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Year : 2018  |  Volume : 61  |  Issue : 1  |  Page : 147-148
Hypernucleate plasma cell: A rare morphological finding


1 Department of Hematopathology and Genetics, AmPath, India
2 Department of Clinical Haematology, American Oncology Institute, Hyderabad, Telangana, India

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Date of Web Publication22-Mar-2018
 

How to cite this article:
Gupta A, Goyal M, Aribandi A. Hypernucleate plasma cell: A rare morphological finding. Indian J Pathol Microbiol 2018;61:147-8

How to cite this URL:
Gupta A, Goyal M, Aribandi A. Hypernucleate plasma cell: A rare morphological finding. Indian J Pathol Microbiol [serial online] 2018 [cited 2022 Dec 7];61:147-8. Available from: https://www.ijpmonline.org/text.asp?2018/61/1/147/228169




A 34–year-old male presented to the hospital with pain abdomen. Clinical examination showed the presence of hepatomegaly. His peripheral blood investigations revealed a low hemoglobin (9.0 g/dl) with normal total leukocyte counts and platelet counts with peripheral blood smear showing increased rouleaux formation and presence of 1%–2% plasma cells. Biochemical investigations revealed normal serum levels of creatinine and calcium, while β2 microglobulin levels were markedly raised (12.85 mg/L) along with a raised total bilirubin levels (2.98 mg/dL). Serum protein electrophoresis showed a “M band” in gamma region (5.26 g/dL) with serum-free light chains showing lambda restriction (free lambda chain-1879 mg/L) and markedly raised IgG levels. Computed tomography (CT) scan showed the presence of a liver mass which on CT-guided biopsy was diagnosed as plasmacytoma. X-ray skull showed multiple lytic lesions. Bone marrow studies showed marked plasma cell prominence constituting 69% of all nucleated cells with many binucleate, few trinucleate, and occasional multinucleated plasma cells containing up to 5 and 6 nuclei [Figure 1]. Fluorescence in situ hybridization done on the bone marrow aspirate sample showed the absence of any deletions of the 17p/Tp53 gene, del13q, or rearrangement of the IgH gene. A final diagnosis of multiple myeloma, International Staging System stage III, was rendered, and patient was started on bortezomib-based therapy. The patient currently is under follow-up.
Figure 1: (a) Penta-nucleated plasma cell (×100 oil immersion, Giemsa stain). (b) Hexa-nucleated plasma cell arrow mark (×100 oil immersion, Giemsa stain). (c) Multinucleated plasma cell in bone marrow biopsy – arrow mark (×100 oil immersion, hematoxylin, and eosin stain). (d) Immunohistochemical staining on trephine biopsy showing cytoplasmic lambda light chain restriction (×40, DAB with hematoxylin counterstain, IHC; Rabbit monoclonal anti lambda antibody, clone EP172, PathnSitu Biotechnologies, CA, USA)

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The presence of three or more than three nuclei in plasma cells is considered to be abnormal and pointer toward the presence of plasma cell dyscrasia.[1] Multinucleated plasma cells with five or more nuclei are a rare finding, and such plasma cells should be differentiated from other multinucleated cells that may be found in bone marrow aspirates in normal and pathological conditions. Differential diagnosis of multinucleated plasma cells includes foreign body giant cells, osteoclasts, dysmorphic megakaryocytes, Langhans giant cells, multinucleated anaplastic giant cells, and histiocytes.

Although a disease of the elderly, multiple myeloma occurs in patients under the age of 40 years with an incidence of <2%.[2] Prognostic significance of multinucleated plasma cells is debatable with few studies linking multinucleated plasma cell to an aggressive clinical course, light chain type of disease, and resistance to conventional chemotherapy, while some studies refuted any such association.[3],[4]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Ribourtout B, Zandecki M. Plasma cell morphology in multiple myeloma and related disorders. Morphologie 2015;99:38-62.  Back to cited text no. 1
    
2.
Antonio P, Kenneth A. Multiple myeloma. NEJM 2011;364:1046-60.  Back to cited text no. 2
    
3.
Erkut N, Çobanoǧlu Ü, Sönmez M. Multiple myeloma with multilobated plasma cell nuclei. Turk J Haematol 2011;28:158-9.  Back to cited text no. 3
    
4.
Shumate M, Whitehead C. The presence of multinuceated plasma cells in bone marrow aspirates has no clinical significance. Blood 2009;114:4904.  Back to cited text no. 4
    

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Correspondence Address:
Anurag Gupta
Department of Hematopathology and Genetics, AmPath, Hyderabad - 500 019, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IJPM.IJPM_374_17

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