FIGURE 6 - available via license: CC BY
Content may be subject to copyright.
The "Foreign Body" from the Myeloma Kidney Found in the H&E Stain H&E: hematoxylin and eosin
Source publication
Multiple myeloma (MM) is characterized by a proliferation of malignant plasma cells and a subsequent overabundance of monoclonal paraprotein. This disease commonly presents with hypercalcemia, kidney failure, anemia, and bone lesions. Acute kidney failure (AKF) as an initial presentation of MM has rarely been reported. Herein, we present a case of...
Context in source publication
Context 1
... nephropathy is characterized by three main components: proximal renal tubular atrophy, the formation of eosinophilic cylinders in the distal tubule, and inflammation with interstitial fibrosis [5]. The typical histopathological finding is the presence of light chain eosinophilic cylinders inside the lumen of the renal tubules surrounded by cellsmultinucleated giants generating a "foreign body" reaction in the distal tubules and collecting duct ( Figure 6). Studies of the immunofluorescence and ultrastructure of the cylinders identified TammHorsfall mucoprotein, which is synthesized by distal tubular cells, validating the diagnostic suspicion of myeloma kidney. ...
Similar publications
Background
Renal involvement in monoclonal gammopathies presents with different clinico-morphological patterns and can manifest at the onset or the late phase of hematological disease, or after chemotherapy. The spectrum is ever-expanding with advancements in diagnostic methods. Renal biopsy is needed for accurate diagnosis, as each of these patter...
Citations
... Clinically, PCM presenting with abdominal pain as the initial symptom, like in our patient, is unusual and seldom reported. Upon review of the biomedical literature, we found only four reports of patients with IgA PCM presenting with abdominal pain (Table 2) [10][11][12][13]. In all four reports, a single monoclonal IgA paraprotein was identified. ...
... In all four reports, a single monoclonal IgA paraprotein was identified. Interestingly, three of these four cases of IgA PCM presenting with abdominal pain occurred in adults of a younger age (39, 49, 57 years) [10][11][12] than the reported average age for IgA patients (66.5 years) [1]. Our 65-yearold patient would be the first report of an aggressive biclonal IgA PCM presenting as new-onset abdominal pain. ...
IgA plasma cell myeloma (PCM) has been linked to molecular abnormalities that confer a higher risk for adverse patient outcomes. However, since IgA PCM only accounts for approximately 20% of all PCM, there are very few reports on high-risk IgA PCM. Moreover, no such reports are found on the more infrequent biclonal IgA PCM. Hence, we present a 65-year-old Puerto Rican female with acute abdominal pain, concomitant hypercalcemia, and acute renal failure. Protein electrophoresis with immunofixation found high IgA levels and detected a biclonal IgA gammopathy with kappa specificity. Histomorphologically, bone marrow showed numerous abnormal plasma cells (32%) replacing over 50% of the marrow stroma. Immunophenotyping analysis detected CD45-negative plasma cells aberrantly expressing CD33, CD43, OCT-2, and c-MYC. Chromosomal analysis revealed multiple abnormalities including the gain of chromosome 1q. Thus, we report on an unusual biclonal IgA PCM and the importance of timely diagnosing aggressive plasma cell neoplasms.
