An 85-year-old man was diagnosed with Multiple Myeloma, clinical stage IIIB. He presented with renal failure, anemia, thrombocytopenia, multiple lytic areas of skull, and a narrow band in γ-globulin region. A monoclonal IgG/Kappa immunoglobulin in both serum and urine was found. Bone marrow examination showed 20% atypical plasma cells, almost all of them containing numerous large azurophilic, bright red, cytoplasmic inclusions on May-Grünwald-Giemsa staining with strong positivity to alpha-naphtyl acetate esterase and acid phosphatase (Fig. 1).
Fig. 1.
Bone marrow hypergranular myelomatous plasma cells
Cytoplasmic crystalline inclusion bodies in neoplastic plasma cells are not a rare event. Inclusions are usually described as Auer rod-like bodies, crystalline structures and Snappen-Schneid granules. Despite initially considered excessive immunoglobulins deposition, they have been thought to be fused lysosomal granules, as suggested by the strong alpha-naphtyl acetate esterase and acid phosphatase activity, also demonstrated in our case [1–3]. Its prognostic values has not been investigated because of its rarity. This patient refused to continue treatment program just after the first bortezomib and dexamethasone infusion and dead 5 months later for progression disease.
Compliance with Ethical Standards
Conflict of interest
Authors declare no conflict of interest.
Ethical Approval
All procedures performed in this study were in accordance with the ethical standard of the instituinal and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed Consent
Informed consent was obtained from the patient to anonymously publish figures.
References
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