VARIANT LYMPHOCYTE

1.
2.
3.
4.
5.
6.
7.
8.

Reactive lymphocyte
Atypical lymphocyte
Virocytes
Stress lymphocytes
Transformed lymphocytes
Transitional lymphocytes
Glandular fever lymphocytes
Downey cells

MORPHOLOGY OF VARIANT LYMPHOCYTES

There are variation in its structure to classify the reactive lymphocytes

3 distinct types- type I, type II, type III
Presence of variant lymphocytes should be reported

LYMPHOCYTOSIS WITH VARIANT LYMPHOCYTES

Infectious mononucleosis
Acute viral hepatitis
CMV infection
Toxoplasmosis
Other viral infection- measles, mumps, rubella, chicken pox, viral pneumonia
Immune disorders- drug reaction, serum sickness, ITP, AIHA
Non-viral infection, TB, syphilis, malaria, thypus, brucellosis, rickettsia, diphtheria

@colezekiel

3 MORPHOLOGIC TYPES OF REACTIVE LYMPHOCYTES

Other
names

Type I
Plasmacytoid lymphocyte
turks irritation cell

Type II
Infective
mononucleosis cell
(IM) because it
predominate in IM

Descriptio
n

Functionally immunocompetent and

probably B-cell origin

Size
Shape
Nucleus

9-20 m
Round to oval
Heavy chromatin strands or dense blocks
of chromatin irregularly clumped with
sharp, small, defined areas of
parachromatin; nuclear shape may be
indented or oval.
Nuclear membrane is distinct.

15-25 m
Irregular or scalloped
The chromatin strands are
not as condensed a type I.
Masses of chromatin are
interspersed throughout.
Nuclear shape is round or
oval and raely lobulated.
Nucleoli--- not visible.

Cytoplasm

Basophilia varies, but usually moderately

basophilic. It may be vacuolated, with
darker areas of basophilia at the
periphery. It may have a foamy
appearance and may contain azurophilic
granules.

Abundant, indented by
surrounding structure.
NC ratio 1:2 1:4
Has few vacuoles and
usually pale except for
baso[hilia at the periphery.
Azure granules may or
may not be present. Often
described as FRIED EGG
APPEARANCE or a
FLARED SKIRT
APPEARANCE.

Type III
Transformed
lymphocytes
reticular
lymphocytes
Cell at the intermediate
stage of transformation
and ultimately become a
fully immunocompetent
lymphocyte or plasma cell
12-35 m
Round or irregular
Fine reticulated chromatin,
finely disaoersed with
loose indistinct clumping
and poorly defined
parachromatin.
Nucleoli--- are visible,
elongated or irregular in
shape.
Abundant, may or may not
be basophilic and a clear
perinuclear area may be
seen.

@colezekiel

PLASMA CELLS

Not normally found in the PB

BM- does not exceed 4-5%
Some may arise for differentiated lymphocytes and some from immature plasma cells

Size
Nucleu
s

Cytopla
sm

Other

Plasmablast
8-20 m
Round to oval and
eccentric
Chromatin is bluish
purple and
arranged in a fine
chromatin network
with some
clumping. Blue
nucleoli are seen
and several maybe
present.

Proplasmacyte
15-25 m
Round to oval
nucleus, eccentric
and contains coarse
chromatin network.
Parachromatin
spaces are irregular
and nucleoli are
visible.

Plasmacyte/ plasma cell

14-20 m
Small and eccentric and oval. Its long axis is at right angle
to the long axis of the cell. The condensed chromatin
forms large angular clumps that may be concentrated in
the periphery and the center of the nucleus, creating a so
called cartwheel pattern. The parachromatin is pale
pink. Some cells are binucleated or trinucleated.

Non-granular and
moderate in
amount and maybe
mottled

Abundant, deep blue,

non-granular and
shows clear
perinuclear zone

Dark blue, ovoid. There is a clear zone between nucleus at

one end and the dark blue marginal cytoplasm at the
other end. Non-granular but may contain secretory
globules (Russell Bodies) if completely fills the
cytoplasm is called grape cell or mott cell.If there is a
deposition of amorphous material material that give a pink
cytoplasm, its called Flame cell.
Related to Hypergammaglobulinemia

details
@colezekiel