Plasma cell leukemia with pleomorphic plasma cells--a case report.

Area of Science:

• Hematology
• Oncology
• Pathology

Background:

• Plasma cell leukemia (PCL) is an aggressive hematologic malignancy.
• PCL is characterized by the proliferation of malignant plasma cells in the peripheral blood.
• Morphological variations in plasma cells can impact diagnosis and prognosis.

Observation:

• A rare case of PCL presented with congestive cardiac failure and nephropathy.
• Bone imaging revealed no lytic lesions.
• Peripheral blood analysis showed predominantly pleomorphic plasma cells with atypical nuclear features.

Findings:

• Serum electrophoresis was negative for M-band, but urine electrophoresis detected Bence Jones protein.
• This confirmed a light chain-only myeloma, a subtype of multiple myeloma.
• The presence of pleomorphic plasma cells, though rare, was a key diagnostic feature.

Implications:

• Recognizing unusual plasma cell morphology is crucial for diagnosing rare PCL variants.
• This case underscores the importance of integrating morphology with biochemical findings for accurate myeloma classification.
• Prompt diagnosis and management of PCL, even with atypical features, can lead to favorable outcomes.