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MPGN secondary to monoclonal immunoglobulins. A: LM shows an MPGN with mesangial and endocapillary proliferation and thickened capillary walls with double contour formation. A small cellular crescent is also noted (PAS ×40). B, C, D, E: IF microscopy shows mesangial and capillary wall staining for IgG, C3 and kappa light chains but is negative for lambda light chains (×40). F: EM shows small subendothelial deposits (white arrow) with double contour formation (black arrows) (×3400).
