Department of Clinical Laboratory, Affiliated Hospital of Engineering University of Hebei, Hebei Province, China.
Department of Clinical Laboratory, Affiliated Zhongshan Hospital of Dalian University, Liaoning Province, China.
Indian J Pathol Microbiol. 2020 Jul-Sep;63(3):485-487. doi: 10.4103/IJPM.IJPM_282_19.
Myeloma plasma cells vary from mature forms to immature, plasmablastic, and pleomorphic cells. Only a few cases of morphologic variant of plasma cell neoplasm have been reported, in which the plasma cell neoplasm presented with lymphoplasmacytic, megakaryocytic, plasmablastic, lymphocytosis-like, and variant hairy cell leukemia-like morphological features. A 66-year-old man sought medical attention with a previous 2-month history of lower back and chest pain. Magnetic resonance imaging (MRI) of the thoracic spine showed thoracic vertebral body shape and disc degeneration, and bone lesion. Blood work showed mild anemia (hemoglobin, 101 g/L; white blood cells, 6.98 × 10/L; platelets, 146 × 10/L.), hyperuricemia (UA 671 umol/L), and immunoglobulin G kappa [IgG(κ)] paraproteins. Bone marrow study revealed diffuse invasion by sheets of megakaryoblast-like cells. Flow cytometric analysis and bone marrow biopsy revealed plasma cell myeloma (PCM), and thoracic puncture biopsy indicated plasma cell neoplasms. Overall, the findings were in accordance with a PCM. To date, this is the first reported case of PCM with megakaryoblastic morphology mimicking acute leukemia. Recognizing the morphological variant of PCM is important in differentiating it from acute leukemia.
骨髓瘤浆细胞从成熟形式到未成熟、浆母细胞和多形性细胞不等。仅有少数报道的浆细胞瘤形态变异病例，其中浆细胞瘤表现为淋巴浆细胞性、巨核细胞性、浆母细胞性、类淋巴细胞增多症样和变异毛细胞白血病样形态特征。一名 66 岁男性因 2 个月前出现腰背和胸痛而求医。胸椎磁共振成像（MRI）显示胸椎体形状和椎间盘退变以及骨病变。血液检查显示轻度贫血（血红蛋白 101g/L；白细胞 6.98×10/L；血小板 146×10/L.）、高尿酸血症（UA 671μmol/L）和免疫球蛋白 G kappa [IgG(κ)]副蛋白。骨髓研究显示大片巨核母细胞样细胞弥漫浸润。流式细胞术分析和骨髓活检显示浆细胞骨髓瘤（PCM），胸椎穿刺活检提示浆细胞瘤。总的来说，这些发现与 PCM 相符。迄今为止，这是首例报道的表现为急性白血病样巨核母细胞形态的 PCM。认识到 PCM 的形态变异对于将其与急性白血病区分开来很重要。
