CLINICAL INFORMATION

77 year-old gentleman with a history of prostate cancer for 10 years and monoclonal paraproteinemia for one year, either a monoclonal gammopathy of uncertain significance or smoldering myeloma. He had a back pain for three months and an MRI revealed compression fractures of the vertebral body.

PERIPHERAL BLOOD SMEAR AND DIFFERENTIATION

CBC RESULTS:

    WBC:            4.3 K/uL     

    RBC:            3.41 M/uL L  

    HGB:            10.8 g/dL L   

    HCT:            33.1  % L    

    PLT:            173 K/uL     

    HGB/HCT:        33.1  % L    

    MCV:            97.1 fL      

    MCH:            31.7 pg      

    MCHC:           32.6 g/dL    

    RDW:            14.9  %      

    MPV:            9.0 fL       

COMPREHENSIVE METABOLIC PANEL:

    Glucose:             85 mg/dL  

    Sodium:            140 mmol/L

    Potassium:         4.6 mmol/L

    Chloride:          108 mmol/L

    Anion Gap:         10 mmol/L 

    Urea Nitrogen:     18 mg/dL  

    Creatinine:          1.1 mg/dL 

    Calcium, Total:    8.3 mg/dL

    PSA:                  1.4 ng/mL 

    GAM GLO            3.5 g/dL  

    M-Prot                  3.3 g/dL  

    IGG                       4.2 g/dL

• Circulating activated lymphocytes and few plasmacytoid lymphocytes are noted. Severe normocytic normochromic anemia with mild polychromasia is present. No Rouleaux formation is seen.

BONE MARROW ASPIRATE AND TOUCH IMPRINT

Wright-Giemsa, 100×

Wright-Giemsa, 100×

Wright-Giemsa, 100×

BONE MARROW CORE BIOPSY AND CLOT

HE, 40×

HE, 40×

HE, 40×

CYTOGENETICS (UNMC Cytogenetics)

Results: Positive for IgH/CCND1 fusion(19%)

INTERPRETATION:

There was no cytogentic evidence of an abnormal clone in this bone marrow specimen at this band level.  However, adjunct FISH studies detected a rearrangement of the IgH region at 4q32 in 31% of the interphase cells from this specimen.  Subsequent studies revealed variant IgH/CCND1 fusion in 19% of the cells analyzed.  Specifically, there results are positive for a variant t(11;14).  Additional studies were negative for a t(14;16), trisomies 9, 11, and 15 and for deletions of 6q21, 13q14, 13q34 and 17p13.1.

Click here for diagnosis and case discussion.

Source: Department of Pathology, Creighton University Medical Center, Omaha, NE

Photo: Zenggang Pan

Interpretation: Dr. Sotomayor

Discussion: Zenggang Pan