IgG‐λ plasma cell myeloma with cytoplasmic azurophilic inclusion bodies

Abstract

A 70-year-old man with a history of coronary artery disease status post coronary artery bypass graft presented to his urologist with 1 month urinary frequency. Prostate examination was unremarkable, but a routine urine analysis revealed glucosuria (31). Additional laboratory tests confirmed the diagnosis of type II diabetes mellitus. As a part of the initial investigation, routine laboratory tests revealed elevated total serum protein (9.4 g/dL; reference range, 6.4-8.2 g/dL). Complete blood count demonstrated white blood cell of 7.3 3 10 3 /lL (reference range, 4.8-10.8 3 10 3 /lL), red blood cells 2.91 3 10 6 /lL (reference range, 4.2-5.4 3 10 6 /lL), hemoglobin of 9.1 g/dL (reference range, 14-18 g/dL), MCV of 91 fL (reference range, 80.0-94.0 fL), and platelet count of 269 3 10 3 /lL (reference range, 150-400 3 10 3 /lL). Blood urea nitrogen was 39 mg/dL (reference range, 7-18 mg/dL) and creatinine was 1.6 mg/dL (reference range, 0.6-1.3 mg/dL). Further analysis with serum protein electrophoresis (SPEP) showed a monoclonal paraprotein in the gamma globulin region (3.71 g/dL) (see Image 1). Immunofixation electrophoresis (IFE) confirmed that the paraprotein to be IgG-type with a monotypic lambda light chain (Image 1, inset). b-2-microglobulin was increased to 9.1 mg/dL (reference range, < 2 mg/dL). A bone survey was negative for lytic lesions. Peripheral blood smear demonstrated a moderate normocytic/normochromic anemia with some rouleaux formation and unremarkable leukocyte and platelet morphology. The WrightGiemsa stained bone marrow aspirate smear revealed numerous abnormal plasma cells, which comprised approximately 85% of nucleated cells. The majority of the plasma cells exhibited azurophilic crystalline bodies in the cytoplasm (Images 2 and 3), which were negative with Prussian blue stain. Residual hematopoietic elements were markedly decreased. The bone marrow core biopsy was hypercellular at 90% with sheets of abnormal plasma cells (Image 4). Immunohistochemical staining for CD56 (Image 5A) and CD138 (Image 5B) highlighted a dense plasmacytic infiltrate. The plasma cells were positive for cytoplasmic lambda light chain (Image 6B) but negative for both kappa light chain (Image 6A) and CD20 stains. Cytogenetic studies detected a complex abnormal hyperdiploid clone with multiple numeric and structural abnormalities: 53-55,XY,dic(1;3)(p13;q29)

Auer rod-like inclusions in plasma cells in multiple myeloma

“…Additionally, there is no known cytogenetic association as most reports have not provided results of karyotyping. In one report, however, a complex hyperdiploid clone comprising multiple numerical and structural abnormalities was described 4. This is in contrast to our case where hypodiploid abnormalities were present.…”

Plasma cell myeloma with intracytoplasmic crystalloid inclusions, mimicking a Niemann–Pick disease

“…While myeloma with cytoplasmic inclusions has been reported previously (1,2), the present case is unique as the cytoplasm of the plasma cells was strikingly foamy on the histologic section mimicking a Niemann-Pick disease. The case emphasizes the diagnostic significance of correlating morphology with clinical findings, because it could have been initially considered to be an unidentified storage disease resulting in unnecessary diagnostic workup or even misdiagnosis if pertinent laboratory data were not available.…”

Clinical significance of granule‐containing myeloma cells in patients with newly diagnosed multiple myeloma

“…The significance of the presence of cytoplasmic granules in myeloma cells is poorly understood. The GM cells are considered to be detectable infrequently because the study about large number of cases with the GM cells has not been demonstrated, and only several cases with cytoplasmic granules in myeloma cells were reported . In our study, 20.5% of MM patients displayed cytoplasmic granules, and hence we speculated that GM cells could be detected occasionally.…”