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
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.
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. 1e: CD20
Fig. 1f: PAX5
Fig. 1f: PAX5
Fig. 1g: CD3
Fig.1h: MUM-1
Fig. 1i: VS38C
Fig. 1j: IgG |
