLL, as LPL doesn't usually have a leukemic phase. Serum protein electrophoresis (SPEP) with appropriate followup studies for clonality (e.g., immunofixation), if a suspicious band is present, should be done to evaluate the possibility of presence of hyperviscosity (Waldenstrom's macroglobulinemia). We would also do urine PEP, looking for Bence Jones protein. Serum viscosity studies could also be done; we don't do them very often here in my lab. Thank you for allowing me to review this case.
 

 

 

 

for me a clear cut lyphoplasmocytic immunocytoma.  
 
The cases presented here illustrate the DD lymphplasmocytoid CLL vs. lyphoplasmocytic immunocytoma (LPL) and "secretory" marginal zone lymphoma (the latter two considered by Müller-Hermelink as the same entity). lymphplasmocytoid CLL is often IgM and IgD+, while LPL, like in the present case is IgM+ but IgD-.  
 
would you please add pictures of the IgM and igD stains of the case "63 yrs woman, part 2".  
 
did the serum IgG or the M-gradient raise? are these IgGs mono- or polyclonal?

i agree with dr. tzankov. the diagnosis of this case, as already mentioned by Dr. Mickys, is LPL, which is frequently IgD-.

Thank you all for the comments. Appologies for delay: some clinical details of this LPL please find above.

The clinics and morphology in the bone marrow fit well with Morbus Waldenstrom diagnosis - I attach a recent review.

Thank you, dr.Anna for comment and review.