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Case 1
“Bone Marrow Biopsy”
Daoud Rahal – Humanitas Clinical Institute - Rozzano
(Pictures by Dr. Rahal)
Clinical history
67 y.o. woman with hepatic cirrhosis correlated to HCV. Diagnosis for MGUS IgG/K, stationary since 1993.
In August 2005 symptoms worsened with suspected evolution of Multiple Myeloma with a Bence Jones protein level of 4g/24h and a monoclonal component of 4g/dl. The patient underwent a bone marrow biopsy.
Microscopical description
The bone marrow structure was disarranged (Pict. 1 - Pict. 2), there were diffuse deposits of crystalloid material (Pict. 3 - Pict. 4 - Pict. 5) mainly needle and rhomboid shaped (Pict. 6 - Pict. 7) in an interstitial extracellular site but often intracellular too (Pict. 8 - Pict. 9 - Pict. 10). Immunohistochemistry studies showed a wide plasmacellular CD138+ proliferation (Pict. 11) and kappa light chain monoclonal antibodies (Pict. 12). No evidence of macrophages with CD68 (osteoclast as internal positive control).
Diagnosis
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