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Intracellular and extracellular rhomboid shaped crystalline inclusions in a case of IgG lambda restricted plasma cell myeloma: a case report and review of the literature.

Matoso A, Rizack T, Treaba DO - Diagn Pathol (2010)

Bottom Line: The presence of crystalline inclusions in plasma cell myeloma is a rare phenomenon and cases have been reported with rod, needle, and rectangular shaped crystals.Here, we present a case of IgG lambda restricted plasma cell myeloma with rhomboid shaped intracellular crystalline inclusions and extracellular crystal depositions in the bone marrow.Since rhomboid crystal depositions can be seen in other clinical conditions such as pseudogout, this case invites consideration of plasma cell myeloma in the differential diagnosis of patients with rhomboid crystalline deposition in the bone marrow and in sites/organs other than the bone marrow.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI, USA.

ABSTRACT
The presence of crystalline inclusions in plasma cell myeloma is a rare phenomenon and cases have been reported with rod, needle, and rectangular shaped crystals. Here, we present a case of IgG lambda restricted plasma cell myeloma with rhomboid shaped intracellular crystalline inclusions and extracellular crystal depositions in the bone marrow. Since rhomboid crystal depositions can be seen in other clinical conditions such as pseudogout, this case invites consideration of plasma cell myeloma in the differential diagnosis of patients with rhomboid crystalline deposition in the bone marrow and in sites/organs other than the bone marrow.

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Plasma cell myeloma with intracytoplasmic and extracellular rhomboid crystalline inclusions. (a and b) Bone marrow aspirate stained with Wright-Giemsa. Note abundant rhomboid crystals present in the extracellular space (a; arrows) and intracytoplasmic in plasma cells (b; arrow-heads). (c) H&E stain of bone marrow biopsy section showing prominent rhomboid crystals (arrow). (d) Immunohistochemistry for lambda-chain highlights monotypic plasma cells with positive stain of the extracellular crystals (arrow). Bar 200 μm (a), 20 μm (b), and 50 μm (c and d).
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Figure 1: Plasma cell myeloma with intracytoplasmic and extracellular rhomboid crystalline inclusions. (a and b) Bone marrow aspirate stained with Wright-Giemsa. Note abundant rhomboid crystals present in the extracellular space (a; arrows) and intracytoplasmic in plasma cells (b; arrow-heads). (c) H&E stain of bone marrow biopsy section showing prominent rhomboid crystals (arrow). (d) Immunohistochemistry for lambda-chain highlights monotypic plasma cells with positive stain of the extracellular crystals (arrow). Bar 200 μm (a), 20 μm (b), and 50 μm (c and d).

Mentions: Both, the bone marrow biopsy and aspirate had normocellular bone marrow with trilineage hematopoiesis, slightly decreased myeloid and erythroid series and an increased population of plasma cells, 27% plasma cells in the 500 cell count aspirate differential (normal range up to 3%). Megakaryocytes were present in adequate number and had an unremarkable morphology. The plasma cell population included a subset with round conspicuous nucleoli and intracytoplasmic, single or multiple, nonbirefringent translucent crystalline structures with rhomboid shapes. Scattered free extracellular rhomboid shaped crystals were also noted (Figure 1a, 1b and 1c). Flow cytometry immunophenotypic analysis performed on bone marrow aspirate sample identified a monotypic, cytoplasmic lambda light chain restricted CD38+, CD138+ plasma cell population with dim CD45+, CD56+ and CD117+ expression. By immunohistochemistry, there were approximately 25-27% CD138+ plasma cells, which in a large subset expressed immunoglobulin lambda light chain restriction, and a subset was also IgG restricted. The crystals were weakly Ig lambda positive (Figure 1d). A Congo red stain to evaluate for possible amyloid deposition was negative.


Intracellular and extracellular rhomboid shaped crystalline inclusions in a case of IgG lambda restricted plasma cell myeloma: a case report and review of the literature.

Matoso A, Rizack T, Treaba DO - Diagn Pathol (2010)

Plasma cell myeloma with intracytoplasmic and extracellular rhomboid crystalline inclusions. (a and b) Bone marrow aspirate stained with Wright-Giemsa. Note abundant rhomboid crystals present in the extracellular space (a; arrows) and intracytoplasmic in plasma cells (b; arrow-heads). (c) H&E stain of bone marrow biopsy section showing prominent rhomboid crystals (arrow). (d) Immunohistochemistry for lambda-chain highlights monotypic plasma cells with positive stain of the extracellular crystals (arrow). Bar 200 μm (a), 20 μm (b), and 50 μm (c and d).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC2823683&req=5

Figure 1: Plasma cell myeloma with intracytoplasmic and extracellular rhomboid crystalline inclusions. (a and b) Bone marrow aspirate stained with Wright-Giemsa. Note abundant rhomboid crystals present in the extracellular space (a; arrows) and intracytoplasmic in plasma cells (b; arrow-heads). (c) H&E stain of bone marrow biopsy section showing prominent rhomboid crystals (arrow). (d) Immunohistochemistry for lambda-chain highlights monotypic plasma cells with positive stain of the extracellular crystals (arrow). Bar 200 μm (a), 20 μm (b), and 50 μm (c and d).
Mentions: Both, the bone marrow biopsy and aspirate had normocellular bone marrow with trilineage hematopoiesis, slightly decreased myeloid and erythroid series and an increased population of plasma cells, 27% plasma cells in the 500 cell count aspirate differential (normal range up to 3%). Megakaryocytes were present in adequate number and had an unremarkable morphology. The plasma cell population included a subset with round conspicuous nucleoli and intracytoplasmic, single or multiple, nonbirefringent translucent crystalline structures with rhomboid shapes. Scattered free extracellular rhomboid shaped crystals were also noted (Figure 1a, 1b and 1c). Flow cytometry immunophenotypic analysis performed on bone marrow aspirate sample identified a monotypic, cytoplasmic lambda light chain restricted CD38+, CD138+ plasma cell population with dim CD45+, CD56+ and CD117+ expression. By immunohistochemistry, there were approximately 25-27% CD138+ plasma cells, which in a large subset expressed immunoglobulin lambda light chain restriction, and a subset was also IgG restricted. The crystals were weakly Ig lambda positive (Figure 1d). A Congo red stain to evaluate for possible amyloid deposition was negative.

Bottom Line: The presence of crystalline inclusions in plasma cell myeloma is a rare phenomenon and cases have been reported with rod, needle, and rectangular shaped crystals.Here, we present a case of IgG lambda restricted plasma cell myeloma with rhomboid shaped intracellular crystalline inclusions and extracellular crystal depositions in the bone marrow.Since rhomboid crystal depositions can be seen in other clinical conditions such as pseudogout, this case invites consideration of plasma cell myeloma in the differential diagnosis of patients with rhomboid crystalline deposition in the bone marrow and in sites/organs other than the bone marrow.

View Article: PubMed Central - HTML - PubMed

Affiliation: Department of Pathology and Laboratory Medicine, Rhode Island Hospital, Providence, RI, USA.

ABSTRACT
The presence of crystalline inclusions in plasma cell myeloma is a rare phenomenon and cases have been reported with rod, needle, and rectangular shaped crystals. Here, we present a case of IgG lambda restricted plasma cell myeloma with rhomboid shaped intracellular crystalline inclusions and extracellular crystal depositions in the bone marrow. Since rhomboid crystal depositions can be seen in other clinical conditions such as pseudogout, this case invites consideration of plasma cell myeloma in the differential diagnosis of patients with rhomboid crystalline deposition in the bone marrow and in sites/organs other than the bone marrow.

Show MeSH
Related in: MedlinePlus