Histiocytes containing immunoglobulin crystals in the urine of a patient with IgA κ plasmacytoma of the bladder

Abstract

Exfoliative cytology specimens from patients with plasma cell dyscrasias are rarely diagnostic, though there are reports of neoplastic plasma cells observed in pleural fluid and urine. Immunoglobulin concretions or crystals associated with neoplastic plasma cell populations have been well described. These crystals may be found within plasma cell nuclei or cytoplasm, extracellularly, or within cells of histiocytic lineage where they are presumably derived by phagocytosis. To the best of our knowledge, this is the first report of immunoglobulin crystals within histiocytes in the urine of a patient with plasmacytoma. A 61-year-old male underwent routine cystoscopy and urine collection to evaluate hematuria. The bladder biopsy demonstrated IgA kappa-producing plasmacytoma. Urine cytopsin preparations did not contain plasma cells, but there were histiocytic cells with degenerative nuclei and eccentrically located cytoplasmic spherical refractile hyaline crystals thought to be immunoglobulin crystals. This was supported by immunocytochemical staining.

Immunoglobulin Crystal-Storing Histiocytosis in a Pleural Effusion from a Woman with Iga EEMultiple Myeloma

“…10 In fact, they have seen rarely in exfoliative cytology specimens. 11 Assuming that deposits of immunoglobulin can irritate the surrounding tissues and contribute to progressive organ damage, 4,10 it is not surprising that they may induce functional alterations in mesothelial layers, stimulating the formation of a pleural effusion or ascites.…”

“…Pleural effusions occur in 6% of patients with MM, and < 1% are due to myelomatous involvement. 11,12 Furthermore, a pleural effusion in MM may be due to nephrotic syndrome, pulmonary embolism, congestive heart failure secondary to amyloidosis, secondary neoplasms and infections (mainly tuberculosis), infiltration by myeloma and radiation therapy. 13 In spite of the suspicious plasma cell features found in the second pleural fluid sample in the present case, they were so scanty that it was impossible to demonstrate monoclonality.…”

“…3,5,6 Although CSH can involve multiple sites and organs, [1][2][3][4][6][7][8][9] its presence in effusions from serous cavities has rarely been observed 10 because exfoliative cytology is an unusual method of CSH diagnosis. 11 This is the first published report describing histiocytes containing immunoglobulin crystals in the pleural fluid of a patient with multiple myeloma (MM).…”

Crystal‐storing histiocytes in ascites leading to a diagnosis of plasma cell myeloma

“…Crystal‐storing histiocytosis can be localized (in one organ) or generalized, and can involve almost any tissue or anatomic site, including bone marrow, lung, kidney, lymph nodes, spleen, liver, skin, eye, and gastrointestinal mucosa 1 . Crystal‐storing histiocytes in the setting of a known hematolymphoid malignancy have also been identified in body fluid samples 2‐4 . The diagnosis of crystal‐storing histiocytosis can be challenging, as it can mimic other conditions such as storage disorders and certain infectious diseases.…”

“…1 Crystal-storing histiocytes in the setting of a known hematolymphoid malignancy have also been identified in body fluid samples. [2][3][4] The diagnosis of crystal-storing histiocytosis can be challenging, as it can mimic other conditions such as storage disorders and certain infectious diseases. Here, we present a case where the incidental finding of peritoneal fluid crystal-storing histiocytes has led to the diagnosis of previously undetected IgA kappa plasma cell myeloma.…”