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INDIANA ASSOCIATION OF PATHOLOGISTS


Save the Date --- 71st IAP Spring Slide Seminar--April 25, 2020

Head and Neck Pathology (focus on thyroid and parathroid pathology)


Final diagnosis:

Non-secretory plasma cell myeloma lacking light chain expression

Discussion:

Non-secretory myeloma is a rare subtype of plasma cell myeloma.

The initial work-up used for diagnosing non-secretory myeloma is no different than the standard multiple myeloma. The diagnosis of non-secretory myeloma relies on presence of monoclonal plasma cells established by immunophenotyping. Lack of light chain expression in non-secretory myeloma poses a diagnostic challenge.

The addition of immunohistochemical stain for heavy chain and Cyclin D1 may aid in definitive diagnosis.

A high incidence (83%) of t(11;14) (q13;q32) is present in non-secretory myeloma; which can be detected by karyotyping or fluorescence in situ hybridization (FISH).

Due to the rarity of the disease; there is no enough data to support using different treatment regimen other than the standard multiple myeloma regimen.

Monitoring patients with non-secretory myeloma is challenging; since we can us serum or urine Ig level in detecting response to therapy.


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List of References:

1. Bieber AK, Martires KJ, Driscoll MS, Grant-Kels JM, Pomeranz MK1, Stein JA. Nevi and pregnancy. J Am Acad Dermatol. 2016 Oct;75(4):661-666.

2. Chan MP, Chan MM, Tahan SR. Melanocytic nevi in pregnancy: histologic features and Ki-67 proliferation index. J Cutan Pathol. 2010 Aug;37(8):843-51.

3. Caron M. Grin, M.D., Department of Dermatology, MC 6230, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA. Does pregnancy alter melanocytic nevi? J Cutan Pathol. 2001 Sep;28(8):389-92.

4. Driscoll MS, Grant-Kels JM. Nevi and melanoma in pregnancy. Dermatol Clin. 2006 Apr;24(2):199-204.

5. Piana S, Tagliavini E, Ragazzi M, Zanelli M, Zalaudek I, Ciarrocchi A, Valli R. Lymph node melanocytic nevi: pathogenesis and differential diagnoses, with special reference to p16 reactivity. Pathol Res Pract. 2015 May;211(5):381-8. 

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