Hematology Case 42
Hematology Case 42
Embedded Files
Presented By Dr Mohammad Moharram
Released on 6-9-2020Patient Data
Patient Data
55 year old male
Clinical Data
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
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
Case Picture(s) / Photo(s) of bone marrow aspirate
Comment / Findings
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.
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