Notes

CLINICAL DETAILS: MRI dorsolumber spine shows, "multiple abnormally enhancing foci in the visualised dorsolumbar and sacral vertebra and the bilateral iliac bones likely secondary to diffuse bony metastasis" .Diagnosed as a case of plasma cell neoplasm on sacral mass biopsy (2021 PS-48948). Serum protein electrophoresis shows M-spike of 1.7 gm /dl and immunofixation shows IgG lamda. Light chain shows lamda of 495 mg/L with FLC ratio is 0.02. Beta2 microglobulin are pending. ?Myeloma. bone marrow examination is done for diagnostic work up.

PERIPHERAL BLOOD COUNTS:
HB: 13.3 G/DL
HCT: 38.4 %
MCV: 91.0 FL
MCH: 31.5 PG
WBC: 7.1 x 10E9/L
ANC: 4.8 x 10E9/L
PLATELETS: 226 x 10E9/L

PERIPHERAL BLOOD FILM: Shows normocytic, normochromic red blood cells. WBC's and platelets are normal on film. Hypersegmented neutrophils noted.

BONE MARROW ASPIRATE: Cellular specimen showing active trilineage hematopoiesis. Erythropoiesis is normoblastic. Myelopoiesis is active and shows all stages of maturation and differentiation. M:E ratio is 3:1. Adequate megakaryocytes seen. There is prominent plasma cells (8%) with bilobation observed. No non-hematopoietic clump or hemoparasite identified on the stained smear examined.

BONE TREPHINE TOUCH PREP: Reflective of bone marrow aspirate.

BONE TREPHINE (H&E) SECTIONS: Adequate length specimen with areas of patchy cellularity. The majority of the core has intact architecture, with hypocellularity for its age (15-20%) showing the presence of erythroid and myeloid precursors, as well as interstitial plasma cells. While one area is hypercellular showing infiltration with sheet of plasma cells. Megakaryocytes noted. No granuloma identified in the sections examined.

RESULTS OF IMMUNOHISTOCHEMICAL STAINS (IN PLASMA CELLS):
CD138: Positive
CD56 : Positive
MUM1 : Positive

RESULTS OF RETICULIN STAIN: Shows grade MF-0 reticulin fiber pattern.

OPINION: Bone marrow shows increased plasma cells with positive immunohistochemistry. Based on the these findings and clinical details provided bo/////////////////



DR. MUHAMMAD SALMAN ARIF, DR. SALMAN N. ADIL,
M.B.B.S F.C.P.S (HAEMATOLOGY),
RESIDENT HAEMATOLOGY CONSULTANT HAEMATOLOGIST