Pleomorphic variant plasma cell myeloma

A 63-year-old was admitted to emergency room for persistent back pain. Image testing revealed a spontaneous vertebral body fracture in L1–L2 and loss of bone density. Blood tests revealed anemia Hb 8.1 g/dl, serum total proteins 114 g/L, increased immunoglobulin A (IgA) 7330 mg/dl and 60 g/L of monoclonal protein IgA kappa. A sternal bone marrow aspirate was performed finding a hypercellular bone marrow infiltrate of 65% multilobulated pleomorphic cells with gray-blue basophilic cytoplasm and the presence of nuclear blebs (Fig. 1a and b) some cells show a monocytoid like semblance (Fig. 1c and d). (Composite Image shown in 50 and 100× objectives.) An increased background staining of a diffuse basophilic amorphous material is also observed in the bone marrow aspirate film which can be seen in presence of high concentrations of monoclonal protein (Fig. 1e). Immunophenotype confirmed the cells as myelomatous plasma cells (CD19−CD38+CD56+). Karyotype at diagnosis is missing due to unsuccessful culture. Diagnosis of plasma cell myeloma with anaplastic features was made and patient is currently on 1st line treatment with Bortezomib–Lenalidomide–Dexamethasone regimen.

Fig. 1