Metastatic CD138+ Lobular Breast Carcinoma Mimicking a Plasma Cell Neoplasm

Abstract We present a case of an 85-year-old female who received a bone marrow biopsy for concern over myelodysplastic symptoms and was subsequently diagnosed with a CD138-positive metastatic lobular breast carcinoma that mimicked a plasma cell neoplasm. Her medical history included endometrial serous adenocarcinoma (pT1a N0), severe mitral regurgitation, and atrial fibrillation. She presented with a 3-month history of thrombocytopenia (60,000/mcL) and a down-trending macrocytic anemia (nidus hemoglobin: 6-7 g/dL) that prompted a bone marrow biopsy. The aspirate smears were aparticulate and hemodiluted, while the touch preparations revealed a homogeneous population of large, plasmacytoid cells. These were again seen filling the medullary cavity on the bone marrow biopsy with eccentrically placed nuclei containing nucleoli and abundant eosinophilic cytoplasm. The cells were CD138, cytokeratin 7 and 8/18, mammoglobulin, and GATA-3 positive. They were cytokeratin 20, TTF-1/Napsin, PAX-8, and uroplakin negative. Further testing revealed the cells to be estrogen receptor positive (strong, 90%+), progesterone negative, HER2 negative, p120 positive (strong cytoplasmic), and E-cadherin negative. The patient’s prior serous adenocarcinoma histomorphology was not consistent with the plasmacytoid cells. Prior literature revealed a case report on a metastatic lobular carcinoma to bone marrow and discussion on the morphologic similarities, but the case was CD138 negative. This case highlights that CD138 can be positive in certain carcinomas, some of which can have a plasmacytoid morphology. Suspicion should be raised in an elderly female population.

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Plasma cell neoplasm with varied morphology: A report of two cases

Journal of Laboratory Physicians ◽

10.4103/jlp.jlp_172_18 ◽

2019 ◽

Vol 11 (03) ◽

pp. 281-283

Author(s):

Gautam Kumar Vasnik ◽

S. Venkatesan ◽

Sanjeevan Sharma ◽

Ajay Malik

Keyword(s):

Bone Marrow ◽

Differential Diagnosis ◽

Plasma Cell ◽

Final Diagnosis ◽

Plasma Cell Neoplasm ◽

Clonal Proliferation ◽

Cytoplasmic Vacuoles ◽

Cell Neoplasm ◽

Morphological Diagnosis ◽

Morphological Variants

AbstractPlasma cell (PC) neoplasm (PCN) with varied morphology has been described in the literature. The majority of clonal proliferation of PCs is composed of easily recognizable morphology in the bone marrow (BM). However, few cases may cause diagnostic complexity, as they exhibit varied cytological and architectural heterogeneity which may pose problem in morphological diagnosis and require the use of ancillary techniques like immunohistochemistry (IHC). We illustrate here two such cases of PCN with varied morphology in BM aspirate, in the form of clustering/rosetting and multiple clear cytoplasmic vacuoles, respectively, leading to varied differential diagnosis. However, later, the histopathological features on BM biopsy findings were relatively characteristic and IHC confirmed the final diagnosis. The morphological variants documented in both these cases are exceptional and representative of the various forms of atypical PCs.

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Accuracy of Bone Marrow Flow Cytometry Analysis in Patients With Plasma Cell Neoplasm in Thailand: A Single Institutional Study

Clinical Lymphoma Myeloma & Leukemia ◽

10.1016/j.clml.2015.12.002 ◽

2016 ◽

Vol 16 (3) ◽

pp. e27-e37

Author(s):

Wasithep Limvorapitak ◽

Thammasiree Srisum-ang ◽

Chutima Chimres ◽

Naree Warnnissorn ◽

Nonglak Kanitsap

Keyword(s):

Bone Marrow ◽

Flow Cytometry ◽

Plasma Cell ◽

Flow Cytometry Analysis ◽

Plasma Cell Neoplasm ◽

Cell Neoplasm

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Primary Amyloidosis

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa161.182 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S83-S83 ◽

Cited By ~ 1

Author(s):

R Bhuyan ◽

T T Tran ◽

L Mc Phaul ◽

Y Liu

Keyword(s):

Bone Marrow ◽

Renal Failure ◽

Physical Examination ◽

Plasma Cell ◽

Light Chain ◽

Plasma Cells ◽

Amyloid Deposition ◽

Primary Amyloidosis ◽

Plasma Cell Neoplasm ◽

Cell Neoplasm

Abstract Introduction/Objective Amyloid light chain (AL) results from the deposition of immunoglobulin light chain fragments, and can lead to dysfunction in multiple organs. Our patient was being investigated for unknown malignancy with high differential for plasma cell neoplasm for severe amyloidosis leading to renal failure, uncontrolled ascites and thickening of the skin. The patient died of progressive liver and renal failure. Our autopsy findings show severe amyloidosis deposition in spleen, heart, kidney and liver with no significant plasma cells in the bone marrow, the findings correlate with a rare condition of primary AL amyloidosis. Methods 63 years old man with no past medical history presenting with progressive leg swelling with 15 pounds weight loss. He was admitted to another hospital a month ago. Patient was a smoker with a pack in 2-3 days for 38 years, occasional alcohol intake with no history of heavy alcohol use and no drug use. The patient worked as a chef and lived with his wife. Physical examination shows temporal wasting with cachecxia, had difficulty in staying upright and wanting to sleep when presented to the emergency department. Physical examination was significant for decreased breath sound bilaterally, more on left side, central weakness noted given difficultly sitting upright from laying down flat. Also, there were some lymphadenopathy in the jugular digastric region. Laboratory showed an increase elevation in alkaline phosphatase to the 1000s along with elevated LDL to 300s, nephrotic range proteinuria. Chest X-ray showed left pleural effusion and CT chest and abdomen showed slight hepatosplenomegaly with hypoattenuation and focal calcification. Autopsy finding indicated heavy spleen (260 grams) with a stiff and hard texture. Liver weighs in upper limit of normal (1660 grams) with a yellow firm surface. There is significant amyloid deposition in spleen. Also, moderate amyloid deposition was seen in all the organs including liver, kidney, heart and, also in the skin. No definite lesion was seen in the gross, nor cancer cells found in the microscopy examination. Bone marrow examination did not reveal plasma cells, ruling out the possibility of multiple myeloma or plasma cell dyscrasia. Conclusion This is a rare case of AL primary amyloidosis with aggressive progression and poor prognosis not associated with plasma cell neoplasm.

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Concurrent Polycythemia of Undetermined Etiology and Smouldering Plasma Cell Myeloma

Case Reports in Pathology ◽

10.1155/2018/8781721 ◽

2018 ◽

Vol 2018 ◽

pp. 1-5 ◽

Cited By ~ 1

Author(s):

Roula Katerji ◽

Chad A. Hudson

Keyword(s):

Bone Marrow ◽

Polycythemia Vera ◽

Plasma Cell ◽

Final Diagnosis ◽

Organ Damage ◽

Plasma Cell Myeloma ◽

Biochemical Tests ◽

Plasma Cell Neoplasm ◽

Cell Neoplasm ◽

Undetermined Etiology

The combination of polycythemia and plasma cell myeloma occurring concurrently is very rare and few cases have been reported in the literature. Further, the vast majority of these cases are cases of polycythemia vera and myeloma. Here, we present a case of polycythemia of undetermined etiology and myeloma. The patient is a 48-year-old Caucasian male who was originally diagnosed with polycythemia of undetermined etiology. Twelve years later, when a bone marrow biopsy was performed in an attempt to determine the etiology of the polycythemia, findings diagnostic of plasma cell myeloma were discovered. Subsequent serum studies were also consistent with a plasma cell neoplasm, while evaluation for end-organ damage was negative. A battery of genetic and biochemical tests ruled out various congenital polycythemias, leading to a final diagnosis of polycythemia of undetermined etiology and smouldering plasma cell myeloma. This case highlights that while being unusual, polycythemia and plasma cell myeloma can occur concurrently, and, in this report, we discuss both entities and potential mechanisms of the pathophysiology of the concurrent presentation.

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Epstein-Barr virus-driven bone marrow aplasia and plasmacytosis mimicking a plasma cell neoplasm

British Journal of Haematology ◽

10.1111/bjh.12721 ◽

2014 ◽

Vol 165 (3) ◽

pp. 272-272 ◽

Cited By ~ 2

Author(s):

Michael J Desborough ◽

Henri Grech

Keyword(s):

Bone Marrow ◽

Plasma Cell ◽

Epstein Barr Virus ◽

Bone Marrow Aplasia ◽

Barr Virus ◽

Plasma Cell Neoplasm ◽

Cell Neoplasm ◽

Epstein Barr

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Practical diagnostic approaches to composite plasma cell neoplasm and low grade B-cell lymphoma/clonal infiltrates in the bone marrow

Hematological Oncology ◽

10.1002/hon.2129 ◽

2014 ◽

Vol 33 (1) ◽

pp. 31-41 ◽

Cited By ~ 4

Author(s):

Shafinaz Hussein ◽

Kamraan Gill ◽

Lea N. Baer ◽

Daniela Hoehn ◽

Mahesh Mansukhani ◽

...

Keyword(s):

Bone Marrow ◽

B Cell ◽

Plasma Cell ◽

Cell Lymphoma ◽

B Cell Lymphoma ◽

Low Grade ◽

Plasma Cell Neoplasm ◽

Cell Neoplasm ◽

Diagnostic Approaches

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Keratin Immunohistochemistry Detects Clinically Significant Metastases in Bone Marrow Biopsy Specimens in Women With Lobular Breast Carcinoma

The American Journal of Surgical Pathology ◽

10.1097/00000478-200012000-00002 ◽

2000 ◽

Vol 24 (12) ◽

pp. 1593-1599 ◽

Cited By ~ 10

Author(s):

Mark H. Lyda ◽

Merry Tetef ◽

Nora H. Carter ◽

David Ikle ◽

Lawrence M. Weiss ◽

...

Keyword(s):

Bone Marrow ◽

Breast Carcinoma ◽

Bone Marrow Biopsy ◽

Biopsy Specimens ◽

Lobular Breast Carcinoma ◽

Clinically Significant

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Del20q and Gain/Loss of Sex Chromosomes in Patients with Plasma Cell Neoplasm

American Journal of Clinical Pathology ◽

10.1093/ajcp/aqaa137.021 ◽

2020 ◽

Vol 154 (Supplement_1) ◽

pp. S12-S12

Author(s):

Benjamin Lee ◽

Shiyong Li

Keyword(s):

Bone Marrow ◽

Plasma Cell ◽

Sex Chromosomes ◽

Plasma Cells ◽

Sex Chromosome ◽

Plasma Cell Neoplasm ◽

Clonal Proliferation ◽

Age Related ◽

Cell Neoplasm ◽

Gain Loss

Abstract Aim Plasma cell neoplasm (PCN) is a clonal proliferation of plasma cells involving bone marrow and extramedullary anatomic sites. The purpose of this study is to investigate the prevalence and clinical significance of del20q and gain/loss of sex chromosomes in patients with PCN. Materials and Methods Routine karyotype analysis was performed on bone marrow aspirate specimens from patient with plasma cell neoplasm in the cytogenetics laboratory using the G-banding technology. Results from January 1, 2012 to June 21, 2019 were retrieved for analysis. Results Among the 8,665 karyotype results, 1,116 were abnormal and 593 demonstrated del20q and/or gain/loss of sex chromosomes. 33% (113/347) have bone marrow PCN when del20q and gain/loss of sex chromosomes occur in isolation, while 94% (256/250) have bone marrow PCN when 1 or more other autosomal abnormalities are also present. In those with isolated del20q or gain/loss of sex chromosomes, the frequency of bone marrow PCN ranges from 29–50%. Del20 occurs 1–6 years after therapy and in some patients is transient. Gain/loss of sex chromosome is generally present during the follow-up period. Conclusion Del20q and gain/loss of sex chromosomes do not appear to correlate with bone marrow PCN. Isolated Del20q likely represents transient treatment-related abnormality, while isolated gain/loss of sex chromosomes is probably age-related.

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