Plasma cell leukemia (PCL) represents a rare and aggressive form of plasma cell dyscrasia which can be primary (pPCL) or secondary (sPCL). It is diagnosed based on absolute plasma cell count of more than 2.0 9 10 9 /l or a relative proportion of greater than 20% of the peripheral blood leukocyte count. Although pPCL and sPCL share several clinical features, important differences exist. Patients with pPCL are younger; often have extra osseous organ involvement (liver, spleen and other extramedullary sites), increased frequency of renal failure, fast declining performance status and rapid progression to the terminal stage. Patients with sPCL have advanced bone disease. Presented in this article is India data of a short series of five cases of PCL diagnosed at a tertiary care centre from south India over last 5 years. All cases were de novo and had varied spectrum of presentation and so were not suspected to be plasma cell dyscrasia clinically. Detailed hemato-pathological evaluation clinched the diagnosis in all the cases.
Multiple myeloma is a neoplasm of plasma cells characterised by the presence of M protein in serum and urine. Angiogenesis and proliferation play a major role in the pathogenesis of various neoplasms. The study evaluated proliferation and angiogenesis in 48 cases of myeloma, and correlated it with morphological and clinical parameters. The histomorphological features like plasma cell morphology, percentage of plasma cells and pattern of infiltration were studied in the bone marrow aspirate and trephine biopsy. Angiogenesis was assessed by calculating the microvessel density (MVD) using immunohistochemistry for CD34. Proliferation was assessed using Ki67 and CD38 highlighted the plasma cells. The mean Ki67 % was found to be significantly higher (19.6 % range 2-40 %) in poorly differentiated morphology compared to well differentiated morphology (4.06 % range 0.2-20 %) ( = 0.003). The mean MVD in the well differentiated morphology was 10.6 (range 1.2-47.4) compared to 20.3 (range 6.9-39.6) in the poorly differentiated morphology ( = 0.04). The mean MVD was 5.7 (range 1.2-12.8) in the interstitial pattern of infiltration compared to 20.04 (2.9-47.4) in the diffuse pattern ( < 0.0001). The mean MVD was 6.4 in cases with serum albumin >3.5 gm/dl compared to 13.3 in cases with serum albumin <3.5 gm/dl ( = 0.009). Both the Ki67 and MVD showed an increasing trend with the clinical staging. Thus the study of proliferation and angiogenesis in bone marrow biopsy is useful for prognosticating patients with multiple myeloma.
Aims Of the Study: To study the type of light chain restriction and correlate it with the morphological parameters, proliferation index, angiogenesis and clinical parameters. Materials And Methods: The study includes 46 cases of myeloma diagnosed over the period of five years. The histomorphological features like plasma cell morphology, percentage of plasma cells and pattern of infiltration were studied. Immunohistochemistry for kappa and lambda light chains was done. Angiogenesis was assessed by calculating the microvessel density (MVD) using anti CD34 immunohistochemistry. Proliferation was assessed immunohistochemically using Ki67 by comparing with anti CD38 which was used to highlight the plasma cells. Results: The cases with kappa light chain restriction had significantly less of poorly differentiated morphology (7.4% vs 36.8%; p=0.02) and diffuse pattern of infiltration (22% vs 63%; p=0.01) compared to lambda. The kappa group also had lower MVD (9.9 vs 16.5; p=0.02) and proliferation index (4.7 vs 94; p=0.04) compared to the lambda. Conclusion: Therefore, the type of light chain restriction is also a prognostic factor in plasma cell myeloma.
Background: The mediastinum is the space between the two lungs, bounded anteriorly by the sternum and posteriorly by the vertebral column. A spectrum of neoplastic and non-neoplastic lesions can arise in the mediastinum. Methods: A total of 14 cases were retrospectively retrieved from the Histopathology department. The cases had histopathological diagnosis either in image guided, thorocoscopic, transbronchial or excision biopsies. Results: The majority of cases (43% n=6) were of thymic origin, which included both neoplastic lesions of thymoma group and non-neoplastic lesion like thymic cysts. The thymoma group included 3 cases of thymoma B3 and 1 case of thymoma AB. The lymphoid lesions include Hodgkin lymphoma (14.3%; n=2) and non-Hodgkin lymphoma (7.1%; n=1). The mesenchymal lesions (21.4%; n=3) included lipoma, solitary fibrous tumor and schwannoma which accounts for one case each. A rare case of ectopic parathyroid adenoma (7.1%; n=1). and a case of metastatic papillary carcinoma (7.1%; n=1) were also reported. Conclusion: The diagnosis of mediastinal mass lesions can pose difficulties due to its wide clinicopathologic spectrum to the clinician, radiologists and pathologist. A multimodal approach with histopathological examination and immunohistochemistry can help in arriving at an accurate diagnosis.
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