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A case of simultaneous presentation of symptomatic PCM and MDS unrelated to prior chemotherapy.

Kim H, Park SH, Lee EY, Song MK - Blood Res (2015)

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Pusan National University Hospital, Busan, Korea.

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As chemotherapy for the treatment of plasma cell myeloma (PCM) includes alkylating agents, the incidence of therapy-related myeloid neoplasms such as acute myeloid leukemia, myelodysplastic syndrome (MDS), and myeloproliferative neoplasm due to prior PCM chemotherapy has increased... Several studies reported the mutagenic effect of some PCM treatment regimens on the development of MDS... A recent study reported that in a period of 14 years, only 14 cases of monoclonal gammopathy and MDS unrelated to chemotherapy or radiotherapy were reported, representing 12 cases of monoclonal gammopathy of undetermined significance (MGUS) and 2 cases of smoldering myeloma (SM)... Bone marrow aspirates showed hypocellular marrow without an increase in the number of myeloblasts but showed increased infiltration of plasma cells at a frequency of 14.9% (Fig. 1A)... In addition, megakaryocytic dysplasias such as separated nuclei (Fig. 1A) and hypolobulated nuclei (Fig. 1B and C) were found, accounting for 30% of the total number of megakaryocytes... Erythroid dysplasias such as binucleation and delayed mitosis were also found (Fig. 1C and D), as well as mild granulocytic dysplasias such as hyposegmentation, accounting for 15% and 10% of the total numbers of erythroid and granulocytic lineage cells, respectively... The subsequently performed serum electrophoresis using Capillarys Protein(E) 6 kit (Sebia, France) showed the presence of monoclonal gammopathy accompanied by M-peaks of 1.27 g/dL... All radiological evaluation results did not show definite evidence of osteolytic lesion... As the patient showed pancytopenia accompanied with multilineage dysplasia, MDS-related chromosomal abnormality, and monoclonal gammopathy with an increase in serum creatinine level, she was finally diagnosed with the simultaneous presentation of symptomatic PCM and MDS and refractory cytopenia with multilineage dysplasia (RCMD) that were unrelated to prior chemotherapy... In addition, our case did not show any history of prior chemotherapy or radiotherapy, which supports the occurrence of simultaneous MDS and symptomatic PCM... Notably, compared with previously reported cases, our case presented unique clinical features that are worth reporting... In conclusion, we report a rare case of simultaneous presentation of symptomatic PCM and MDS RCMD unrelated to prior chemotherapy or radiotherapy.

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Bone marrow findings showing both features of plasma cell myeloma and myelodysplastic syndrome. The arrows indicate megakaryocytes with separated (A) and hypolobulated nuclei (B, C), and erythroblasts with binucleation (C, lower side) and delayed mitosis (D), respectively. Bone marrow biopsy revealed diffuse infiltration of plasma cells (E) that were CD138 positive (F).
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Figure 1: Bone marrow findings showing both features of plasma cell myeloma and myelodysplastic syndrome. The arrows indicate megakaryocytes with separated (A) and hypolobulated nuclei (B, C), and erythroblasts with binucleation (C, lower side) and delayed mitosis (D), respectively. Bone marrow biopsy revealed diffuse infiltration of plasma cells (E) that were CD138 positive (F).

Mentions: An 80-year-old woman was admitted to our hospital because of chest pain that developed 1 day prior to admission. She had been treated for bronchial asthma with a bronchodilator and leukotriene antagonist for 2 years but had no medical history related to hematologic malignancy. The patient's hemogram results at admission were as follows: white blood cell count, 0.95×109/L; hemoglobin level, 8.0 g/dL; mean corpuscular volume, 105.9 fL; and platelet count, 29.0×109/L. The patient's biochemical test results at admission were as follows: serum protein level, 6.8 g/dL; serum albumin level, 2.8 g/dL; serum creatinine level, 1.54 mg/dL; serum calcium level, 7.4 mg/dL; and serum lactate dehydrogenase level, 719 IU/L. In the examination of a peripheral blood smear, pancytopenia with rouleaux formation was observed. Bone marrow aspirates showed hypocellular marrow without an increase in the number of myeloblasts but showed increased infiltration of plasma cells at a frequency of 14.9% (Fig. 1A). In addition, megakaryocytic dysplasias such as separated nuclei (Fig. 1A) and hypolobulated nuclei (Fig. 1B and C) were found, accounting for 30% of the total number of megakaryocytes. Erythroid dysplasias such as binucleation and delayed mitosis were also found (Fig. 1C and D), as well as mild granulocytic dysplasias such as hyposegmentation, accounting for 15% and 10% of the total numbers of erythroid and granulocytic lineage cells, respectively. Examination of a bone marrow biopsy specimen (Fig. 1E) revealed 35% cellular marrow with diffuse infiltration of plasma cells in the immunohistochemical stain for CD138 expression (DAKO, Glostrup, Denmark; Fig. 1F).


A case of simultaneous presentation of symptomatic PCM and MDS unrelated to prior chemotherapy.

Kim H, Park SH, Lee EY, Song MK - Blood Res (2015)

Bone marrow findings showing both features of plasma cell myeloma and myelodysplastic syndrome. The arrows indicate megakaryocytes with separated (A) and hypolobulated nuclei (B, C), and erythroblasts with binucleation (C, lower side) and delayed mitosis (D), respectively. Bone marrow biopsy revealed diffuse infiltration of plasma cells (E) that were CD138 positive (F).
© Copyright Policy - open-access
Related In: Results  -  Collection

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getmorefigures.php?uid=PMC4595585&req=5

Figure 1: Bone marrow findings showing both features of plasma cell myeloma and myelodysplastic syndrome. The arrows indicate megakaryocytes with separated (A) and hypolobulated nuclei (B, C), and erythroblasts with binucleation (C, lower side) and delayed mitosis (D), respectively. Bone marrow biopsy revealed diffuse infiltration of plasma cells (E) that were CD138 positive (F).
Mentions: An 80-year-old woman was admitted to our hospital because of chest pain that developed 1 day prior to admission. She had been treated for bronchial asthma with a bronchodilator and leukotriene antagonist for 2 years but had no medical history related to hematologic malignancy. The patient's hemogram results at admission were as follows: white blood cell count, 0.95×109/L; hemoglobin level, 8.0 g/dL; mean corpuscular volume, 105.9 fL; and platelet count, 29.0×109/L. The patient's biochemical test results at admission were as follows: serum protein level, 6.8 g/dL; serum albumin level, 2.8 g/dL; serum creatinine level, 1.54 mg/dL; serum calcium level, 7.4 mg/dL; and serum lactate dehydrogenase level, 719 IU/L. In the examination of a peripheral blood smear, pancytopenia with rouleaux formation was observed. Bone marrow aspirates showed hypocellular marrow without an increase in the number of myeloblasts but showed increased infiltration of plasma cells at a frequency of 14.9% (Fig. 1A). In addition, megakaryocytic dysplasias such as separated nuclei (Fig. 1A) and hypolobulated nuclei (Fig. 1B and C) were found, accounting for 30% of the total number of megakaryocytes. Erythroid dysplasias such as binucleation and delayed mitosis were also found (Fig. 1C and D), as well as mild granulocytic dysplasias such as hyposegmentation, accounting for 15% and 10% of the total numbers of erythroid and granulocytic lineage cells, respectively. Examination of a bone marrow biopsy specimen (Fig. 1E) revealed 35% cellular marrow with diffuse infiltration of plasma cells in the immunohistochemical stain for CD138 expression (DAKO, Glostrup, Denmark; Fig. 1F).

View Article: PubMed Central - PubMed

Affiliation: Department of Laboratory Medicine, Pusan National University Hospital, Busan, Korea.

AUTOMATICALLY GENERATED EXCERPT
Please rate it.

As chemotherapy for the treatment of plasma cell myeloma (PCM) includes alkylating agents, the incidence of therapy-related myeloid neoplasms such as acute myeloid leukemia, myelodysplastic syndrome (MDS), and myeloproliferative neoplasm due to prior PCM chemotherapy has increased... Several studies reported the mutagenic effect of some PCM treatment regimens on the development of MDS... A recent study reported that in a period of 14 years, only 14 cases of monoclonal gammopathy and MDS unrelated to chemotherapy or radiotherapy were reported, representing 12 cases of monoclonal gammopathy of undetermined significance (MGUS) and 2 cases of smoldering myeloma (SM)... Bone marrow aspirates showed hypocellular marrow without an increase in the number of myeloblasts but showed increased infiltration of plasma cells at a frequency of 14.9% (Fig. 1A)... In addition, megakaryocytic dysplasias such as separated nuclei (Fig. 1A) and hypolobulated nuclei (Fig. 1B and C) were found, accounting for 30% of the total number of megakaryocytes... Erythroid dysplasias such as binucleation and delayed mitosis were also found (Fig. 1C and D), as well as mild granulocytic dysplasias such as hyposegmentation, accounting for 15% and 10% of the total numbers of erythroid and granulocytic lineage cells, respectively... The subsequently performed serum electrophoresis using Capillarys Protein(E) 6 kit (Sebia, France) showed the presence of monoclonal gammopathy accompanied by M-peaks of 1.27 g/dL... All radiological evaluation results did not show definite evidence of osteolytic lesion... As the patient showed pancytopenia accompanied with multilineage dysplasia, MDS-related chromosomal abnormality, and monoclonal gammopathy with an increase in serum creatinine level, she was finally diagnosed with the simultaneous presentation of symptomatic PCM and MDS and refractory cytopenia with multilineage dysplasia (RCMD) that were unrelated to prior chemotherapy... In addition, our case did not show any history of prior chemotherapy or radiotherapy, which supports the occurrence of simultaneous MDS and symptomatic PCM... Notably, compared with previously reported cases, our case presented unique clinical features that are worth reporting... In conclusion, we report a rare case of simultaneous presentation of symptomatic PCM and MDS RCMD unrelated to prior chemotherapy or radiotherapy.

No MeSH data available.


Related in: MedlinePlus