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Case 236 - Discussion

Hematopathology Case


Plasma Cell Myeloma

  • This case shows packed marrow with large plasmablastic/immunoblastic cells

  • Neoplastic plasma cells may show a variety of morphologic features, including mature, intermediate, immature, and plasmablastic features. Some myeloma cells may even be lymphoid-appearing. Plasma cell myeloma infiltration in the marrow can be very focal and subtle, and occasionally it is almost impossible to appreciate the tumor with clot/trephine biopsy only.  Therefore, it is probably worthwhile to perform CD138 immunostain if no apparent plasma cells are noted in the marrow
  • Also, solitary plasmacytoma may present  at the extramedullary sites without typical clinical presentations or marrow involvement; occasionally, the tumor cells may not be plasma cell-appearing at all, which can resemble poorly differentiated carcinoma, sarcoma, melanoma or lymphoma. Therefore, plasmacytoma should be considered as one of the differential diagnoses when facing a wired tumor of unknown origin.