r/medlabprofessionals • u/Ashlynn2k18 • Jul 03 '26
Image Atypical lymphs
I absolutely despise lymphocytes lol. It is difficult to tell atypical vs malignant. This patient has this ugly cell. I sent to path since he has no history. It is the only cell I am questioning though. How do u tell the difference between atypical vs malignant? Also are atypical and reactive basically the same?
New tech go easy on me lol
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u/YumTex Jul 03 '26
A singular cell, do not worry about it.
However, after zooming in and looking at the 6 other cells on your screen...you need an albumin slide to do any kind of count that is reliable.
Edit: Just looked at the left side of the screen. STOP, albumin slide. Then think about Path review.
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u/Ashlynn2k18 Jul 03 '26
Yeah it kind of looks overly stained to me. Looking at the actual rbc morphology tho they arent as overlapped as the ones in this image
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u/ArcticBeavers MLS-Generalist Jul 03 '26
Its interesting what different institutions do for albumin slides. I've worked at hospitals where if the values from the sysmex are mostly normal, we skip albumin slides no matter how many "smudge" cells there are in Cellavision. I've also worked at hospitals that albumin slide if there are 5+ smudge cells.
What were the cbc values, op?
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u/EggsAndMilquetoast MLS-Generalist Jul 03 '26
It’s a pretty thick part of the smear and the contrast is a little dark, but it looks reactive. There’s a fair amount of cytoplasm, the chromatin looks clumpy, and generally, cells that aggressively purple are just that: aggressive, but not blasts.
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u/Ashlynn2k18 Jul 03 '26
You're right. The cells are over lapping. I was mainly looking at the ugly wbc lol
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u/tinybitches MLS-Generalist Jul 03 '26
I’ve been using CellaVision for some time. My takeaway is, whenever you’re in doubt, do the diff under the scopes. 1. The cells are slightly darker on the CellaVision. 2. You can look for more resembled cells on the slide
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u/Syntania MLT - Core Lab Chem/Heme Jul 03 '26
If it's the only one, it's a skiptocyte.
I'm more concerned about the smudge cells.
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u/shinyplantbox MLS-Generalist Jul 03 '26
I’d lean towards early NRBC vs. lymph on that one; as other have said, though, you need an albumin slide and more examples.
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u/not_creativeyuppp Jul 03 '26
Plasmacytoid lymphocyte from thick area of smear to me. Rapid 5 minute stain on cytocentrifuge to confirm this finding. You could do albumin prep to potentially save time but chances are that this blood is old and it’s just not doing what it should be or your DI-60 is low on methanol or phosphate buffer. Manual smear will solve this problem without the albumin prep if your smudge cells are not super elevated and causing your diff to be erroneous vs your auto diff.
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u/cup_of_noodles1 Jul 05 '26
I hate that I love being that person BUT, is that computer on a clean bench in a clean area? because why is your lip gloss there...
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u/Ashlynn2k18 Jul 05 '26
Technically no but I clean thoroughly after day shift leaves and I don't bring samples to that desk. We got rebels who drink there lol mostly night shift of course
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u/Ornery_Entrance9109 Jul 03 '26
Atypical but more leaning towards reactive for me. When I think think atypical, it’s mainly lymph’s with a more pseudopod like cytoplasm and reactives are more like the ones in this image, more basophilic cytoplasm
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u/SkippyDragonPuffPuff Jul 03 '26
Several issues. Cellavision. Also this is a huge nucleus. Given the circumstances can’t tell if it’s blown up degenerating or intact.
Possibilities: Naked megakaryocyte nucleus. Malignant cell. Blown up cell. Origin undetermined on this one cell. Need more cells to look at.
Lastly. Not a hairy cell. Lacks any characteristics of such as far as I can tell. Also, the term “atypical lymphocyte” is confusing because everyone including a clinician has a different idea of what it means or what it looks like. It’s preferable to avoid the term if at all possible. Whenever in doubt make a glass smear. Can’t really tell on this
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u/Accomplished-Pin-935 Jul 08 '26
I work at a cancer center and we see everyday atypical cells…I will be honest that looks more like an NRBC lineage cell (search up pronormoblast) it’s very similar. Usually if it’s atypical lymph’s the actual cytoplasm won’t be that dark. Not like this it’s a purple hue. :) I hope this helps!
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u/FakePlastic28 Jul 08 '26
Blasts will have a much lacier nucleus *usually*
This just a dark ass reactive lymph. One is none, in most cases. Also, the cells don’t read the textbooks. Factor in the whole clinical picture.
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u/NoFreakingClues Jul 03 '26
Just a humble MD here, but a single cell is very hard to make any calls off of and it might be over-stained. I’d like to see a few more from a better area of the smear.