Hematology Case 32
Presented By Dr Shahab Al-Hammadi - Dr Mohammad Moharram
Released on 22-4-2020Patient Data
46 year old male
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
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
Picture suggestive of plasma cell myeloma
Case Picture(s) / Photo(s)
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
Plasma cell neoplasm consistent with plasma cell myeloma for immunophenotyping, clinical and radiological correlation.
Additional Note
The patient was referred to higher center for immunophenotyping.