Primary plasma cell leukaemia presenting with flower?shaped nuclei

A 64-year-old man presented with a persistent cough. His past medical history included COVID-19 pneumonia one month previously. On admission, full blood count showed haemoglobin concentration of 120 g/l, platelet 98 × 109/l and leukocyte 44 109/l. peripheral film 80% atypical lymphoid cells. Many the abnormal cells had deeply basophilic cytoplasm markedly irregular nuclear contour producing petal-shaped nucleus, mimicking flower adult T-cell leukaemia/lymphoma (ATLL) (all images; May–Grünwald–Giemsa stain, ×100 objective), while other either bilobed or rounded nuclei. Flow cytometric analysis strong expression CD38, CD56 CD138 no CD3, CD4, CD7, CD8, CD19, CD20, CD25 CD45. Serum calcium was normal. protein electrophoresis immunofixation lambda monoclonal component (12 g/l) lambda-free light chains being quantified at 42.9 g/l. Antibodies to human lymphotropic virus-1 (HTLV-1) were not detected. diagnosis primary plasma cell leukaemia made. bone marrow aspirate hypercellular 95% Cytogenetic complex karyotype: 42,X,?Y,add(1)(q?),+del(1)(p21),del(2)(q32),?5,?10,del(11)(q23),?12,?13,add(14)(q32)[16]/46,XY[9]. Fluorescence in situ hybridisation (FISH) deletion RB1 LAMP1 on 13q, t(4;14) (IGH/FGFR3 rearrangement) amp(1q21).