Doughnut Cells or Ring Neutrophil by Immunofluorescence

CLINICAL IMAGE The presence of ring-shaped nuclei neutrophils or doughnut cells (Figure 1) is well known in rats and mousesgranulopoiesis, and it was later described in humans. Ring and/or hyposegmented neutrophils are already well-known findings in leukemia patients, [1] megaloblastic anemia and myeloproliferative diseases [2,3]. An occasional occurrence is also present in patients with myelodysplastic syndrome (MDS) or chronic granulocytic leukemia (CGL). Besides there are still reports on infectious mononucleosis, Chagas disease, [4] and lymphoproliferative disorders (multiple myeloma and monoclonal gammopathy of undetermined significance) or even in healthy individuals. [5,6] Thus, this peculiar morphological presentation can be considered a nonspecific finding of several hematological diseases. Hence, we present not only the hematoxylin and eosin stain representation but a unique point of view (by immunofluorescence) of a ring-shaped nuclei neutrophil in a years old male patient with multiple myeloma suspicion.