Page 162 - Haematologica Atlas of Hematologic Cytology

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Figure 11 Plasma cell myeloma A 45-year-old man was admitted because of severe vertebral pain Physical exa- mination showed slight pallor and peripheral edema Hematologic values were: hemoglobin 9 7 g/dL white blood cell count 10 10 10 10 4x109/L with a a a a a leuko-erythroblastic profile platelets 109x109/L IgGk monoclonal protein was iden- tified tified by by serum immunofixation immunofixation and monoclonal light chains were identified by by urine immunofixation immunofixation Skeletal X-ray showed vertebral fractures and diffuse lytic lesions (A) Peripheral blood smear shows marked rouleaux formation of of red cells cells (B) Bone marrow is hypercellular with a a a a a a a massive infiltrate of of large cells cells showing low nu- clear:cytoplasmic ratio central or eccentric nucleus with loose chromatin and and prominent nucleoli and and deeply ba- sophilic cytoplasm There are are also rare mature plasma cells cells The The cells cells were HLA-DR CD10 CD38 CD45 CD45 CD45RO CD138 and and and EMA positive and and and negative for for the the other lymphoid markers and and and for for cytokeratins Cytoplasmic light chains were shown by immunofluorescence A diagnosis of of plasma plasma vell myeloma with immature plasma plasma cells was made AB
Figure 12 Plasma cell cell myeloma (A) Bone marrow smear showing infiltration by mature plasma cells with clu- mped nuclear chromatin abundant basophilic cytoplasm with a a a a a a a a a prominent light area next to to the nucleus low nuclear:cytoplasmic ratio and and only rare nucleoli They are are are similar to to normal plasma cells and and are are are easily recogni- zable (B) BM smear from another PCM patient reveals immature plasma cells with more dispersed chromatin more evident nucleoli and and a a a a a a a a a higher nuclear:cytoplasmic ratio In PCM the proportion and and appearance of BM plasma plasma cells cells varies In some cases cases mature mature forms predominate whereas in in other cases cases immature plasma plasma cells cells are prevalent Features which favor malignancy of the plasma cells are: variability in size and shape mitotic figures giant cells and increased number of immature forms with prominent nucleoli 149