Leukemia Research Reports 3 (2014) 49–50
Contents lists available at ScienceDirect
Leukemia Research Reports journal homepage: www.elsevier.com/locate/lrr
Case Report
Extracellular crystals in plasma cell myeloma Jacqueline T. Brown a, W. Richard Burack a, Michael W. Becker a, Roxana Vlad-Vonica b,c, Tibor Nadasdy d, John M. Bennett a, Jason H. Mendler a,n a
James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA Department of Hematology/Oncology, Unity Hospital, Rochester, NY, USA c Ambulatory Infusion Center, Unity Hospital, Rochester, NY, USA d Department of Pathology, The Ohio State University, Columbus, OH, USA b
ar t ic l e i nf o Article history: Received 10 February 2014 Received in revised form 14 April 2014 Accepted 23 April 2014 Available online 18 June 2014
A 66-year-old man presented to the emergency department with weakness and back pain. Remarkable laboratory results included a hemoglobin of 6.1 g/dL (13.5–17.5 g/dL) and creatinine of 17.3 mg/dL (0.6–1.3 mg/dL). Serum protein electrophoresis showed a gamma paraprotein spike demonstrated by immunofixation to be IgG lambda. Serum free lambda light chains were markedly elevated at 11,160 mg/L (5.7–26.3 mg/L). Bone marrow biopsy demonstrated 80% plasma cells with lambda light chain restriction, confirming the diagnosis of plasma cell myeloma (Fig. 1). Strikingly, both bone marrow (panel A) and renal (panel B) biopsies showed numerous, extracellular, eosinophilic, rectangular crystals measuring as large as several cell diameters and
n
staining positive for lambda light chains (panel C) and negative for kappa light chains (panel D). Extracellular crystals have rarely been reported in plasma cell myeloma, and to our knowledge, only once previously demonstrated in both renal and bone marrow tissue from the same patient [1]. The precise etiology of these crystals is unknown; however, they are thought to arise from the precipitation of light chains in certain cases. Our patient received plasmapheresis and hemodialysis, followed by a combination of steroids and bortezomib. Unfortunately, his disease progressed rapidly despite treatment, resulting in death from disease-related complications seven months after diagnosis.
Correspondence to: University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA. Tel.: þ 1 585 275 4099; fax: þ1 585 276 0350. E-mail address: [email protected] (J.H. Mendler).
http://dx.doi.org/10.1016/j.lrr.2014.04.004 2213-0489/& 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).
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J.T. Brown et al. / Leukemia Research Reports 3 (2014) 49–50
Fig. 1
Conflicts of interest
Reference
We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its content.
[1] Kanno Y, Okada H, Nemoto H, Sugahara S, Nakamoto H, Suzuki H. Crystal nephropathy: a variant form of myeloma kidney – a case report and review of the literature. Clin Nephrol 2001;56(5):398–401.
Contents lists available at ScienceDirect
Leukemia Research Reports journal homepage: www.elsevier.com/locate/lrr
Case Report
Extracellular crystals in plasma cell myeloma Jacqueline T. Brown a, W. Richard Burack a, Michael W. Becker a, Roxana Vlad-Vonica b,c, Tibor Nadasdy d, John M. Bennett a, Jason H. Mendler a,n a
James P. Wilmot Cancer Center, University of Rochester Medical Center, Rochester, NY, USA Department of Hematology/Oncology, Unity Hospital, Rochester, NY, USA c Ambulatory Infusion Center, Unity Hospital, Rochester, NY, USA d Department of Pathology, The Ohio State University, Columbus, OH, USA b
ar t ic l e i nf o Article history: Received 10 February 2014 Received in revised form 14 April 2014 Accepted 23 April 2014 Available online 18 June 2014
A 66-year-old man presented to the emergency department with weakness and back pain. Remarkable laboratory results included a hemoglobin of 6.1 g/dL (13.5–17.5 g/dL) and creatinine of 17.3 mg/dL (0.6–1.3 mg/dL). Serum protein electrophoresis showed a gamma paraprotein spike demonstrated by immunofixation to be IgG lambda. Serum free lambda light chains were markedly elevated at 11,160 mg/L (5.7–26.3 mg/L). Bone marrow biopsy demonstrated 80% plasma cells with lambda light chain restriction, confirming the diagnosis of plasma cell myeloma (Fig. 1). Strikingly, both bone marrow (panel A) and renal (panel B) biopsies showed numerous, extracellular, eosinophilic, rectangular crystals measuring as large as several cell diameters and
n
staining positive for lambda light chains (panel C) and negative for kappa light chains (panel D). Extracellular crystals have rarely been reported in plasma cell myeloma, and to our knowledge, only once previously demonstrated in both renal and bone marrow tissue from the same patient [1]. The precise etiology of these crystals is unknown; however, they are thought to arise from the precipitation of light chains in certain cases. Our patient received plasmapheresis and hemodialysis, followed by a combination of steroids and bortezomib. Unfortunately, his disease progressed rapidly despite treatment, resulting in death from disease-related complications seven months after diagnosis.
Correspondence to: University of Rochester Medical Center, 601 Elmwood Avenue, Box 704, Rochester, NY 14642, USA. Tel.: þ 1 585 275 4099; fax: þ1 585 276 0350. E-mail address: [email protected] (J.H. Mendler).
http://dx.doi.org/10.1016/j.lrr.2014.04.004 2213-0489/& 2014 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-SA license (http://creativecommons.org/licenses/by-nc-sa/3.0/).
50
J.T. Brown et al. / Leukemia Research Reports 3 (2014) 49–50
Fig. 1
Conflicts of interest
Reference
We wish to confirm that there are no known conflicts of interest associated with this publication and there has been no significant financial support for this work that could have influenced its content.
[1] Kanno Y, Okada H, Nemoto H, Sugahara S, Nakamoto H, Suzuki H. Crystal nephropathy: a variant form of myeloma kidney – a case report and review of the literature. Clin Nephrol 2001;56(5):398–401.
