scholarly journals Plasma Cell Rich Osteomyelitis: A Rare Entity

2020 ◽  
Author(s):  
Prakhar Maheshwari ◽  
Rajesh Kumar Maheshwari ◽  
Anuradha Kusum ◽  
Digvijay Agarwal
Keyword(s):  
Clinical Features ◽  
Plasma Cell ◽  
Pathological Fracture ◽  
Plasma Cells ◽  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Left Shoulder ◽  
Correct Treatment ◽  
Cortical Irregularity ◽  
Post Traumatic

Plasma cell rich osteomyelitis is a rare finding characterised by a plethora of plasma cells localised in the affected bone without the typical clinical features of infection. It usually affects the metaphysis of long bones with a radiological appearance as a dense thickening of bone without sequestrum formation. We present an atypical case of plasma cell osteomyelitis with a lesion in the metaphysis as well as the diaphysis of the humerus without sclerosis but with sequestrum formation. An 11-year-old girl was brought to OutPatient Department (OPD) with complaints of post-traumatic pain and swelling at left shoulder and proximal arm since one and a half months with aggravation of symptoms since last 10 days. Patient had also been treated for Urinary Tract Infection (UTI) by a paediatrician who prescribed antibiotics and antipyretics because of which fever subsided but the pain persisted. The x-ray of left shoulder with arm revealed a fracture of surgical neck of humerus with cortical irregularity noted in the mid-shaft of humerus along with lamellated periosteal reaction suggestive of post-traumatic osteomyelitis with a pathological fracture. Clinicoradiologic diagnosis of pathological fracture of left neck of humerus was made with an underlying neoplastic or infective aetiology. An open biopsy was taken from left proximal humerus. Histopathological examination showed plasma cells in sheets having abundant basophilic cytoplasm, round to eccentric nuclei and perinuclear hoff along with lymphocytes and few polymorphs with surrounding area showing fibrosis, oedema and hyperemia. A diagnosis of chronic plasma cell osteomyelitis was rendered, which is an uncommon condition without specific clinical findings and an ambigious cause. Histopathology is the definitive tool for obtaining an accurate diagnosis and we strongly recommend a meticulous histopathological examination correlated with clinico-radiological description for a correct diagnosis in order to avoid an increased frequency of diagnosis of neoplastic plasma cell lesion as well as for advocating the correct treatment. This case is discussed for presentation of plasma cell osteomyelitis and also to report a case of chronic primary plasma cell rich osteomyelitis with atypical clinical features.

Not All Polyps Are Created Equal: Multiple Myeloma in the Gut

Blood ◽  
2016 ◽  
Vol 128 (22) ◽  
pp. 5602-5602
Author(s):  
Divya Akella ◽  
Fnu Aparna ◽  
Marijeta Pekez ◽  
Nirmala S. Nathan ◽  
Hemchand Ramberan ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Plasma Cell ◽  
Light Chain ◽  
Plasma Cells ◽  
Conflicts Of Interest ◽  
Correct Diagnosis ◽  
Colonic Polyps ◽  
Immunohistochemical Analysis ◽  
Recurrent Bleeding ◽  
Dexamethasone Therapy

Abstract Background: Multiple myeloma is a neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin usually restricted to the bone marrow. Recent literature confirms increased extramedullary involvement of skin, liver and lymph nodes but gastrointestinal multiple myelomas remain rare. Case: We report a case of 57-year-old female with a past medical history of progressive multiple myeloma IgA lambda on elotuzumab, lenalidomide and dexamethasone therapy, who presented with generalized weakness and black stools for approximately one week. Initial laboratory work demonstrated a hemoglobin of 6.7 grams per deciliter and heme positive stools consistent with anemia secondary to presumed gastrointestinal blood losses. Esophagogastroduodenoscopy (EGD) was unremarkable. Colonoscopy revealed 6 colonic polyps scattered throughout the distal transverse, cecal and descending colon which were excised and sent for pathology. Pathology of the polyps showed plasma cell myeloma with anaplastic features. Immunohistochemistry demonstrated cells that were positive for CD-138 and negative for keratin staining, confirming plasma cell origin. Furthermore analysis was positive for lambda light chain, but negative for kappa light chain. The patient was managed with packed red cell transfusion with no further evidence of recurrent bleeding. Conclusion: Gastrointestinal multiple myeloma are rare, but as our case demonstrates, they must be considered in the differential diagnosis of patients with gastrointestinal bleeding, particularly those with multiple myeloma. The endoscopic appearance of multiple myeloma polyps may be similar to other more common conditions, making pathological and immunohistochemical analysis of biopsies essential for making a correct diagnosis. Disclosures No relevant conflicts of interest to declare.

scholarly journals Extramedullary plasmacytoma of the tongue: A case report

2021 ◽  
Vol 2 (6) ◽  
Author(s):  
Leart Berdica ◽  
◽  
Teona Bushati ◽  
Alfred Aga ◽  
Emirjona Vajushi ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Differential Diagnosis ◽  
Plasma Cell ◽  
Plasma Cells ◽  
Histopathological Examination ◽  
English Literature ◽  
Extramedullary Plasmacytoma ◽  
Imaging Data ◽  
Plasma Cell Neoplasms ◽  
Extramedullary Plasmocytoma

Background: Tongue extramedullary plasmacytoma is a very rare pathology. Despite rare cases, extramedullary plasmacytoma should be considered as a differential diagnosis in case of a mass in the tongue. A total of 19 cases were reported with EMP in English literature along with the case we will address. It is characterized by a monoclonal neoplastic proliferation of plasma cells in the absence of multiple myeloma (MM). Histopathology and immunohistochemistry are very important for the diagnosis and differential diagnosis. Case presentation: The case we will describe is an 80-year-old lady from Albania who presents with a vegetative lesion in the form of a thick plate on the dorsal part of the tongue with dimensions 6 X 5 X 1.5 cm. A material of 0.5 cm diameter was taken from the lesion for the biopsy. After histopathological examination, immunohistochemical examinations, and after correlations with laboratory, clinical and imaging data, the diagnosis of extramedullary plasmacytoma of the tongue was reached. The patient underwent radiotherapy treatment. Conclusions: EMP is a rare tumor, accounting for 3% of plasma cell neoplasms and <1% of all head and neck tumors. The diagnosis of EMP, in this case, was reached with biopsy, immunohistochemistry, and the correlation with laboratory and imaging data. We will show the importance of biopsy along with immunohistochemistry in the diagnosis and differential diagnosis of extramedullary plasmocytoma of the tongue. Keywords: plasmacytoma; immunohistochemistry; biopsy; plasma cell. Abbreviations: EMP: Extramedullary plasmacytoma; MM: Multiple myeloma; Cm: centimeter

Diagnostic and Clinical Considerations in Concomitant Bone Marrow Involvement by Plasma Cell Myeloma and Chronic Lymphocytic Leukemia/Monoclonal B-Cell Lymphocytosis: A Series of 15 Cases and Review of Literature

2013 ◽  
Vol 137 (4) ◽  
pp. 503-517 ◽  
Author(s):  
Christopher L. Alley ◽  
Endi Wang ◽  
Cherie H. Dunphy ◽  
Jerald Z. Gong ◽  
Chuanyi M. Lu ◽  
...  
Keyword(s):  
Bone Marrow ◽  
B Cells ◽  
Chronic Lymphocytic Leukemia ◽  
Plasma Cell ◽  
Plasma Cells ◽  
Correct Diagnosis ◽  
Bone Marrow Involvement ◽  
Rare Event ◽  
Lymphocytic Leukemia ◽  
Plasma Cell Myeloma

Context.—Plasma cell myeloma and chronic lymphocytic leukemia are both common hematologic malignancies, sharing many epidemiologic features. Concomitant detection of the 2 conditions poses special diagnostic challenges for the pathologist. Objective.—To describe the pathologic findings in cases of concomitant bone marrow involvement by myeloma and CD5+ monoclonal B cells and to outline the differential diagnostic possibilities, suggest a workup for correct diagnosis, and examine clinical outcome. Design.—Fifteen cases that met the diagnostic criteria were identified from pathology databases at 4 participating institutions. Morphologic findings were reviewed, additional immunohistochemical stains performed, and flow cytometric, cytogenetic, and relevant laboratory and clinical information was summarized. Previously published cases were searched from electronic databases and cross-references. Results.—Most patients (13 of 15) were older males. Often (11 of 15) they presented clinically with myeloma, yet had both monotypic plasma cells and B cells in the diagnostic marrow. In 4 patients, myeloma developed 24 months or later after chronic lymphocytic leukemia. In 7 patients, myeloma and CD5+ B cells showed identical immunoglobulin light-chain restriction. Primary differential diagnoses include lymphoplasmacytic lymphoma, marginal zone lymphoma, and chronic lymphocytic leukemia with plasmacytoid differentiation. CD56 and/or cyclin D1 expression by plasma cells was helpful for correct diagnosis. Most patients in our cohort and published reports were treated for plasma cell myeloma. Conclusions.—Concomitant detection of myeloma and chronic lymphocytic leukemia in the bone marrow is a rare event, which must be carefully differentiated from lymphomas with lymphoplasmacytic differentiation for correct treatment.

scholarly journals Solitary Plasmacytoma of the Mesentery: A Systematic Clinician’s Diagnosis

2017 ◽  
Vol 2017 ◽  
pp. 1-4 ◽  
Author(s):  
Georgia Mitropoulou ◽  
Adamantia Zizi-Sermpetzoglou ◽  
Hippokrates Moschouris ◽  
Athanasios Kountourogiannis ◽  
Despoina Myoteri ◽  
...  
Keyword(s):  
Plasma Cell ◽  
Plasma Cells ◽  
Histopathological Examination ◽  
Extramedullary Plasmacytoma ◽  
Solitary Plasmacytoma ◽  
Plasma Cell Neoplasm ◽  
Mesenteric Root ◽  
Laparoscopic Biopsy ◽  
Bone Marrow Plasma ◽  
Solitary Extramedullary Plasmacytoma

Introduction. Plasmacytoma is an uncommon plasma cell neoplasm and its localized form is solitary plasmacytoma of the bone and solitary extramedullary plasmacytoma. Solitary plasmacytoma of the mesentery is extremely rare, reported only in a handful of cases. Case Presentation. A 47-year-old man with nonspecific abdominal complains was found to have an ill-defined mass on his mesenteric root. Laparoscopic biopsy and stepwise histopathological examination revealed a mesenteric plasmacytoma, and extensive imaging and laboratory investigations led to the diagnosis of the solitary mesenteric plasmacytoma. The patient underwent definitive radiotherapy and remains under remission one year later. Discussion. Plasma cell dyscrasias include a variant of proliferative disease, characterized by clonal expansion of bone marrow plasma cells, producing a massive quantity of monoclonal immunoglobulin called paraprotein or M-protein. Solitary extramedullary plasmacytoma accounts for only 3–5% of all plasma cell neoplasms. Meticulous adherence to the established diagnostic criteria helps the clinician to set the correct, yet very unusual and unexpected diagnosis.

scholarly journals Distinct Clinical Features of Plasma Cell Myeloma Patients Exhibiting Dysmorphic Plasma Cells: Association with More Plasma Cells at Diagnosis

2019 ◽  
Vol 35 (4) ◽  
pp. 662-672
Author(s):  
Sang Hyuk Park ◽  
Joseph Jeong ◽  
Seon-Ho Lee ◽  
Yunsuk Choi ◽  
Jae-Cheol Jo ◽  
...  
Keyword(s):  
Clinical Features ◽  
Plasma Cell ◽  
Plasma Cells ◽  
Plasma Cell Myeloma

scholarly journals Primary Malignant Fibrous Histiocytoma of Proximal Humerus with Pathological Fracture- Case Report

2021 ◽  
pp. 148-153
Author(s):  
Malkesh D. Shah ◽  
Ajinkya Arun Naik ◽  
Sai Sabharish Reddy ◽  
Sarvang M. Desai
Keyword(s):  
Malignant Fibrous Histiocytoma ◽  
Pathological Fracture ◽  
Mononuclear Cells ◽  
Proximal Humerus ◽  
Fibrous Histiocytoma ◽  
Histopathological Examination ◽  
Giant Cells ◽  
Left Shoulder ◽  
Intralesional Curettage ◽  
Operative Specimen

Malignant fibrous histiocytoma (MFH) is a tumor of late adulthood that occurs in men more commonly than women. Proximal humerus involvement in PMFH is comparatively rare. A 45 year old female presented with complain of pain and mild swelling over the left shoulder with restricted range of movement since 15 days. Radiography of the affected part was suggestive of an osteolytic eccentric lesion with a pathological fracture. A trucut needle biopsy showed minimal tumour tissue with abundant necrosis and showed giant cells with pleomorphic mononuclear cells. So intralesional curettage followed by osteosynthesis with PHILLOS plating and bone cementing was done. Intra operative specimen sent for histopathological examination showed presence of fibroblast cells arranged in storiform pattern s/o MFH along with occasional multinucleated giant cells. Postoperatively patient was started with adjuvant chemotherapy. Patient had good results functionally and clinically with no signs of recurrence till follow up of 1.5 years.

scholarly journals Percutaneous C-Arm Free O-Arm Navigated Biopsy for Spinal Pathologies: A Technical Note

Diagnostics ◽  
2021 ◽  
Vol 11 (4) ◽  
pp. 636
Author(s):  
Masato Tanaka ◽  
Sumeet Sonawane ◽  
Koji Uotani ◽  
Yoshihiro Fujiwara ◽  
Kittipong Sessumpun ◽  
...  
Keyword(s):  
Histopathological Examination ◽  
Correct Diagnosis ◽  
Standard Technique ◽  
Percutaneous Biopsy ◽  
Technical Note ◽  
Spinal Tumors ◽  
Histopathological Diagnosis ◽  
Ct Guided ◽  
Ct Guided Biopsy ◽  
The Right

Background: Percutaneous biopsy under computed tomography (CT) guidance is a standard technique to obtain a definitive diagnosis when spinal tumors, metastases or infections are suspected. However, specimens obtained using a needle are sometimes inadequate for correct diagnosis. This report describes a unique biopsy technique which is C-arm free O-arm navigated using microforceps. This has not been previously described as a biopsy procedure. Case description: A 74-year-old man with T1 vertebra pathology was referred to our hospital with muscle weakness of the right hand, clumsiness and cervicothoracic pain. CT-guided biopsy was performed, but histopathological diagnosis could not be obtained due to insufficient tissue. The patient then underwent biopsy under O-arm navigation, so we could obtain sufficient tissue and small cell carcinoma was diagnosed on histopathological examination. A patient later received chemotherapy and radiation. Conclusions: C-arm free O-arm navigated biopsy is an effective technique for obtaining sufficient material from spine pathologies. Tissue from an exact pathological site can be obtained with 3-D images. This new O-arm navigation biopsy may provide an alternative to repeat CT-guided or open biopsy.

scholarly journals Plasma cells shape the mesenchymal identity of ovarian cancers through transfer of exosome-derived microRNAs

2021 ◽  
Vol 7 (9) ◽  
pp. eabb0737
Author(s):  
Zhengnan Yang ◽  
Wei Wang ◽  
Linjie Zhao ◽  
Xin Wang ◽  
Ryan C. Gimple ◽  
...  
Keyword(s):  
Ovarian Cancer ◽  
Cancer Cells ◽  
Plasma Cell ◽  
Plasma Cells ◽  
Ovarian Cancer Cells ◽  
Mesenchymal Phenotype ◽  
Ovarian Cancers ◽  
Novel Approach

Ovarian cancer represents a highly lethal disease that poses a substantial burden for females, with four main molecular subtypes carrying distinct clinical outcomes. Here, we demonstrated that plasma cells, a subset of antibody-producing B cells, were enriched in the mesenchymal subtype of high-grade serous ovarian cancers (HGSCs). Plasma cell abundance correlated with the density of mesenchymal cells in clinical specimens of HGSCs. Coculture of nonmesenchymal ovarian cancer cells and plasma cells induced a mesenchymal phenotype of tumor cells in vitro and in vivo. Phenotypic switch was mediated by the transfer of plasma cell–derived exosomes containing miR-330-3p into nonmesenchymal ovarian cancer cells. Exosome-derived miR-330-3p increased expression of junctional adhesion molecule B in a noncanonical fashion. Depletion of plasma cells by bortezomib reversed the mesenchymal characteristics of ovarian cancer and inhibited in vivo tumor growth. Collectively, our work suggests targeting plasma cells may be a novel approach for ovarian cancer therapy.

Should CD138 Immunohistochemistry be Standard Recommended Practice for Bone Marrow Evaluation of Plasma Cell Neoplasms?

2020 ◽  
Vol 154 (Supplement_1) ◽  
pp. S110-S110
Author(s):  
A Vijayanarayanan ◽  
K Inamdar ◽  
M Menon ◽  
P Kuriakose
Keyword(s):  
Bone Marrow ◽  
Plasma Cell ◽  
Linear Correlation ◽  
Plasma Cells ◽  
Pearson Correlation ◽  
Protein Electrophoresis ◽  
Pearson Correlation Coefficient ◽  
Cell Percentage ◽  
Significant Linear Correlation ◽  
Plasma Cell Neoplasms

Abstract Introduction/Objective Myeloma diagnosis by a pathologist requires 10% plasma cells (PC) or a biopsy proven plasmacytoma in addition to myeloma defining events. PC% &gt; 60% is a biomarker of malignancy under this definition. WHO allows for assesment of plasma cell percentage either by aspirate count or by CD138 immunohistochemistry (IHC). There is lack of consensus on aspirate smear adequacy for PC% estimation. Uneven distribution of plasma cells, hemodilution and/or patchy infiltration can lead to gross underestimation. We compared PC% by aspirate count and CD138 IHC and established corelation with serum protein electrophoresis (SPEP) values. Methods 67 myeloma cases were included after excluding cases with suboptimal or inadequate aspirate smears. Two hematopathologists evaluated the diagnostic marrow (therapy naive) for PC% by aspirate count and CD138 IHC on biopsy/clot section. Corresponding SPEP and Free light chain (FLC) values were obtained. Correlation coefficent was calculated using Pearson correlation coefficient (GraphPad Prism). Results The Ig subtypes included IgG (41/67) and IgA (17/67). 12 cases had available FLC values. Both average and median PC% by CD138 IHC was considerably higher (50%, 52%) compared to aspirate count (29%, 21%). However, PC% by aspirate smear count and CD138 IHC demonstrated a significant linear correlation (r=0.71, p60% by CD138 (and not by aspirate count). Conclusion CD138 IHC based PC% is consistently higher, nevertheless, statistically significant linear corelation is observed between aspirate count PC% and CD138 IHC. A significant linear correlation is observed between CD138 IHC and SPEP (IgG and IgA), however, no such correlation is observed with aspirate count. More cases were diagnosed as myeloma (11%) and higher propotion of cases (35%) had biomarker of malignancy i.e. PC% &gt;60% by CD138 IHC. Based on these findings, we propose estimation of PC% by CD138 immunostain be a recommended standard practice for better clinicopathologic and biologic correlation.

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