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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
Case report
CD138-negative plasma cell myeloma: a diagnostic challenge and a unique entity
  1. Audi Francesca Setiadi1,2 and
  2. Yuri Sheikine1,2
  1. 1Pathology and Laboratory Medicine, The University of British Columbia, Vancouver, British Columbia, Canada
  2. 2Pathology and Laboratory Medicine, Vancouver General Hospital, Vancouver, British Columbia, Canada
  1. Correspondence to Dr Audi Francesca Setiadi; audi85{at}gmail.com

Abstract

Plasma cell neoplasms may exhibit variations in morphology and immunophenotype, which can mimic mature B-cell lymphoproliferative disorders and pose diagnostic challenges. This case illustrates a rare entity of plasma cell myeloma, where the entire plasma cell population exhibited lymphoid morphology, negativity for CD138, positivity for CD20 and cyclin D1, and positive fluorescence in situ hybridisation for t(11;14) and del(17 p), mimicking a mature B-cell lymphoproliferative disorder, in particular mantle cell lymphoma. In this case, a careful analysis of flow cytometry gating strategies and use of other ancillary tests were keys for correct diagnosis. In addition to the diagnostic implications due to its rarity, CD138-negative plasma cell myeloma may represent a unique entity, which is associated with ‘stem cell’-like clonogenic properties, more aggressive clinical behaviour and resistance to chemotherapy.

  • haematology (incl blood transfusion)
  • immunology
  • malignant and benign haematology
  • pathology

https://doi.org/10.1136/bcr-2019-232233

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    Footnotes

    • Contributors AFS reviewed the patient’s bone marrow specimen, analysed flow cytometry data, conducted literature search and wrote the case report. YS reviewed the case, created the figures, conducted literature search and contributed to writing the case report. All authors approved the final manuscript.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent for publication Next of kin consent obtained.

    • Provenance and peer review Not commissioned; externally peer reviewed.