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Punchoo R. Through the looking crystal: clarifying the pathogenesis and laboratory work-up of cryocrystalglobulinaemia. J Clin Pathol 2023; 76:658. [PMID: 34893519 DOI: 10.1136/jclinpath-2021-207585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 06/08/2021] [Indexed: 11/04/2022]
Affiliation(s)
- Rivak Punchoo
- Chemical Pathology, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa
- Chemical Pathology, Tshwane Academic Divsion, National Health Laboratory Service, Pretoria, South Africa
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Nawata A, Iwamura R, Shiba E, Inaba Y, Kubo C, Kusano M, Komatsu K, Tanaka Y, Hisaoka M. Light chain proximal tubulopathy after improvement of tubulointerstitial nephritis in Sjögren's syndrome. Pathol Int 2022; 72:525-527. [PMID: 35876455 DOI: 10.1111/pin.13263] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 06/17/2022] [Accepted: 07/13/2022] [Indexed: 12/01/2022]
Affiliation(s)
- Aya Nawata
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Ryuji Iwamura
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Eisuke Shiba
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yuna Inaba
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Chisachi Kubo
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Midori Kusano
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Kazuki Komatsu
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Yoshiya Tanaka
- The First Department of Internal Medicine, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
| | - Masanori Hisaoka
- Department of Pathology and Oncology, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan
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Fitzpatrick MJ, Nardi V, Sohani AR. Plasma cell myeloma: role of histopathology, immunophenotyping, and genetic testing. Skeletal Radiol 2022; 51:17-30. [PMID: 33687521 DOI: 10.1007/s00256-021-03754-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Revised: 02/27/2021] [Accepted: 03/02/2021] [Indexed: 02/02/2023]
Abstract
Myeloma is a malignant neoplasm of plasma cells with complex pathogenesis. Diagnosis and risk stratification require the integration of histology, radiology, serology, and genetic data. Bone marrow biopsies are essential for myeloma diagnosis by providing material for histologic and cytologic assessment as well as immunophenotypic and genetic studies. Flow cytometry and genetic studies are, in particular, becoming increasingly important for diagnosis, risk stratification, and assessment of treatment response. Myeloma has traditionally been characterized by recurrent cytogenetic abnormalities that can be divided into two subtypes: hyperdiploid, characterized by trisomies, and non-hyperdiploid, characterized by translocations involving chromosome 14. These abnormalities are thought to be primary events, initiating a premalignant state, which progresses to myeloma through the acquisition of secondary mutations. The emergence of next-generation sequencing has led to the discovery of numerous mutations and gene fusions that comprise the heterogenous genomic landscape of myeloma. As the underlying pathogenesis of myeloma continues to be delineated, possible therapeutic targets have also emerged. Herein, we describe the importance of histology, immunophenotype, and mutational analysis in the assessment of myeloma.
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Affiliation(s)
- Megan J Fitzpatrick
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WRN 219, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Valentina Nardi
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WRN 219, Boston, MA, 02114, USA
- Department of Pathology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA
| | - Aliyah R Sohani
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, 55 Fruit St, WRN 219, Boston, MA, 02114, USA.
- Department of Pathology, Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA.
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Ningombam A, Acharya S, Sarkar A, Kumar K. Diverse atypical lymphocytes in the peripheral blood smear of dengue patients: Crystalline rods, mott cells, and downey cells. JOURNAL OF APPLIED HEMATOLOGY 2022. [DOI: 10.4103/joah.joah_33_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Multiple myeloma with Russell bodies and needle-shaped crystalline inclusions. Int J Hematol 2016; 103:483-5. [PMID: 26984592 DOI: 10.1007/s12185-016-1985-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Revised: 03/07/2016] [Accepted: 03/07/2016] [Indexed: 10/22/2022]
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Plasma cell morphology in multiple myeloma and related disorders. Morphologie 2015; 99:38-62. [PMID: 25899140 DOI: 10.1016/j.morpho.2015.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/23/2015] [Indexed: 12/28/2022]
Abstract
Normal and reactive plasma cells (PC) are easy to ascertain on human bone marrow films, due to their small mature-appearing nucleus and large cytoplasm, the latter usually deep blue after Giemsa staining. Cytoplasm is filled with long strands of rough endoplasmic reticulum and one large Golgi apparatus (paranuclear hof), demonstrating that PC are dedicated mainly to protein synthesis and excretion (immunoglobulin). Deregulation of the genome may induce clonal expansion of one PC that will lead to immunoglobulin overproduction and eventually to one among the so-called PC neoplasms. In multiple myeloma (MM), the number of PC is over 10% in most patients studied. Changes in the morphology of myeloma PC may be inconspicuous as compared to normal PC (30-50% patients). In other instances PC show one or several morphological changes. One is related to low amount of cytoplasm, defining lymphoplasmacytoid myeloma (10-15% patients). In other cases (40-50% patients), named immature myeloma cases, nuclear-cytoplasmic asynchrony is observed: presence of one nucleolus, finely dispersed chromatin and/or irregular nuclear contour contrast with a still large and blue (mature) cytoplasm. A peculiar morphological change, corresponding to the presence of very immature PC named plasmablasts, is observed in 10-15% cases. Several prognostic morphological classifications have been published, as mature myeloma is related to favorable outcome and immature myeloma, peculiarly plasmablastic myeloma, is related to dismal prognosis. However, such classifications are no longer included in current prognostic schemes. Changes related to the nucleus are very rare in monoclonal gammopathy of unknown significance (MGUS). In contrast, anomalies related to the cytoplasm of PC, including color (flaming cells), round inclusions (Mott cells, Russell bodies), Auer rod-like or crystalline inclusions, are reported in myeloma cases as well as in MGUS and at times in reactive disorders. They do not correspond to malignant changes of PC but are related to abnormal synthesis, trafficking, or excretion of the immunoglobulin that is stored in excess within the cytoplasm. Occurrence of crystalline inclusions within PC may be the first anomaly leading to the diagnosis of adult Fanconi syndrome. After a historical perspective, the authors report on the various morphological aspects of PC that may occur in multiple myeloma and related disorders, and discuss about their clinical and pathophysiological significance. Today, morphological identification and accurate determination of % PC within bone marrow remain ancillary criteria for the diagnosis of MM and help for the diagnosis of rare renal disorders.
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Abstract
Monoclonal gammopathy is produced by neoplastic or non-neoplastic expansion of a clone of plasma cells or B lymphocytes. Monoclonal gammopathy of unknown significance is characterized by low levels of the monoclonal protein and a relatively small population of clonal lymphocytes or plasma cells in the bone marrow. In these cases, the patient is asymptomatic with no evidence of overt myeloma or lymphoma. The abnormal serum protein may be present as a complete immunoglobulin molecule or may consist of ≥1 of its components such as light chains or heavy chains. These proteins may cause a variety of diseases in various tissues and organs, of which the kidney appears to be the most vulnerable. Renal involvement in monoclonal gammopathy may occur as part of a generalized disease such as amyloidosis, immunoglobulin deposition disease, and cryoglobulinemia. In addition, there may be evidence of kidney damage by processes which are renal specific. These include light chain proximal tubulopathy, light chain cast nephropathy, and a variety of glomerulopathies encompassing a wide spectrum of disease patterns.
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Stompór T, Perkowska-Ptasińska A, Wojciechowska M, Zając K, Chmielewska-Badziąg A, Pawłowska A. Unusual manifestation of crystalline light chain tubulopathy in patient with multiple myeloma: case report and review of the literature. Ren Fail 2014; 36:795-9. [DOI: 10.3109/0886022x.2014.884446] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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Srivastava S, Danilova O, Malhotra S, Ornstein DL. Intracellular and extracellular immunoglobulin crystals assuming a multitude of geometric shapes in an IgG-λ plasma cell neoplasm. Am J Hematol 2013; 88:1094-5. [PMID: 23720061 DOI: 10.1002/ajh.23489] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2013] [Revised: 05/11/2013] [Accepted: 05/15/2013] [Indexed: 11/12/2022]
Affiliation(s)
- Swati Srivastava
- Department of PathologyDartmouth‐Hitchcock Medical Center, One Medical Center DriveLebanon New Hampshire
| | - Olga Danilova
- Department of PathologyDartmouth‐Hitchcock Medical Center, One Medical Center DriveLebanon New Hampshire
| | - Saurabh Malhotra
- Department of PathologyDartmouth‐Hitchcock Medical Center, One Medical Center DriveLebanon New Hampshire
| | - Deborah L. Ornstein
- Department of PathologyDartmouth‐Hitchcock Medical Center, One Medical Center DriveLebanon New Hampshire
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Son KM, Kim JK, Kim HA, Park HR, Park EJ, Oh JM, Seo YI. Vasculitis as a Presenting Feature of Multiple Myeloma in a Patient with Rheumatoid Arthritis. JOURNAL OF RHEUMATIC DISEASES 2013. [DOI: 10.4078/jrd.2013.20.1.44] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Affiliation(s)
- Kyeong Min Son
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Anyang, Korea
| | - Ja Kyung Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Anyang, Korea
| | - Hyun Ah Kim
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Anyang, Korea
| | - Hye Rim Park
- Department of Pathology, Hallym University Sacred Heart Hospital, College of Medicine, Anyang, Korea
| | - Eun Ju Park
- Department of Dermatology, Hallym University Sacred Heart Hospital, College of Medicine, Anyang, Korea
| | - Ji Min Oh
- Department of Rheumatology, Sam Hospital, Anyang, Korea
| | - Young Il Seo
- Department of Internal Medicine, Hallym University Sacred Heart Hospital, College of Medicine, Anyang, Korea
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Tasso D, Gulbahce HE, Berger MJ, McKenna RW, Pambuccian SE. Intracytoplasmic crystalline and globular inclusions in small lymphocytic lymphoma in transformation. Diagn Cytopathol 2010; 40:42-4. [PMID: 22180236 DOI: 10.1002/dc.21609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 10/21/2010] [Indexed: 11/06/2022]
Affiliation(s)
- David Tasso
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
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