|IMAGE IN HEMATOLOGY
|Year : 2022 | Volume
| Issue : 2 | Page : 109
Plasma cells in cerebrospinal fluid
Urmimala Bhattacharjee1, Parikshaa Gupta2, Arihant Dr. Jain1
1 Department of Internal Medicine, Clinical Hematology Unit, Postgraduate Institute of Medical Education and Research, Chandigarh, India
2 Department of Cytology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||30-Sep-2020|
|Date of Decision||15-Dec-2020|
|Date of Acceptance||16-Jan-2021|
|Date of Web Publication||04-Aug-2022|
Arihant Dr. Jain
Department of Internal Medicine, Clinical Hematology Unit, Postgraduate Institute of Medical Education and Research, Sector 12, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bhattacharjee U, Gupta P, Jain AD. Plasma cells in cerebrospinal fluid. J Appl Hematol 2022;13:109
A 45-year-old female, known case of IgA kappa multiple myeloma on lenalidomide, bortezomib, and dexamethasone regimen for the past 12 months, presented to our clinic with a week long history of holocranial headache associated with diplopia and left-sided facial deviation. Examination revealed left-sided cranial nerve VI and right-sided cranial nerve VII (LMN type) palsies.
Contrast-enhanced magnetic resonance imaging of brain was normal. However, cerebrospinal fluid (CSF) cytology [Figure 1] showed many plasma cells with round-to-oval eccentric cart-wheel like nuclei and moderate amount of cytoplasm. CSF protein electrophoresis was also positive for a “monoclonal” band for IgA Kappa. Serum kappa: lambda ratio was elevated at 1.99, and a repeat bone marrow biopsy showed large aggregates of plasma cells implicating concurrent systemic relapse.
|Figure 1: (a and b) Cerebrospinal fluid cytospin smears showing sheets of plasma cells with eccentrically placed nuclei and cart-wheel chromatin. In addition, scattered, binucleated, and multinucleated plasma cells and plasma blasts with central nuclei and prominent nucleoli are also seen (a: May Grunwald Giemsa, ×20; b: Papanicolaou, ×20)|
Click here to view
A prompt lumbar puncture and CSF cytology examination can clinch the diagnosis of central nervous system (CNS) pathology in a large number of benign and malignant disorders. CNS infiltration by multiple myeloma though rare should be suspected in patients who present with neurological manifestations. Leptomeningeal infiltration by multiple myeloma carries a very poor prognosis with reported median overall survival of 7 months or less following its diagnosis.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that name and initials will not be published and due efforts will be made to conceal identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Fassas AB, Muwalla F, Berryman T, Benramdane R, Joseph L, Anaissie E. Myeloma of the central nervous system: Association with high-risk chromosomal abnormalities, plasmablastic morphology and extramedullary manifestations. Br J Haematol 2002;117:103-8.
Egan PA, Elder PT, Deighan WI, O'Connor SJM, Alexander HD. Multiple myeloma with central nervous system relapse. Haematologica 2020;105:1780-90.