ABSTRACT
Plasma cell leukemia (PCL) is a rare and aggressive variant of myeloma accounting for 2-3% of all plasma cell dyscrasias characterized by the presence of circulating plasma cells. The diagnosis is based on the % (≥20%) and absolute number (≥2x109/L) of plasma cells in the peripheral blood. The incidence of primary PCL (pPCL) is very rare and reported to occur in <1 in a million. It is classified as either pPCL occurring at diagnosis or as secondary PCL in patients with relapsed/refractory myeloma. pPCL is a distinct clinicopathological entity with different cytogenetic and molecular findings. The clinical course is aggressive with short remissions and survival duration. We report two cases of pPCL, both having acute onset of illness, varied clinical presentation with one of them showing “hairy cell morphology,” with rapidly progressing renal failure, and was not suspected to be plasma cell dyscrasia clinically. A detailed hematopathological evaluation clinched the diagnosis in this case. It is recommended that techniques such as immunophenotyping by flow cytometry and protein electrophoresis must be performed for confirmatory diagnosis. A detailed report of two cases and a review of PCL are presented here.
ABSTRACT
Aim: To study the bone marrow changes in elderly patients (above 60 years of age). Material and methods: Bone marrow records from the pathology laboratory in the Department of Pathology, Bangalore Medical College, Bangalore, from March 2012 to june 2013, were searched, and cases from all patients at least 60 years old at the time of bone marrow study were retrospectively reviewed. Results: During the 16 months period, 164 bone marrow examinations were performed, andout of these, 50 patients were at least 60 years old. The age range of the patients was 60 to 82 years , 27 were males and 23 were females. 47 cases (94%) yielded specific diagnosis. 27 cases (54%) had nutritional anemia, 6 cases (12%) were diagnosed as myeloma, 3 cases (6%) had aplastic anemia, 3 cases (6%) had chronic lymphocytic leukemia/ small lymphocytic leukemia infiltrating the bone marrow; 2 cases (4%) had acute myeloid leukemia, 2 myelofibrosis - grade 3, 2 cases were diagnosed to have monoclonal gammopathy of undetermined significance (4%), 1 case (2%) had metastatic deposits from prostatic carcinoma and 1 case (2%) of mylodysplastic syndrome - refractory cytopenia with multi lineage dysplasia and ringed sideroblasts was diagnosed. Conclusions: In this study we found that after nutritional anemia, plasma cell dyscrasias were the most common findings in bone marrow studies in elderly patients. Diagnosis of plasma cell dyscrasias prompt for early institution of treatment resulting in reduced morbidity and mortality in such patients.
ABSTRACT
A 58-year-old-man presented with painful rapidly progressive bilateral proptosis with restricted ocular movements of 15 days duration. There was history of significant weight loss in the recent past. Computed tomography scan of the head and orbit revealed bilateral multiple, well-defined, round, soft tissue masses, isointense with muscles in intraconal and extraconal space. Fine needle aspiration cytology and incision biopsy from the lesion, urine for Bence-Jones proteins and immunofixation clinched the diagnosis of multiple myeloma. Skeletal survey did not reveal any bony involvement.The diagnosis of multiple myeloma should be kept in mind in cases of bilateral proptosis. Bony involvement is not universal in cases of orbital myeloma. Early diagnosis can be established with extensive biochemical and histopathological investigations and timely treatment is life saving for these patients.