Plasma Cell Myeloma with an Aggressive Clinical Course and Anaplastic Morphology in a 22-Year-Old Patient: A Case Report and Review of Literature

Abstract

Unusual clinical course Background: Plasma cell myeloma is a neoplastic plasma cell disorder that usually presents after the fifth decade of life; it is rarely described in younger population especially under 30 years of age. However, there are conflicting reports in the literature about the clinical behavior and overall survival in younger age groups. In approximately 2% of plasma cell myeloma, the morphology of the neoplastic cells is highly pleomorphic, quite anaplastic, and may resemble metastatic tumor cells. While this poses a challenge for morphological interpretation during diagnosis, it has been demonstrated that bone marrow morphologic features (including diffuse sheet growth pattern, immature cell morphology and high mitotic index) significantly correlates with high risk disease. Moreover, there is limited description available about the morphology of the neoplastic cells when correlating the age at presentation with the clinical outcome/biological behavior; hence, the need to report and collect such cases. Case Report: We report a case of plasma cell myeloma in a 22-year-old male who presented with non-specific clinical features and posed a diagnostic challenge during clinical, radiological, and laboratory examination. The pathology specimens showed anaplastic morphology. Unfortunately, after diagnosis, despite treatment with brotezomib, his disease had an aggressive clinical course and he passed away 4 months after diagnosis. Conclusions: Although plasma cell myeloma is rare in patients younger than 30 years, it must be considered in the differential diagnosis and investigated properly especially in patients with clinical suspicion of a metastatic non-hematological tumor. The anaplastic variant in a young patient is a diagnostic challenge and is associated with bizarre morphology, aggressive presentation, adverse cytogenetics, resistance to chemotherapy, and poor, short-term, survival.

Aberrant acquisition of T-cell associated markers in plasma cell neoplasms: An aggressive disease with extramedullary involvement and very short survival

“…Therefore, a new line of chemotherapy [cisplatin, doxorubicin, etoposide, cyclophosphamide] combined with pomalidomide and Carfilzomib was started for two cycles the patient planned for ASCT. 1, cases [4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. Upon an extensive review of English literature, a total of 22 cases of PCNs (including the three cases reported here) showed aberrant co-expression of Tcell associated markers.…”

“…16 Moreover, anaplastic myeloma variant, in which the malignant PCs are highly pleomorphic, has been reported more common in younger patients with a predisposition for the extramedullary site and poor prognosis. 14,17 This morphologic variant may present initially at diagnosis 16 or as a feature of disease progression. 18 Aberrant expression of T-cell antigens has also been rarely described in cases with the plasmablastic transformation of PCM, and it has been postulated that EBV may stimulate T-cell antigen expression in B-lineage neoplasms.…”

Cardiovascular Involvement of a CD138-Negative Anaplastic Myeloma: A Diagnostic Dilemma

“…They can mimic high-grade lymphoma or non-hematopoietic malignancy by morphology [ 15 ]. The cells often resemble dysplastic megakaryocytes or giant cell osteoclasts [ 16 ]. In this case, the initial panel including CD3, CD20, CD138, and AE1/3 were all negative.…”

Plasma Cell Myeloma dengan Temuan Histopatologi pada Tulang Humerus

“…2,4,5 Penelitian oleh Elsabah dkk juga menemukan hiperkalsemia dan peningkatan kreatinin pada pasien PCM. 10 Berbeda dengan kepustakaan, pada kasus ini hanya sedikit peningkatan kreatinin, tidak ada hiperkalsemia, hipoalbuminemia maupun leukopenia dan trombositopenia. Laporan kasus oleh Gupta dkk menemukan 25% PCM dengan insufisiensi renal serta 0% hiperkalsemia dan hipoalbuminemia.21 Sejalan dengan penelitian oleh Sudandyo dkk, ditemukan hanya 4% hiperkalsemia pada pasien PCM.…”