A 61-year-old man had 1 week of fatigue, nausea, weight loss, and hypertension. His creatinine was 1271μM and potassium was 5.6mM. The complete blood count, sedimentation rate, lactate dehydrogenase, calcium, phosphate, and albumin were normal. Tests for ANCA and anti-GBM were negative. His serum immunoglobulin levels were markedly suppressed. Serum electrophoresis showed monoclonal kappa light chains (2690 mg/L) and the urine had a trace of kappa chains. Multiple lytic lesions were also seen. Bone marrow showed monoclonal kappa light chain plasma cells (8% of the nucleated cells) with numerous large, blue spherical depositions, both extracellularly (shown, left) and within plasma cells (shown, right). A kidney biopsy revealed cast nephropathy with spherical deposits of monoclonal kappa chains.
He was begun on bortezomib and dexamethasone and required hemodialysis. After 3 months of no improvement, he was referred for intensive chemotherapy and stem cell transplantation. Interestingly, his father and uncle had multiple myeloma that required acute hemodialysis and chemotherapy.
Plasma cells occasionally contain blue, pink, or colorless cytoplasmic spherules that are known as Russell bodies. These globules can also be seen extracellularly. When large accumulations of spherules appear within a plasma cell, it may be referred to as a Mott cell. These abnormalities are not specific for light chain myeloma and may be seen in other types of myeloma, as well as in chronic inflammation or immunologic stimulation (tuberculosis, rheumatoid arthritis, etc).
A 61-year-old man had 1 week of fatigue, nausea, weight loss, and hypertension. His creatinine was 1271μM and potassium was 5.6mM. The complete blood count, sedimentation rate, lactate dehydrogenase, calcium, phosphate, and albumin were normal. Tests for ANCA and anti-GBM were negative. His serum immunoglobulin levels were markedly suppressed. Serum electrophoresis showed monoclonal kappa light chains (2690 mg/L) and the urine had a trace of kappa chains. Multiple lytic lesions were also seen. Bone marrow showed monoclonal kappa light chain plasma cells (8% of the nucleated cells) with numerous large, blue spherical depositions, both extracellularly (shown, left) and within plasma cells (shown, right). A kidney biopsy revealed cast nephropathy with spherical deposits of monoclonal kappa chains.
He was begun on bortezomib and dexamethasone and required hemodialysis. After 3 months of no improvement, he was referred for intensive chemotherapy and stem cell transplantation. Interestingly, his father and uncle had multiple myeloma that required acute hemodialysis and chemotherapy.
Plasma cells occasionally contain blue, pink, or colorless cytoplasmic spherules that are known as Russell bodies. These globules can also be seen extracellularly. When large accumulations of spherules appear within a plasma cell, it may be referred to as a Mott cell. These abnormalities are not specific for light chain myeloma and may be seen in other types of myeloma, as well as in chronic inflammation or immunologic stimulation (tuberculosis, rheumatoid arthritis, etc).
Many Blood Work images are provided by the ASH IMAGE BANK, a reference and teaching tool that is continually updated with new atlas images and images of case studies. For more information or to contribute to the Image Bank, visit http://imagebank.hematology.org.
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