Hematology Case 42

Presented By Dr Mohammad Moharram

Released on 6-9-2020

Patient Data

55 year old male

Clinical Data

History of left humerus pathological fracture.

MRI and CT of left arm: Expansile osteolytic lesion of the proximal humeral shaft measuring 5.5 cm in length.

Left humerus true cut biopsy: cores of bone and soft tissue exhibit infiltration by sheet of plasma cells with attached bony tissue and fibromuscular tissue noticed. Features consistent with plasma cell neoplasm.

Related Laboratory Results

Normal RFT and LFT

Normal serum ALP, serum calcium, serum total protein and LDH

Normal CBC

ESR: 47 mm/Hr

Bone marrow aspirate was ordered - see below

Case Picture(s) / Photo(s) of bone marrow aspirate

Comment / Findings

  • Cellularity: Mild hyper-cellular Bone marrow (Although partially diluted sample)
  • Differential Cell Count: Promyelocytes: 4% - Myelocytes: 9% - Metamyelocytes: 11.5% - Band neutrophils: 9.5% - Segmented Neutrophils: 10.5% - Eosinophils: 2% - Basophils: 0.5% - Monocytes: 1.5% --- Lymphocytes: 6% --- Plasma cells: 12.5% --- Erytheroid cells (Normoblasts) : 29%
  • Plasma cells: are Increased. There is plasma cells dysplastic features ; immature forms , pleomorphism, mitotic features, nuclear lobulation, binucleation and multinuceation. Mott cells are seen (multiple pale bluish-white, grape-like cytoplasmic accumulations; contain condensed or crystallized cytoplasmic Ig )
  • Comment: A case of plasma cell neoplasm mostly plasma cell myeloma to be confirmed by bone marrow trephine biopsy iimmunohistochemistry, immunophenotyping, serum protien electrophoresis and bone scan. Other plasma cell disorders are differential diagnosis.