Plasma cell myeloma: a case report

Abstract

Introduction: Plasma Cell Myeloma or Multiple Myeloma (MM) is the most frequent plasma cell neoplasm of malignant monoclonal gammopathies. Frequently present between the ages of 60 and 70. They are disorders characterized by clonal proliferation of immunoglobulin-secreting plasma cells from a single progenitor cell. This condition is presented with typical symptoms and signs, such as bone pain, hypercalcemia, bone fractures, kidney damage, anemic syndrome, neurological symptoms and recurrent infections. The objective of our work is report a case of MM, review its medical clinic, form of presentation, macro and microscopic appearance, with its respective immunohistochemistry, immunophenotyping, biological behavior and prognosis, comparing it with other similar cases.

Case presentation: It was a 62-year-old woman with severe humeral bone pain. The physical examination and imaging studies suspected a tumor lesion on her humerus, and others were discovered in the ribs, vertebrae and pelvis. A biopsy was taken for pathological analysis, which reported poorly differentiated neoplasia with numerous "plasmacytoid" type cells. Immunohistochemistry was positive for CD138 and CD79a. In addition, a biopsy of the iliac bone marrow was requested, which revealed hypercellularity with interstitial-like infiltration of mature-appearing plasma cells. Immunophenotyping indicated 1.5% of plasma cells, of which 99% presented restriction in the expression of cytoplasmic immunoglobulins, lambda light chain; with the phenotype: CD45-/CD38+/ CD138+/CD56+/ CD19-; linkable to abnormal plasma cells. The multiple osteolytic lesions, conjointly with the data obtained by histopathology, the immunohistochemically profile and the immunophenotyping, were found to be associated to plasma cell myeloma. The patient was treated with chemotherapy, being her evolution favourable with 6 months of follow-up.

Conclusions: MM is the most frequent plasma cell neoplasm, characterized by clonal proliferation of immunoglobulin-secreting plasma cells. They are usually classified into secretory or non-secretory MM, being the non-secretory with the most unfavorable prognosis. Our case agree, from the clinical view, the anatomopathological, immunohistochemical and immunophenotypic findings, with what is described in the consulted bibliography.