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Auer rod-like inclusions in multiple myeloma: Report of two diagnostically challenging cases
Arpita Mathur1, Shashi Bansal2, Upendra Sharma3
1Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India.
Abstract:
Non-immunoglobulin intracytoplasmic inclusions in plasma cells of multiple myeloma are very rare presentation. These are morphologically similar to Auer rods but chemically different from them. We studied two cases of multiple myeloma in a 60-year-old woman and 45-year-old man. In both cases, plasma cells of bone marrow aspirate revealed multiple Auer rod-like inclusions (ARLI). Sudan black B (SBB) and myeloperoxidase (MPO) cytochemistry were negative. Serum protein electrophoresis in both of them showed M spike, one with raised IgA-kappa levels, while the other with raised IgG-kappa levels. Very few case reports have been published in the literature and its prognostic implications are still unknown. Due to its rarity, it is important to distinguish such cases from acute myeloid leukemia and its exact incidence with its therapeutic and prognostic implications.
Insights
Multiple myeloma can rarely present with Auer rod-like inclusions (ARLI) in plasma cells. These inclusions are distinct from those seen in acute myeloid leukemia, requiring careful differentiation.
Area of Science:
- Hematology
- Oncology
- Cellular Pathology
Background:
- Multiple myeloma is a plasma cell malignancy.
- Intracytoplasmic inclusions in plasma cells are uncommon.
- Auer rods are typically associated with myeloid neoplasms.
Observation:
- Two multiple myeloma cases (60-year-old female, 45-year-old male) presented with plasma cells containing multiple Auer rod-like inclusions (ARLI).
- These inclusions were morphologically similar to Auer rods but chemically distinct.
- Cytochemical stains for Sudan black B (SBB) and myeloperoxidase (MPO) were negative in the inclusions.
Findings:
- Serum protein electrophoresis revealed M spikes in both patients.
- One patient had elevated IgA-kappa, and the other had elevated IgG-kappa levels.
- The presence of ARLI in multiple myeloma is a rare finding.
Implications:
- Distinguishing ARLI in multiple myeloma from acute myeloid leukemia is crucial for accurate diagnosis.
- The exact incidence, therapeutic strategies, and prognostic significance of ARLI in multiple myeloma remain unknown.
- Further research is needed to understand the implications of these rare inclusions.
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