Published in:
01-02-2018 | Images in Hematology
Plasma cell myeloma mimicking classical Hodgkin lymphoma in the bone marrow
Published in: International Journal of Hematology | Issue 2/2018
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A 49-year-old woman presented with anemia, thrombocytopenia and back pain. Imaging revealed multiple paraspinal soft tissue masses as well as a destructive bone lesion in the pelvis. This bone marrow biopsy was performed for further evaluation, and revealed focal areas with bizarre anaplastic cells (Fig. 1), many of which resembled Reed Sternberg cells. There was also some granulomatous inflammation in the background. By immunohistochemistry, these bizarre looking cells were negative for CD30 and positive for CD138. By in situ hybridization, they were positive for kappa and negative for lambda light chains. Flow cytometry confirmed an immunophenotype characteristic of plasma cell myeloma. Upon further request, serum protein electrophoresis showed a 1.8 g/dl monoclonal protein, IgA kappa. A diagnosis of plasma cell myeloma was made.
Fig. 1
Bone marrow with bizarre anaplastic cells resembling Reed Sternberg cells (original magnification × 400, hematoxylin and eosin stain), and background granulomatous inflammation (inset, original magnification × 40, hematoxylin and eosin stain). Immunohistochemical markers included CD30, CD138, kappa in situ hybridization, and lambda in situ hybridization (top to bottom right, original magnification × 200) show that the neoplastic plasma cells are positive for CD138 and kappa and are negative for CD30 and lambda
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