Advertisement

CD38 negative anaplastic plasma cell myeloma with (14;16) translocation: a diagnostic dilemma for highly aggressive neoplasm: case report

  • Mansour S. AljabryEmail author
Case Report
  • 3 Downloads

Abstract

Anaplastic plasma cell myeloma (PCM) is an aggressive morphological variant of myeloma characterized by involvement of extramedullary sites and extremely poor prognosis. Moreover, anaplastic PCM is frequently associated with high frequency of 17p(p53) deletions, 1q21(CKS1B) amplifications and immunoglobulin A (IgA) isotype. It usually manifests as an adverse progression of previously treated conventional plasma cell myeloma. However, the anaplastic morphology can be encountered in newly diagnosed cases and might pose a major diagnostic challenge. Herein, we present a rare case of anaplastic plasma cell myeloma with (14;16) translocation which was diagnosed initially as a non-hematopoietic malignancies due to its unusual clinicopathological profile comprising acute presentation, extremely anaplastic morphology, and negative staining of CD38 immunohistochemical marker. In view of lack of clinical suspicion of plasma cell myeloma, no serological investigations for myeloma had been requested initially. In fact, high index of suspicion of myeloma arose only when results of MRI and CT scan came out revealing bony lytic lesions and collapsed vertebrae. Subsequently, bone marrow biopsy was repeated and revealed an extensive infiltration with sheets of neoplastic plasma cells which were strongly positive for CD138, KAPPA, and CD56 IHC markers.

Keywords

Anaplastic myeloma CD38 IHC markers t(14;16) 

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Zervas K, Constantinou N, Karakantza M, Tsigalidou-Balla V (1995) Anaplastic myeloma. Leuk Lymphoma 16(5–6):515–518CrossRefGoogle Scholar
  2. 2.
    Ammannagari N, Celotto K, Neppalli V, Lee K, Holstein SA (2016) Anaplastic multiple myeloma: an aggressive variant with a poor response to novel therapies. Clin Lymphoma Myeloma Leuk 16(9):e129–ee31CrossRefGoogle Scholar
  3. 3.
    Foucar K, Raber M, Foucar E, Barlogie B, Sandler CM, Alexanian R (1983) Anaplastic myeloma with massive extramedullary involvement. Report of two cases. Cancer 51(1):166–174CrossRefGoogle Scholar
  4. 4.
    Fujimi A, Nagamachi Y, Yamauchi N, Kanisawa Y (2017) Morphological transformation of myeloma cells into multilobated plasma cell nuclei within 7 days in a case of secondary plasma cell leukemia that finally transformed as anaplastic myeloma. Case Rep Hematol 2017:5758368PubMedPubMedCentralGoogle Scholar
  5. 5.
    Allen SL, Coleman M (1990) Aggressive phase multiple myeloma: a terminal anaplastic transformation resembling high-grade lymphoma. Cancer Investig 8(3–4):417–424CrossRefGoogle Scholar
  6. 6.
    Shaughnessy J (2005) Amplification and overexpression of CKS1B at chromosome band 1q21 is associated with reduced levels of p27Kip1 and an aggressive clinical course in multiple myeloma. Hematology 10(Suppl 1):117–126CrossRefGoogle Scholar
  7. 7.
    Singh N, Agrawal N, Mehta A, Panaych A, Sekhri R (2018) CD38-negative myeloma with anaplastic morphology at presentation: a case report. Indian J Hematol Blood Transfus 34(2):362–364CrossRefGoogle Scholar
  8. 8.
    Fedele G, Di Girolamo M, Recine U, Palazzo R, Urbani F, Horenstein AL et al (2013) CD38 ligation in peripheral blood mononuclear cells of myeloma patients induces release of protumorigenic IL-6 and impaired secretion of IFNgamma cytokines and proliferation. Mediat Inflamm 2013:564687CrossRefGoogle Scholar
  9. 9.
    Raedler LA (2016) Darzalex (daratumumab): first anti-CD38 monoclonal antibody approved for patients with relapsed multiple myeloma. Am Health Drug Benefits 9(Spec Feature):70–73PubMedPubMedCentralGoogle Scholar
  10. 10.
    Bataille R, Jego G, Robillard N, Barille-Nion S, Harousseau JL, Moreau P et al (2006) The phenotype of normal, reactive and malignant plasma cells. Identification of “many and multiple myelomas” and of new targets for myeloma therapy. Haematologica 91(9):1234–1240PubMedGoogle Scholar
  11. 11.
    Ise M, Matsubayashi K, Tsujimura H, Kumagai K (2016) Loss of CD38 expression in relapsed refractory multiple myeloma. Clin Lymphoma Myeloma Leuk 16(5):e59–e64CrossRefGoogle Scholar
  12. 12.
    Kawano Y, Fujiwara S, Wada N, Izaki M, Yuki H, Okuno Y et al (2012) Multiple myeloma cells expressing low levels of CD138 have an immature phenotype and reduced sensitivity to lenalidomide. Int J Oncol 41(3):876–884CrossRefGoogle Scholar
  13. 13.
    Dingli D, Ailawadhi S, Bergsagel PL, Buadi FK, Dispenzieri A, Fonseca R, Gertz MA, Gonsalves WI, Hayman SR, Kapoor P, Kourelis T, Kumar SK, Kyle RA, Lacy MQ, Leung N, Lin Y, Lust JA, Mikhael JR, Reeder CB, Roy V, Russell SJ, Sher T, Stewart AK, Warsame R, Zeldenrust SR, Rajkumar SV, Chanan Khan AA (2017) Therapy for relapsed multiple myeloma: guidelines from the Mayo stratification for myeloma and risk-adapted therapy. Mayo Clin Proc 92(4):578–598CrossRefGoogle Scholar
  14. 14.
    Avet-Loiseau H, Malard F, Campion L, Magrangeas F, Sebban C, Lioure B, Decaux O, Lamy T, Legros L, Fuzibet JG, Michallet M, Corront B, Lenain P, Hulin C, Mathiot C, Attal M, Facon T, Harousseau JL, Minvielle S, Moreau P, for the Intergroupe Francophone du Myelome (2011) Translocation t(14;16) and multiple myeloma: is it really an independent prognostic factor? Blood 117(6):2009–2011CrossRefGoogle Scholar
  15. 15.
    Nair B, van Rhee F, Shaughnessy JD Jr, Anaissie E, Szymonifka J, Hoering A et al (2010) Superior results of total therapy 3 (2003–33) in gene expression profiling-defined low-risk multiple myeloma confirmed in subsequent trial 2006–66 with VRD maintenance. Blood 115(21):4168–4173CrossRefGoogle Scholar
  16. 16.
    Vega F, Chang C-C, Medeiros LJ, Udden MM, Cho-Vega JH, Lau C-C, et al (2005) Plasmablastic lymphomas and plasmablastic plasma cell myelomas have nearly identical immunophenotypic profiles. 806–15 pGoogle Scholar
  17. 17.
    Elyamany G, Al Mussaed E, Alzahrani AM (2015) Plasmablastic lymphoma: a review of current knowledge and future directions. Adv Hematol 2015:315289CrossRefGoogle Scholar
  18. 18.
    Montes-Moreno S, Martinez-Magunacelaya N, Zecchini-Barrese T, Villambrosia SG, Linares E, Ranchal T et al (2017) Plasmablastic lymphoma phenotype is determined by genetic alterations in MYC and PRDM1. Mod Pathol 30(1):85–94CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.HematopathologyKing Khalid University Hospital–King Saud UniversityRiyadhKingdom of Saudi Arabia

Personalised recommendations