Hematopathology — Image #41 — Plasma Cell Dyscrasias—Multiple Myeloma

SPEP Tracing:

SPEP Tracing

Densitrometry Reading

Densitometry reading of the Serum Protein Electrophoresis gel. Starting from the left are albumin, alpha 1 fraction, alpha 2, beta, then gamma--the gamma globulins. The monoclonal band is in the gamma region.

Plasma Cells, Marrow Aspirate:

Marrow Aspirate

Plasma cells are increased in the marrow. These plasma cells resemble their normal counterpart, with eccentric nucleus, abundant cytoplasm, and a prominent hof. The only morphologic clue to their malignancy is that the nucleus is too big. We will need to know quantity and clonality before diagnosing myeloma.

Sheet of Plasma Cells, Marrow Biopsy:

Marrow Biopsy

The core biopsy shows a sheet of plasma cells. The comprise more than 30% of the total cells in this case (entire biopsy not shown). This meets one criterion for myeloma.

Plasma Cells, Kappa Restriction:

Kappa Restriction

The plasma cells show kappa light chain restriction. The brown immunostain here is for kappa. (The lambda slide would show no reactivity.)

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