Plasmablastic Myeloma- A Diagnostic Dilemma
Published: May 1, 2023 | DOI: https://doi.org/10.7860/JCDR/2023/55807.17936
Shiva Kumar Komaravelli, MB Deepak, S Bharath Ram, Hamza Dalal, KS Nataraj
1. Clinical Fellow, Department of Haematology, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru Urban, Karnataka, India.
2. Consultant, Department of Laboratory Haematology, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru Urban, Karanataka, India.
3. Junior Consultant, Department of Haematology, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru Urban, Karnataka, India.
4. Clinical Fellow, Department of Haematology, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru Urban, Karnataka, India.
5. Senior Consultant, Department of Laboratory Haematology, Mazumdar Shaw Medical Center, Narayana Health City, Bengaluru Urban, Karnataka, India.
Correspondence
Dr. MB Deepak,
258/A, Bommasandra Industrial Area, Anekal Taluk, Hosure Road, Bangalore-560099, Karanataka, India.
E-mail: deepak.mb.dr@narayanahealth.org
Plasmablastic neoplasms comprise various haematolymphoid tumours with plasmablastic morphology which includes Plasmablastic Myeloma (PBM) and Plasmablastic Lymphoma (PBL). Distinguishing between these two entities remains a major diagnostic challenge. In view of Epstein Barr Virus (EBV)-Encoded RNA (EBER) negativity, Human Immunodeficiency Virus (HIV) negativity, high Serum Free Light Chain (SFLC) assay and absence of hypermetabolic lymphadenopathy, a final diagnosis of PBM was made. This report is about a 55-year-old lady who presented with fatigue, significant loss of weight, and appetite. She had mild enlargement of the liver, spleen and no significant lymphadenopathy. There were atypical cells in peripheral blood. Bone marrow evaluation showed 51% atypical mononuclear cells. Flow cytometry was negative for acute leukaemia diagnostic markers. Immunohistochemistry (IHC) on the bone marrow biopsy revealed positivity for Cluster of Differentiation (CD) 138, Multiple Myeloma 1 (MUM1) with kappa light chain restriction and negative for EBER. The free light chain showed a kappa:lambda light chain ratio of 28,885 (0.26-1.65). The diagnosis of PBM was made and she was started on a daratumumab-based immunotherapy regimen. She achieved complete remission after induction with Measurable Residual Disease (MRD) <0.01%. She is presently doing well on follow-up with the disease in remission status.
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