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'''Plasma cell neoplasms''' arise from plasma | {{ Infobox diagnosis | ||
| Name = {{PAGENAME}} | |||
| Image = Plasma cell neoplasm -- very high mag.jpg | |||
| Width = | |||
| Caption = Plasma cell neoplasm. [[H&E stain]] | |||
| Synonyms = | |||
| Micro = dyscohesive plasmacytoid cells (abundant cytoplasm, eccentrically placed nucleus), often prominent perinuclear hof, +/-nucleoli, +/-Russell bodies, +/-Dutcher bodies | |||
| Subtypes = | |||
| LMDDx = [[lymphoplasmacytic lymphoma]], [[neuroendocrine carcinoma]], poorly differentiated carcinoma, others | |||
| Stains = | |||
| IHC = [[CD138]] +ve, CD56 +ve, CD45 -ve/+ve, CD79a +ve | |||
| EM = | |||
| Molecular = | |||
| IF = | |||
| Gross = | |||
| Grossing = | |||
| Site = [[bone]] - [[bone marrow]] | |||
| Assdx = [[renal failure]], [[myeloma cast nephropathy]] | |||
| Syndromes = | |||
| Clinicalhx = | |||
| Signs = | |||
| Symptoms = | |||
| Prevalence = | |||
| Bloodwork = +/-[[anemia]], +/-hypercalcemia | |||
| Rads = +/-lytic bone lesions | |||
| Endoscopy = | |||
| Prognosis = poor | |||
| Other = | |||
| ClinDDx = [[metastatic disease]] | |||
| Tx = | |||
}} | |||
'''Plasma cell neoplasms''' arise from [[plasma cell]]s. They are encountered by anatomical pathologists on occasion. | |||
''Plasma cell myeloma'', and ''plasmacytoma'' (solitary myeloma)<ref name=Ref_PCPBoD8_324>{{Ref PCPBoD8|324}}</ref> redirect to this article. | |||
==General== | ==General== | ||
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Note: | Note: | ||
*Plasmacytoma = histology of '''multiple myeloma'''; to diagnose ''multiple myeloma'' other (non-pathology) criteria are needed. | *Plasmacytoma = histology of '''multiple myeloma'''; to diagnose ''multiple myeloma'' other (non-pathology) criteria are needed. | ||
Classified by site: | |||
*Medullary. | |||
*Extramedullary - usu. upper aerodigestive tract.<ref name=pmid10357398>{{Cite journal | last1 = Alexiou | first1 = C. | last2 = Kau | first2 = RJ. | last3 = Dietzfelbinger | first3 = H. | last4 = Kremer | first4 = M. | last5 = Spiess | first5 = JC. | last6 = Schratzenstaller | first6 = B. | last7 = Arnold | first7 = W. | title = Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts. | journal = Cancer | volume = 85 | issue = 11 | pages = 2305-14 | month = Jun | year = 1999 | doi = | PMID = 10357398 }}</ref> | |||
===Multiple myeloma=== | ===Multiple myeloma=== | ||
Diagnosis requires the following:<ref name=pmid18971951>{{cite journal |author=Kyle RA, Rajkumar SV |title=Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma |journal=Leukemia |volume=23 |issue=1 |pages=3–9 |year=2009 |month=January |pmid=18971951 |pmc=2627786 |doi=10.1038/leu.2008.291 |url=http://www.nature.com/leu/journal/v23/n1/full/leu2008291a.html}}</ref> | |||
*Calcium (in the serum) is elevated. | #Clonal plasma cells. Must >10% if on bone marrow biopsy. | ||
*[[Anemia]]. | #Monoclonal protein, i.e. paraprotein, in serum or urine. | ||
*Renal failure. | #End-organ damage thought to be due to the neoplasm - mnemonic ''CARL'': | ||
*Lytic bone lesions. | #*Calcium (in the serum) is elevated. | ||
#*[[Anemia]]. | |||
#*Renal failure. | |||
#*Lytic bone lesions. | |||
''CRAB'' (calclium, renal failure, anemia, bony lesions) is another mnemonic.<ref name=pmid12780789>{{Cite journal | title = Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. | journal = Br J Haematol | volume = 121 | issue = 5 | pages = 749-57 | month = Jun | year = 2003 | doi = | PMID = 12780789 }}</ref> | Note: | ||
*''CRAB'' (calclium, renal failure, anemia, bony lesions) is another mnemonic.<ref name=pmid12780789>{{Cite journal | title = Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. | journal = Br J Haematol | volume = 121 | issue = 5 | pages = 749-57 | month = Jun | year = 2003 | doi = | PMID = 12780789 }}</ref> | |||
==Microscopic== | ==Microscopic== | ||
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*Russell bodies: | *Russell bodies: | ||
**Eosinophilic, large (10-15 micrometres), homogenous immunoglobulin-containing inclusions. | **Eosinophilic, large (10-15 micrometres), homogenous immunoglobulin-containing inclusions. | ||
*Dutcher bodies - intranuclear crystalline rods. | *Dutcher bodies - intranuclear crystalline rods. | ||
**Dutcher bodies are ''PAS stain'' +ve.<ref>URL: [http://www.thefreelibrary.com/Dutcher+bodies+in+chronic+synovitis-a083551789 http://www.thefreelibrary.com/Dutcher+bodies+in+chronic+synovitis-a083551789]. Accessed on: 4 August 2010.</ref> | **Dutcher bodies are ''PAS stain'' +ve.<ref>URL: [http://www.thefreelibrary.com/Dutcher+bodies+in+chronic+synovitis-a083551789 http://www.thefreelibrary.com/Dutcher+bodies+in+chronic+synovitis-a083551789]. Accessed on: 4 August 2010.</ref> | ||
*Prominent ''perinuclear hof'' - cytoplasmic crescent shaped lucency adjacent to the nuclear membrane (due to large Golgi apparatus); nucleus has a [http://en.wikipedia.org/wiki/Bib_%28garment%29 "bib"]. | *Prominent ''perinuclear hof'' - cytoplasmic crescent shaped lucency adjacent to the nuclear membrane (due to large Golgi apparatus); nucleus has a [http://en.wikipedia.org/wiki/Bib_%28garment%29 "bib"]. | ||
Images: | DDx: | ||
*[[Neuroendocrine carcinoma]] - nucleus often has a plasmacytoid (plasma cell-like) appearance. | |||
<!-- [http://ashimagebank.hematologylibrary.org/cgi/content/full/2003/0227/100629 Dutcher bodies (hematologylibrary.org)]. --> | |||
*[[Lymphoplasmacytic lymphoma]] ([[AKA]] Waldenström's macroglobulinemia). | |||
*[[Syphilis]]. | |||
===Images=== | |||
=====Case===== | |||
<gallery> | |||
Image: Plasma cell neoplasm -- low mag.jpg | PCN - low mag. | |||
Image: Plasma cell neoplasm -- intermed mag.jpg | PCN - intermed. mag. | |||
Image: Plasma cell neoplasm -- high mag.jpg | PCN - high mag. | |||
Image: Plasma cell neoplasm -- very high mag.jpg | PCN - very high mag. | |||
</gallery> | |||
=====Other cases===== | |||
<gallery> | |||
Image:Plasmacytoma1.jpg | Plasmacytoma. (WC) | |||
File:Plasmocytoma HE high mag.jpg | Skull base plasmacytoma, higher magnification (WC/jensflorian) | |||
File:Plasmocytoma_frozen_HE_x200.jpg | Plasmacytoma smear (WC/jensflorian) | |||
File:Plasmocytoma_smear_mann_x200.jpg | Leptomeningeal plasmacytoma, frozen section (WC/jensflorian) | |||
</gallery> | |||
=====www===== | |||
*[http://ashimagebank.hematologylibrary.org/cgi/content/full/2004/0126/100984 Various images (hematologylibrary.org)]. | *[http://ashimagebank.hematologylibrary.org/cgi/content/full/2004/0126/100984 Various images (hematologylibrary.org)]. | ||
*[http:// | *[http://path.upmc.edu/cases/case515/images/fig05.jpg Multiple myeloma (upmc.edu)].<ref>URL: [http://path.upmc.edu/cases/case515.html http://path.upmc.edu/cases/case515.html]. Accessed on: 25 January 2012.</ref> | ||
====Russell bodies==== | |||
* | <gallery> | ||
Image:Russell_bodies_2_high_mag_mini.jpg | Russell bodies. (WC) | |||
</gallery> | |||
=====www===== | |||
*[http://www.healthsystem.virginia.edu/internet/hematology/hessimages/russell-bodies-website-arrow.jpg Russell bodies (healthsystem.virginia.edu)]. | |||
*[http://www.pathguy.com/lectures/russ2.jpg Russell bodies - several in one cell (pathguy.com)]. | |||
< | ====Dutcher bodies==== | ||
<gallery> | |||
Image: Dutcher and Russell bodies.jpg | Dutcher bodies and Russell bodies. (WC/Gabriel Caponetti) | |||
</gallery> | |||
==IHC== | ==IHC== | ||
*[[CD138]] +ve. | |||
*[[CD56]] +ve.<ref>URL: [http://www.ncbi.nlm.nih.gov/omim/116930 http://www.ncbi.nlm.nih.gov/omim/116930]. Accessed on: 31 August 2010.</ref> | |||
**Also +ve in NK/T cell lymphomas. | |||
*Kappa -- usu. slightly stronger than lambda. | *Kappa -- usu. slightly stronger than lambda. | ||
*Lambda. | *Lambda. | ||
*CD57. | *CD57. | ||
**Also +ve in T-cell large granular lymphocytic leukemia.<ref>URL: [http://www.nature.com/bmt/journal/v33/n1/full/1704298a.html http://www.nature.com/bmt/journal/v33/n1/full/1704298a.html]. Accessed on: 31 August 2010.</ref>. | **Also +ve in [[T-cell large granular lymphocytic leukemia]].<ref>URL: [http://www.nature.com/bmt/journal/v33/n1/full/1704298a.html http://www.nature.com/bmt/journal/v33/n1/full/1704298a.html]. Accessed on: 31 August 2010.</ref> | ||
* | *CD38 +ve.<ref>{{Cite journal | last1 = Tamamori | first1 = T. | last2 = Nakayama | first2 = F. | last3 = Sugimoto | first3 = H. | last4 = Fenxiang | first4 = J. | last5 = Iwatsuki | first5 = K. | last6 = Takigawa | first6 = M. | title = Extramedullary plasmacytoma: cytological and genotypic studies. | journal = Br J Dermatol | volume = 129 | issue = 4 | pages = 468-72 | month = Oct | year = 1993 | doi = | PMID = 8217765 }}</ref> | ||
* | |||
Others:<ref>URL: [http://e-immunohistochemistry.info/web/Plasmacytoma_plasma_cell_myeloma.htm http://e-immunohistochemistry.info/web/Plasmacytoma_plasma_cell_myeloma.htm]. Accessed on: 9 November 2015.</ref> | |||
*CD79a +ve. | |||
*CD45 -ve/+ve. | |||
*CD10 -ve. | |||
*CD5 -ve. | |||
*Cyclin D1 -ve/+ve. | |||
A panel:<!-- need a good panel - maybe here http://clincancerres.aacrjournals.org/content/15/2/714.full or here http://e-immunohistochemistry.info/web/Plasmacytoma_plasma_cell_myeloma.htm --> | |||
*CD3, CD20, CD56, CD117, CD138, IG-kappa (plasma), IG-lambda (plasma). | |||
==Molecular== | ==Molecular== | ||
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*[[Lymphoma]]. | *[[Lymphoma]]. | ||
*[[Haematopathology]]. | *[[Haematopathology]]. | ||
*[[Plasma cell]]. | |||
==References== | ==References== |
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