The bone marrow (BM) biopsy (panel A; original magnification ×400 for all panels) from a 59-year-old man showed many giant cells we initially thought of as megakaryocytes (yellow arrowheads). Morphological features different from normal megakaryocytes included relatively high nuclear-to-cytoplasmic ratio, hyperchromic nuclei, perinuclear eosinophilic halo, and nuclear inclusion or prominent nucleoli in some cells. On aspirate (panel B), they had bluish cytoplasm whereas megakaryocytes had purple granular cytoplasm. Immunohistochemistry confirmed them as plasma cells (CD138+ and CD61−) (panels C-D).
The patient was diagnosed as having immunoglobulin A (IgA) κ plasma cell myeloma 2 years ago. The plasma cells had aberrant expression of CD28, CD117 partial, CD20, and loss of CD45, CD19, and CD27. Cytogenetic studies reported a near-tetraploid complex karyotype. Fluorescence in situ hybridization detected gain of CDKN2C (1p32.3)/CKS1B (1q21), FGF3 (4p16), CCDN1 (11q13), and IgH (14q32) locus with variant rearrangement, but was negative for monosomy 13, TP53 deletion, and rearrangement of IgH/CCDN1 and IgH/FGF3. He responded partially to multiple lines of chemoradiation therapy and achieved complete remission after autologous stem cell transplant 5 months ago. However, recent BM biopsy showed relapsed disease with these giant bizarre cells accounting for ∼20% of total plasma cells and 5 to 10 times more than megakaryocytes. This case demonstrates the wide morphological spectrum of plasma cell myeloma.
The bone marrow (BM) biopsy (panel A; original magnification ×400 for all panels) from a 59-year-old man showed many giant cells we initially thought of as megakaryocytes (yellow arrowheads). Morphological features different from normal megakaryocytes included relatively high nuclear-to-cytoplasmic ratio, hyperchromic nuclei, perinuclear eosinophilic halo, and nuclear inclusion or prominent nucleoli in some cells. On aspirate (panel B), they had bluish cytoplasm whereas megakaryocytes had purple granular cytoplasm. Immunohistochemistry confirmed them as plasma cells (CD138+ and CD61−) (panels C-D).
The patient was diagnosed as having immunoglobulin A (IgA) κ plasma cell myeloma 2 years ago. The plasma cells had aberrant expression of CD28, CD117 partial, CD20, and loss of CD45, CD19, and CD27. Cytogenetic studies reported a near-tetraploid complex karyotype. Fluorescence in situ hybridization detected gain of CDKN2C (1p32.3)/CKS1B (1q21), FGF3 (4p16), CCDN1 (11q13), and IgH (14q32) locus with variant rearrangement, but was negative for monosomy 13, TP53 deletion, and rearrangement of IgH/CCDN1 and IgH/FGF3. He responded partially to multiple lines of chemoradiation therapy and achieved complete remission after autologous stem cell transplant 5 months ago. However, recent BM biopsy showed relapsed disease with these giant bizarre cells accounting for ∼20% of total plasma cells and 5 to 10 times more than megakaryocytes. This case demonstrates the wide morphological spectrum of plasma cell myeloma.
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