Plasma cell subtypes in bone marrow biopsies from patients without plasma cell dyscrasia
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Little is known about the plasma cell subpopulations in bone marrow. Bone marrow aspirates can only provide percentages of cell types and may not be representative. In this study, biopsies (Bouin's fixed, paraffin-embedded) from patients with a variety of haematological and non-haematological diseases (autoimmune 4, myeloid neoplasia 3, staging biopsies for Hodgkin's or non-Hodgkin's lymphomas – all normal – 5, anaemia 2, carcinoma – bone marrow unaffected – 2, miscellaneous 5) but not plasma cell dyscrasia were retrieved from files. Consecutive 3 µm sections were stained with polyclonal anti-κ, anti-λ, anti-γ, anti-α, anti-µ or anti-δ immunoglobulin (Ig) antisera and the reactions visualized using the avidin–biotin immunoperoxidase labelling method (Dako). All positive cells/section were counted in each section and the areas of bone marrow of the haematoxylin/eosin (H/E) stained sections were measured using a Vidas image analyser (Kontron Electronic) and Videoplan interactive software. The number of cells/mm2 positive with each light and heavy chain antibody was then calculated. The median bone marrow area of the biopsies was 6·1 mm2 (percentiles 4·4, 7·6) and the range was 1·3–13·4 mm2. Positive cells were spread reasonably uniformly throughout the sections apart from the expected concentration around blood vessels. The morphology of Ig µ-positive cells was indistinguishable from that of small plasma cells. The median (percentiles) and range of positive cells with each light and heavy chain antibody are shown in Table I. The κ/λ ratios of the absolute counts ranged between 1·2/1 and 3·4/1; median 1·9/1 (1·3/1, 1·8/1). This study has documented for the first time the range of absolute numbers of different plasma cell subsets in bone marrow biopsies from patients without plasma cell dyscrasia but with a spectrum of diseases commonly encountered in routine haematological practice. In a study of a similar group (n = 17) of patients, Thiele et al (1988) found a mean absolute plasma cell level of 87 (± 34)/mm2 in Giemsa-stained bone marrow sections. This compares well with the median total of 69 κ +ve plus λ +ve cells/mm2 demonstrated in our study. Our findings provide baseline values for comparison with individual plasma cell subsets of patients with plasma cell dyscrasia. In particular, knowledge of the upper limits of subsets encountered in diseases unrelated to plasma cell dyscrasia will enable diagnosis of low volume Igδ +ve or Igµ +ve disease to be made even when there is no overall increase of plasma cell or lymphoplasmacytoid cell numbers in Giemsa-stained sections or even perturbation of the overall κ:λ ratio. Bone marrow biopsies provide optimal material for measurement of absolute numbers of any cell type. Having a framework of bony trabeculae, shrinkage of tissue during fixation is not a problem. The presence of fibrosis and solid areas of tumour that are factors rendering the assessment of aspirated material uncertain either do not affect measurement of cell content or at least can be visualized as interfering factors. We suggest that there is new information to be gained from determination of absolute numbers, in particular plasma cell subsets in bone marrow biopsies.Keywords:
Plasma cell dyscrasia
Immunoperoxidase
Plasma Cell Myeloma
Plasma cell neoplasm
Plasma cell neoplasm
Extramedullary plasmacytoma
Plasma Cell Myeloma
Neoplasm
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Plasma cell neoplasm
Plasma Cell Myeloma
Plasma cell leukemia
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Plasma cell neoplasm
Plasma Cell Myeloma
Neoplasm
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We report a case of a 53-year-old woman who presented with anemia and abnormal uterine bleeding. Endometrial and cervical biopsies revealed infiltration by large atypical cells, which were characterized as neoplastic plasma cells. Further investigations revealed systemic plasma cell dyscrasia (i.e., plasma cell myeloma). We therefore report a case of plasma cell myeloma, initially presenting as abnormal uterine bleeding.
Plasma cell dyscrasia
Plasma Cell Myeloma
Dyscrasia
Infiltration (HVAC)
Plasma cell neoplasm
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Extramedullary plasmactyoma is the solitary, soft tissue form of plasma cell neoplasm but lack the defining features of medullary or multiple myeloma. The diagnosis is difficult to make in routine practice setting due to the morphological and immunohistochemical overlap with plasmablastic lymphoma. We report a case of plasmablastic extramedullary plasmacytoma in a 52-year-old in the mandibular lingual gingiva and discuss its differential from plasmablastic lymphoma. The gingival mass regressed with primary radiotherapy.
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Plasma cell neoplasm
Plasma Cell Myeloma
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Plasma cell dyscrasias are characterized by neoplastic proliferation of a single clone of plasma cells typically producing a monoclonal immunoglobulin. Plasma cell neoplasms can present as a single lesion (solitary plasmacytoma) or more commonly as multiple lesions (multiple myeloma). Plasmacytomas can be present at the initial diagnosis of multiple myeloma or develop later during the course of the disease.
When plasmacytoma is associated with 10 percent or more clonal plasma cells in the bone marrow, the diagnosis is considered to be multiple myeloma rather than solitary plasmacytoma. While solitary plasmacytomas are treated with radiotherapy, multiple myeloma is treated with chemotherapy.
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Plasma cell dyscrasia
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Myeloma protein
clone (Java method)
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Some non-Hodgkin lymphomas show marked plasmacytic differentiation. In such cases, it may be difficult to differentiate these lymphoma from plasmacytoma or myeloma, especially with limited diagnostic material. However, there may be immunophenotypic differences in the plasma cells in these disorders that distinguish them. This study characterizes the immunophenotypes of neoplastic plasma cells in 41 cases of B-lineage non-Hodgkin lymphoma and compares them with those in plasma cell myeloma. We found that plasma cells in lymphoma were significantly more likely to express CD19, CD45, and surface immunoglobulin and less likely to express CD56 than those in myeloma. We further show that CD 19 and CD56 expression can be used reliably to distinguish these entities. Myeloma-associated osseous lesions and solitary plasmacytoma of bone showed myeloma-like immunophenotypes. However, some extramedullary plasmacytomas showed lymphoma-like phenotypes, suggesting that, in reality, they may represent non-Hodgkin lymphomas with extensive plasmacytic differentiation.
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Plasma cell leukemia
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Lymphoplasmacytic Lymphoma
Plasmablastic lymphoma
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In order of frequency, the plasma cell lesions affecting the head and neck are multiple myeloma, extramedullary plasmacytoma, plasma cell granuloma, and solitary plasmacytoma of bone. All except plasma cell granuloma are neoplastic and they are interrelated. The solitary plasmacytoma of bone is regarded as a form of multiple myeloma. The extramedullary plasmacytoma may be a lesion of local significance only or may terminate in a disseminated disease, myelomatosis, that differs clinically and prognostically from multiple myeloma.
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Multiple myeloma (MM) is a malignant proliferation of plasma cells with multiple foci. Plasmacytoma is a solitary plasma cell neoplasm involving a single bone. The most commonly involved bone is vertebra. Jaw bones are rarely involved as a first bone as they have lesser hematopoietic marrow. A solitary plasmacytoma may progress to multiple myeloma within few months to year. We present a case of a swelling of mandible that on further investigations confirmed the diagnosis of multiple myeloma. We have discussed the course of treatment given and its prognosis. Keywords: multiple myeloma; plasmacytoma of jaw; bence jones Protein; abnormal plasma cells; CD138.
Plasma cell neoplasm
Plasma Cell Myeloma
Mandible (arthropod mouthpart)
Bence Jones protein
Myeloma protein
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