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INDIANA ASSOCIATION OF PATHOLOGISTS


January 2020

A 70-year-old male with a 1-month history of progressive chest pain and shortness of breath

Contributors: 



Mohamed Amin Mustafa, MBBS

Resident Education Chief-PGY4 

Department of Clinical Pathology & Laboratory Medicine

Indiana University School of Medicine




Jiehao Zhou, MD, PhD

Associate Professor of Clinical Pathology & Laboratory Medicine

Indiana University School of Medicine


Clinical history:  We present the case of a 70-year-old male with a 1-month history of progressive chest pain and shortness of breath that grew worse on exertion. He denied any bleeding, night sweats, weight loss, or fever.

The physical exam and imaging studies were within normal limits. Complete blood count showed hemoglobin of 8.7 g/dL, WBC of 2.1 k/cumm, and platelets of 32 k/cumm.

Serum/urine protein electrophoresis and immunofixation showed hypogammaglobulinemia without monoclonal protein. Serum free light chain assay was unremarkable.

Gross Examination: N/A

Microscopic examination and immunohistochemistry: Bone marrow biopsy showed hypercellular marrow with numerous plasmacytic/plasmacytoid cells. Flow cytometry analysis and bone marrow aspirates were not available due to dry tap.

Immunohistochemical stains showed these cells were positive for CD138, VS38C, IgG and MUM-1; negative for all other B-cell, T-cell markers tested, including CD20, CD79a, PAX5, CD5 and CD3. Cyclin D1 showed cytoplasmic staining.

In situ hybridization of kappa and lambda light chain was negative.

For PC users, right click to open image in a new window, then zoom to enlarge.

Fig.1 A: Bone marrow biopsy showing sheets of plasmacytoid cells replacing normal hematopoiesis                                

Fig. 1a: Bone marrow biopsy showing sheets of plasmacytoid cells replacing normal hematopoiesis

Figure 1b: CD138


   Fig. 1b: CD138

Fig. 1c: Kappa


 Fig.1c: Kappa

Fig. 1d: Lambda


Fig. 1d: Lambda

Fig. 1e: CD20


Fig. 1e: CD20

Fig. 1f:  PAX5


Fig. 1f:  PAX5

Fig. 1g: CD3


Fig. 1g: CD3

Fig.1h: MUM-1


Fig.1h: MUM-1

Fig. 1i: VS38C


Fig. 1i: VS38C

Fig. 1j: IgG


Fig. 1j: IgG

January 2020 Final Diagnosis and Discussion


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