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IMAGES IN MEDICINE
Year : 2013  |  Volume : 4  |  Issue : 3  |  Page : 121-122

Bone marrow aspiration of plasmablastic multiple myeloma


Department of Pathology, Government Medical College, Miraj, Maharashtra, India

Date of Web Publication19-Dec-2013

Correspondence Address:
Pethkar Abhijit Shrikrishna
Department of Pathology, Government Medical College, Pandharpur Road, Miraj 416 410, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/1658-5127.123316

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How to cite this article:
Shrikrishna PA, Anant RN, Rameshrao AA, Ranjitsingh SK. Bone marrow aspiration of plasmablastic multiple myeloma. J Appl Hematol 2013;4:121-2

How to cite this URL:
Shrikrishna PA, Anant RN, Rameshrao AA, Ranjitsingh SK. Bone marrow aspiration of plasmablastic multiple myeloma. J Appl Hematol [serial online] 2013 [cited 2020 May 28];4:121-2. Available from: http://www.jahjournal.org/text.asp?2013/4/3/121/123316

A 65-year-old female presented with severe anemia and backache since 6 months. Hemogram showed hemoglobin 3.4 g/dl, total leukocyte count 5.50 Χ 10 9 /l, platelet count 220 Χ 10 9 /l, and erythrocyte sedimentation rate (ESR) 90 mm at the end of 1 h. The peripheral blood smear examination showed rouleaux formation, leukoerythroblastic picture with few cells having plasmacytoid morphology along with prominent nucleoli and basophilic cytoplasm. Radiograph of the skull showed multiple punched out osteolytic lesions [Figure 1]. X-ray spine showed wedge compression fracture of D12 vertebra. Serum protein electrophoresis showed 'M' band in gamma region. Bone marrow aspiration was performed. The smears were hypercellular and showed plasmablasts (30% of bone marrow cells) with high nuclear/cytoplasmic ratio, centrally placed nuclei with opened up chromatin, one to two prominent nucleoli, and basophilic cytoplasm. Many mature plasma cells admixed with binucleated and multinucleated forms were also noted [Figure 2]. Other series were within normal limits. The diagnosis of plasmablastic multiple myeloma (PBMM) was given.
Figure 1: X-Ray skull showing multiple punched out osteolytic lesions

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Figure 2: Bone marrow aspiration showing plasmablasts

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PBMM is a morphologic subset of myeloma defined on the bone marrow aspirate as containing ≥2% plasmablasts. [1] These cases represent 5-15% of the cases of multiple myeloma. [2] PBMM is a discrete entity and is an independent prognostic factor predicting shorter overall survival. High values of β-2-microglobulin, plasma cell labeling index, serum calcium, and creatinine; and low values of albumin and hemoglobin are associated with plasmablastic (PB) morphology. These cases generally present in advanced stage of disease and frequently show aggressive behavior. Median overall survival of myeloma patients with PB morphology and non-PB morphology was 1.9 versus 3.7 years; whereas, median event free survival of patients with PB morphology and non-PB morphology was 1.1 versus 2.7 years. [3]

To conclude, PB morphologic feature confers a poor clinical prognosis and identification of the PB morphology on bone marrow aspirate is useful in predicting aggressive clinical behavior.

 
  References Top

1.Greipp PR, Raymond NM, Kyle RA, O'Fallon WM. Multiple myeloma: Significance of plasmablastic subtype in morphological classification. Blood 1985;65:305-310.  Back to cited text no. 1
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2.Lorsbach RB, Hsi ED, Dogan A, Fend F. Plasma cell myeloma and related neoplasms. Am J Clin Pathol 2011;136:168-182.  Back to cited text no. 2
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3.Greipp PR, Leong T, Bennett JM, Gaillard JP, Klein B, Stewart JA, et al. Plasmablastic morphology: An independent prognostic factor with clinical and laboratory correlates: Eastern Cooperative Oncology Group (ECOG) Myeloma Trial E9486 report by the ECOG Myeloma laboratory group. Blood 1998;91:2501-7.  Back to cited text no. 3
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