Hematology Case 32
Hematology Case 32
Embedded Files
Presented By Dr Shahab Al-Hammadi - Dr Mohammad Moharram
Released on 22-4-2020Patient Data
Patient Data
46 year old male
Clinical Data
Clinical Data
Low back pain
Severe bony tenderness specially left lower ribs.
X ray: Multiple bony lytic lesions in skull , ribs and pelvis.
Related Laboratory Results
Related Laboratory Results
Total Protein 98.60 g/L [64-82].
Total Calcium 3 mmol/L [2.2-2.58]
Parathyroid hormone 2 pg/mL [12-88]
CBC: mild normocytic normochromic anemia.
Peripheral blood , bone marrow aspirate and trephine biopsy "See Photos and comment below".
Provisional Diagnosis
Provisional Diagnosis
Picture suggestive of plasma cell myeloma
Case Picture(s) / Photo(s)
Case Picture(s) / Photo(s)
Peripheral Blood Smear
Bone Marrow Aspirate (x400)
Bone marrow Aspirate ( x1000)
Bone Marrow Trephine Biopsy (H.&E.)
Bone Marrow Trephine Biopsy (CD 138)
Bone Marrow Trephine Biopsy (CD 38)
Bone Marrow Trephine Biopsy (CD 56)
Bone Marrow Trephine Biopsy (Kappa)
Bone Marrow Trephine Biopsy (Lambda)
Comment / Findings
Comment / Findings
- Peripheral blood show Rouleaux formation of RBC.
- Bone marrow aspirate commnet:
Hypercellular bone marrow.
Depressed both myeloid and erytheroid series.
Increased plasma cells : 53.5% of ANC.
Plasma cells are hetrogenously distributed. Variable in morphology showing mature , immature , Pleomorphic plasma cells and Binucleated plasma cells are seen.
- Bone Marrow trephine biopsy comment:
Hypercellular bone marriw the estimated cellularity is 80%.
The bone marrow show nodular and interstitial infiltration by sheets of plasma cells about 50-60% which are positive for CD138, CD38 and C56 . For Kappa stain and Lambda stain was non conclusive.
All bone marrow elements are decreased .
Final Diagnosis
Final Diagnosis
Plasma cell neoplasm consistent with plasma cell myeloma for immunophenotyping, clinical and radiological correlation.
Additional Note
Additional Note
The patient was referred to higher center for immunophenotyping.
Google Sites
Report abuse