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Case 10

View the images and select the correct diagnosis from the list below.

Bad to the bone

FNA of the left breast from a 52-year-old woman:

 

 

 

 

 

Select the correct diagnosis:

You answered: Plasmacytoma (multiple myeloma)
That is CORRECT!

CYTOPATHOLOGY:

  • This is a cellular specimen with numerous single cells showing plasmacytoid features. Cells vary from mature plasma cells to large pleomorphic mono- and multinucleate cells that have large nuclei with finely granular chromatin.
  • Cells have a moderate amount of dense cytoplasm and well defined cell membranes.
  • These features suggest a metastatic plasmacytoma (multiple myeloma).

DISCUSSION:

  • In this patient a previous bone marrow biopsy revealed a plasma cell myeloma, consistent with the malignant cells that metastasized to the breast.
  • Plasma cell myeloma is a clonal neoplasm of plasma cells and is synonymous with multiple myeloma, myelomatosis, and Kahler Disease.
  • Single tumours are generally referred to as plasmacytoma and multiple tumours as multiple myeloma.
  • This tumour affects more males than females, is rare before the age of 30 and peaks between the ages of 50-80.
  • It is the most common primary bone tumour, but it is a rare form of cancer. Solitary plasmacytomas are especially rare in the breast and most often seen in the head and neck area.
  • Neoplastic plasma cells are positive for PAS, methyl green pyronine, LCA and vimentin and are clonal for cytoplasmic light chain.
  • In differentiated forms, Russell bodies (intranuclear inclusions containing immunoglobins) and cytoplasmic globules are also present.
  • A cytologic diagnosis of multiple myeloma may be confirmed using immunoelectrophoresis to detect Bence Jones or myeloma proteins. Amyloid, although not seen in this case, may be occasionally present.
  • Neoplastic plasma cells can resemble cells from an array of poorly differentiated neoplasms. Immunoblastic cells with binucleation and prominent nucleoli mimicking Reed Sternberg cells may be present.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago ASCP Press, 1996; 784, 817, 821-822.



Gorczyca W, Olszewski W, Tuziak T, et al: Fine Needle Aspiration Cytology of Rare Malignant Tumors of the Breast. Acta Cytol 1992; 36(6): 918-926.



Kini S. Color Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytopathology. Baltimore: Williams & Wilkins, 1999; 128, 285, 466.



Naib ZM. Cytopathology. New York: Little Brown and Company, 1996; 301.



Xiao Yan Yang MD, PhD, Meera Hameed MD, Eun-Sook Cho MD, Kasturi Das MD. Pathologic Quiz Case: Sacral/Pelvic Mass with Lower Back Pain in a 36-Year Old Man. Arch Path Lab Med 2004; 128(2): 237-238.

You answered: Immunoblastic lymphoma
Sorry, that is INCORRECT

The correct diagnosis is: Plasmacytoma (multiple myeloma)

CYTOPATHOLOGY:

  • This is a cellular specimen with numerous single cells showing plasmacytoid features. Cells vary from mature plasma cells to large pleomorphic mono- and multinucleate cells that have large nuclei with finely granular chromatin.
  • Cells have a moderate amount of dense cytoplasm and well defined cell membranes.
  • These features suggest a metastatic plasmacytoma (multiple myeloma).

DISCUSSION:

  • In this patient a previous bone marrow biopsy revealed a plasma cell myeloma, consistent with the malignant cells that metastasized to the breast.
  • Plasma cell myeloma is a clonal neoplasm of plasma cells and is synonymous with multiple myeloma, myelomatosis, and Kahler Disease.
  • Single tumours are generally referred to as plasmacytoma and multiple tumours as multiple myeloma.
  • This tumour affects more males than females, is rare before the age of 30 and peaks between the ages of 50-80.
  • It is the most common primary bone tumour, but it is a rare form of cancer. Solitary plasmacytomas are especially rare in the breast and most often seen in the head and neck area.
  • Neoplastic plasma cells are positive for PAS, methyl green pyronine, LCA and vimentin and are clonal for cytoplasmic light chain.
  • In differentiated forms, Russell bodies (intranuclear inclusions containing immunoglobins) and cytoplasmic globules are also present.
  • A cytologic diagnosis of multiple myeloma may be confirmed using immunoelectrophoresis to detect Bence Jones or myeloma proteins. Amyloid, although not seen in this case, may be occasionally present.
  • Neoplastic plasma cells can resemble cells from an array of poorly differentiated neoplasms. Immunoblastic cells with binucleation and prominent nucleoli mimicking Reed Sternberg cells may be present.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago ASCP Press, 1996; 784, 817, 821-822.



Gorczyca W, Olszewski W, Tuziak T, et al: Fine Needle Aspiration Cytology of Rare Malignant Tumors of the Breast. Acta Cytol 1992; 36(6): 918-926.



Kini S. Color Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytopathology. Baltimore: Williams & Wilkins, 1999; 128, 285, 466.



Naib ZM. Cytopathology. New York: Little Brown and Company, 1996; 301.



Xiao Yan Yang MD, PhD, Meera Hameed MD, Eun-Sook Cho MD, Kasturi Das MD. Pathologic Quiz Case: Sacral/Pelvic Mass with Lower Back Pain in a 36-Year Old Man. Arch Path Lab Med 2004; 128(2): 237-238.

You answered: Metastatic melanoma
Sorry, that is INCORRECT

The correct diagnosis is: Plasmacytoma (multiple myeloma)

CYTOPATHOLOGY:

  • This is a cellular specimen with numerous single cells showing plasmacytoid features. Cells vary from mature plasma cells to large pleomorphic mono- and multinucleate cells that have large nuclei with finely granular chromatin.
  • Cells have a moderate amount of dense cytoplasm and well defined cell membranes.
  • These features suggest a metastatic plasmacytoma (multiple myeloma).

DISCUSSION:

  • In this patient a previous bone marrow biopsy revealed a plasma cell myeloma, consistent with the malignant cells that metastasized to the breast.
  • Plasma cell myeloma is a clonal neoplasm of plasma cells and is synonymous with multiple myeloma, myelomatosis, and Kahler Disease.
  • Single tumours are generally referred to as plasmacytoma and multiple tumours as multiple myeloma.
  • This tumour affects more males than females, is rare before the age of 30 and peaks between the ages of 50-80.
  • It is the most common primary bone tumour, but it is a rare form of cancer. Solitary plasmacytomas are especially rare in the breast and most often seen in the head and neck area.
  • Neoplastic plasma cells are positive for PAS, methyl green pyronine, LCA and vimentin and are clonal for cytoplasmic light chain.
  • In differentiated forms, Russell bodies (intranuclear inclusions containing immunoglobins) and cytoplasmic globules are also present.
  • A cytologic diagnosis of multiple myeloma may be confirmed using immunoelectrophoresis to detect Bence Jones or myeloma proteins. Amyloid, although not seen in this case, may be occasionally present.
  • Neoplastic plasma cells can resemble cells from an array of poorly differentiated neoplasms. Immunoblastic cells with binucleation and prominent nucleoli mimicking Reed Sternberg cells may be present.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago ASCP Press, 1996; 784, 817, 821-822.



Gorczyca W, Olszewski W, Tuziak T, et al: Fine Needle Aspiration Cytology of Rare Malignant Tumors of the Breast. Acta Cytol 1992; 36(6): 918-926.



Kini S. Color Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytopathology. Baltimore: Williams & Wilkins, 1999; 128, 285, 466.



Naib ZM. Cytopathology. New York: Little Brown and Company, 1996; 301.



Xiao Yan Yang MD, PhD, Meera Hameed MD, Eun-Sook Cho MD, Kasturi Das MD. Pathologic Quiz Case: Sacral/Pelvic Mass with Lower Back Pain in a 36-Year Old Man. Arch Path Lab Med 2004; 128(2): 237-238.

You answered: Lobular carcinoma
Sorry, that is INCORRECT

The correct diagnosis is: Plasmacytoma (multiple myeloma)

CYTOPATHOLOGY:

  • This is a cellular specimen with numerous single cells showing plasmacytoid features. Cells vary from mature plasma cells to large pleomorphic mono- and multinucleate cells that have large nuclei with finely granular chromatin.
  • Cells have a moderate amount of dense cytoplasm and well defined cell membranes.
  • These features suggest a metastatic plasmacytoma (multiple myeloma).

DISCUSSION:

  • In this patient a previous bone marrow biopsy revealed a plasma cell myeloma, consistent with the malignant cells that metastasized to the breast.
  • Plasma cell myeloma is a clonal neoplasm of plasma cells and is synonymous with multiple myeloma, myelomatosis, and Kahler Disease.
  • Single tumours are generally referred to as plasmacytoma and multiple tumours as multiple myeloma.
  • This tumour affects more males than females, is rare before the age of 30 and peaks between the ages of 50-80.
  • It is the most common primary bone tumour, but it is a rare form of cancer. Solitary plasmacytomas are especially rare in the breast and most often seen in the head and neck area.
  • Neoplastic plasma cells are positive for PAS, methyl green pyronine, LCA and vimentin and are clonal for cytoplasmic light chain.
  • In differentiated forms, Russell bodies (intranuclear inclusions containing immunoglobins) and cytoplasmic globules are also present.
  • A cytologic diagnosis of multiple myeloma may be confirmed using immunoelectrophoresis to detect Bence Jones or myeloma proteins. Amyloid, although not seen in this case, may be occasionally present.
  • Neoplastic plasma cells can resemble cells from an array of poorly differentiated neoplasms. Immunoblastic cells with binucleation and prominent nucleoli mimicking Reed Sternberg cells may be present.

BACK TO IMAGES



HISTOLOGY



REFERENCES:

DeMay RM. The Art & Science of Cytopathology. Chicago ASCP Press, 1996; 784, 817, 821-822.



Gorczyca W, Olszewski W, Tuziak T, et al: Fine Needle Aspiration Cytology of Rare Malignant Tumors of the Breast. Acta Cytol 1992; 36(6): 918-926.



Kini S. Color Atlas of Differential Diagnosis in Exfoliative and Aspiration Cytopathology. Baltimore: Williams & Wilkins, 1999; 128, 285, 466.



Naib ZM. Cytopathology. New York: Little Brown and Company, 1996; 301.



Xiao Yan Yang MD, PhD, Meera Hameed MD, Eun-Sook Cho MD, Kasturi Das MD. Pathologic Quiz Case: Sacral/Pelvic Mass with Lower Back Pain in a 36-Year Old Man. Arch Path Lab Med 2004; 128(2): 237-238.

From the Cytopathology files of BC Cancer
Submitted by: Raj Manak, B.Sc., cytotechnology student and Tom Thomson, MD

SOURCE: Case 10 ( )
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