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Bone marrow biopsy specimens delineating multinucleated giant plasma cell infiltration (red arrow) in a patient with diagnosed multiple myeloma after rituximab/lenalidomide (R 2 ) treatment. (A) Hematoxylin and eosin section of bone marrow trephine biopsy showing multinucleated giant plasma cells. (B-F) Following unicolored respectively bicolored immunohistochemistry, the plasma cells were (B) CD20þ (brown), (C) CD79þ (brown), (D) CD138þ, Mib1-(bicolored: CD138 brown; Mib1 red), (E) kappaþ/lambda-(bicolored: kappa red; lamda brown) and (F) cyclinD1þ. CD: cluster of differentiation.
Context in source publication
Context 1
... 4 cycles (28days/cycle) of R 2 , IgG decreased to 1620 mg/dl, free light chain kappa to 89 mg/l and the kappa/lambda quotient to 30. However, BM biopsy still showed continuous MM infil- tration (35%) with persisting aberrant CD20 and high level of cyclinD1 expression after 4 cycles of R 2 ( Figure 1). Interestingly, at this time, multiple giant plasma cells with up to forty nuclei and phagocytosis of erythroid and granulocytic cells could be detected (Figure 2). ...
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Citations
... Multiple myeloma (MM), a clonal malignant hematological condition arising from neoplastic transformation of a plasma cell (PC), is characterized by bone marrow (BM) accumulation of neoplastic clones with hyperproduction of monoclonal immunoglobulins (M-proteins) detected in serum and/or urine. 1 PC morphology might vary from mature cells to plasmablasts, or other pleiomorphic forms, such as hairy cell-like phenotype 2 ; however, findings of giant multinucleated PCs are rarely described and poorly investigated in clinical features and outcomes. 3,4 Here, we report a case of a young female with newly diagnosed MM characterized by multinucleated PCs in the BM and poor prognostic cytogenetic abnormalities successfully treated with induction therapy followed by autologous hematopoietic stem cell transplantation (HSCT). ...
... Moreover, around 10% of BM PCs were multinucleated (from three to 13 strat- BM giant PCs with more than three nuclei are rare, and their presence has been related to poor outcomes. [3][4][5] However, revision of 61 BM MM aspirates has revealed that multinucleated PCs can be commonly found (56% of cases) while not influencing clinical outcomes and renal dysfunction development. 6 In other reports, giant multinucleated PCs have been described in aggressive diseases that F I G U R E 1 (A-D) Bone marrow blood smears showed giant plasma cells with multiple immature nuclei (from 3 to more than 10), inconsistent nucleoli, extensive Golgi, vacuoles, and cell membrane fragility (Wright-Giemsa stain, 60× magnification). ...
Background
Multiple myeloma with giant multinucleated plasma cells is a very rare entity and mostly reported cases are dated. This plasma cell morphology has been observed after monoclonal antibody treatments, such as daratumumab, and patients have experienced a worse prognosis with partial responses and a high rate of relapse.
Results
Here, we showed a newly diagnosed multiple myeloma with giant plasma cells with multiple (up to 13) immature nuclei who achieved a complete remission after a first line therapy and underwent to autologous hematopoietic stem cell transplantation, as per international guidelines.
B-cell malignancies account for the majority of non-Hodgkin’s lymphomas and approximately 2.8% of all cancer cases. CD20 is a prominent surface marker molecule expressed in most stages of B-cell development. The
observation of the high expression of CD20 on many B-cell neoplasms led to its utility as a target for cancer management. Many monoclonal anti-CD20 antibodies were licensed and some were being researched; they
employ varying degrees of the antibody-mediated killing of their target, which includes antibody-dependent cell-mediated cytotoxicity (ADCC), antibody-dependent cell-mediated phagocytosis (ADCP), complementdependent
cytotoxicity (CDC), induction of apoptosis, direct cell death, increased expression of reactive oxygen pecies, and other nonapoptotic cell death mechanisms. Rituximab, an anti-CD20 monoclonal antibody,
was the first FDA-approved CD20-based agent for cancer management with huge success. However, there exist some poor outcomes among some patients and in certain B-cell cancer types. Despite anti-CD20 combination
therapy with chemotherapy and radiotherapy in B-cell non-Hodgkin’s lymphoma, refractory cases arise, which were thought to be caused by mutations in CD20 signaling pathways. Currently, combining anti-CD20 with other monoclonal antibodies has yielded promising results in some B-cell neoplasms. In this chapter, we carefully scrutinized and reviewed the most recent classification of B-cell malignancies and available anti-CD20-based agents. We discussed the origin, mechanism of action, efficacy, and side effects of CD20- based agents in the management of B-cell malignancies. We also show how these shortcomings could be remedied from knowledge obtained from recent advances in molecular, genomic, and clinical studies.
