Cytology and flow cytometry of malignant effusions of multiple myeloma

Abstract

Identifying malignant plasma cells in body fluids from multiple myeloma patients is important for therapeutic and prognostic considerations. This can be difficult when plasma cells are mature in appearance or low in number. We examined the cytological and flow cytometric findings of myelomatous pleural and pericardial effusions from 8 patients with advanced multiple myeloma. Cytoplasmic immunoglobulin light chain excess vs. DNA ploidy in the plasma‐cell population was evaluated by flow cytometry (FCM). The cytology smears of one pericardial and 14 pleural effusions from the 8 patients were reviewed. Screening Papanicolaou‐stained smears facilitated the detection of malignant nuclear features; however, morphology of plasma cells was best seen in Diff‐Quik‐stained smears. Low cellularity and inadequate air‐drying of smears accounted for the false‐negative cytology seen in two fluids from a single patient. A malignant plasma cell population was identified in 9 of 10 fluids submitted for FCM, including the two fluids with negative cytology. The false‐negative FCM was from a suboptimal specimen with high background staining. Six fluids had an aneuploid DNA content, and four were diploid. A combination of Papanicolaou‐ and Diff‐Quik‐stained smears is recommended for the evaluation of plasma cells in effusions from patients with multiple myeloma. Cytology and flow cytometry confirmed malignancy in 87% and 90% of fluids evaluated, respectively; all cases were diagnosed by either one or both methods. Our results suggest that FCM and cytology of serous effusions in multiple myeloma patients are complementary and should be used in difficult cases. Diagn. Cytopathol. 2000;22:147–151. © 2000 Wiley‐Liss, Inc.

Myelomatous Pleural Effusion: A Rare Involvement in Multiple Myeloma: Case Report

“…Thre e cri te ri a are ne cessary to di ag no se mye lo ma to us ple u ral ef fu si on; to de mons tra te mo noc lo nal pro te ins in ple u ral flu id elec trop ho re sis, aty pi cal plas ma cells in the ple u ral flu id, and/or ple u ral in vol ve ment in ple u ral biopsy. 2 A di ag no sis of mye lo ma to us ple u ral ef fu si on was ma de in this ca se fol lo wing the de mons tra ti on of aty pi cal plas ma cells in the ple u ral flu id and invol ve ment in the ple u ral bi opsy.…”

“…[1][2][3] A high adenosine deaminase (ADA) level in the pleural fluid is especially frequent in pleural involvement due to tuberculosis and malignant and lymphoproliferative disease. 4 We present a case with myelomatous pleural effusion in which a significantly increased pleural fluid ADA level was detected.…”

Extramedullary myeloma representing as a pericardial effusion with tamponade: Two case reports and a further review of 19 cases in the literature

“…Case reports vary in terms of postpericardiocentesis management and there is no consensus among experts regarding best practice. The confirmation and diagnosis of a malignant pericardial effusion in myeloma is essential, as benign pericardial effusions are common [3]. Therefore, the presence of a malignant cause is of prognostic importance on the basis of the poor survival and lack of adequate treatment for this condition.…”

Destroyed Lung Secondary to Multiple Myeloma in a Previously Treated Tuberculosis Patient

“…The entity arises with bone pains and tenderness, renal failure, anemia, hypercalcemia, however, pulmonary involvement is rare, which is much more associated with bad prognosis, and encountered in the terminal period or plasma cell leukemi (2,3) Occasions such as chronic heart failure, pneumonia, tuberculosis (TB), connective tissue diseases, carcinoma, AIDS and other viral causes, and pulmonary embolism should be eliminated before the diagnosis of pulmonary or pleural involvement (4). Herein, a case is presented with a pulmonary parenchymal destruction due to acquired multiple myeloma who has a history of pulmonary TB.…”