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Year : 2009  |  Volume : 52  |  Issue : 3  |  Page : 453-454
An unusual soft tissue plasmacytoma with massive intracellular deposition of needle-shaped crystals


Departments of Histopathology and Neurosurgery, PGIMER, Sector-12, Chandigarh - 160 012, India

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Date of Web Publication12-Aug-2009
 

How to cite this article:
Bal A, Kumar Y, Radotra B D, Mohindru S. An unusual soft tissue plasmacytoma with massive intracellular deposition of needle-shaped crystals. Indian J Pathol Microbiol 2009;52:453-4

How to cite this URL:
Bal A, Kumar Y, Radotra B D, Mohindru S. An unusual soft tissue plasmacytoma with massive intracellular deposition of needle-shaped crystals. Indian J Pathol Microbiol [serial online] 2009 [cited 2019 Dec 12];52:453-4. Available from: http://www.ijpmonline.org/text.asp?2009/52/3/453/55033


Sir,

Several rare morphological changes have been described in plasma cell disorders like clear cell variant, signet ring morphology or rarely, deposition of crystals. In the English literature there are only a few case reports of crystal deposition in the gastric, salivary gland, [1] testis, [2] lungs, and lymph node plasmacytoma. Most of these cases represent light chains of immunoglobulins which are concentrated within the cells. [3] A 53-year-old male presented with a history of pain in the upper back and stiffness of lower limbs of two and a half months duration. On computed tomography (CT) scan and magnetic resonance imaging there was a left-sided postero-lateral epidural, soft tissue mass in D3-4 region which was extending into the neural foramen. The mass was associated with a lytic lesion involving the left transverse process, left pedicle and posterior part of body of D3 vertebra. The cord was compressed and displaced to the right and anteriorly. The rest of the spine did not show any cord compression or canal stenosis. The radiological possibilities suggested were neoplastic versus infective conditions. The patient was investigated extensively to exclude a metastasis. The hemogram findings were within normal limits except for raised erythrocyte sedimentation rate (ESR). The bone marrow examination showed only 2% plasma cells. The serum electrophoresis showed a prominent M-band in the beta-gamma region. The immunofixation study confirmed it to be due to IgM type of immunoglobulin. There were no Bence-Jones proteins in the urine. This was followed by D2 and D3 laminectomy and excision of epidural mass. The excised tissue was sent for histopathological examination.

Grossly, the specimen was in the form of multiple, irregular grayish white tissue pieces and all were processed. The microscopic examination showed fibrocollagenous tissue, skeletal muscle and bony fragments. There were focal collections of predominantly mature plasma cells and a few having large size and prominent nucleoli. Inflammatory component or macrophages were absent. The interesting finding was presence of abundant needle-shaped structures within the cell cytoplasm and in the intervening stroma [Figure 1]. Some of the areas were acellular with only sheets of crystals while at other places there were few swollen plasma cells containing abundant cytoplasm filled with crystalloid structures. At places these crystals were obscuring plasma cell morphology and were simulating cells of a striated muscle tumor because of parallel arrangement of the crystals within the cytoplasm. The immunohistochemistry showed strong positivity for syndecan-1, a plasma cell marker and kappa light chain. Congo red stain for amyloid was negative excluding the possibility of amyloid production. The electron microscopy showed numerous needle-shaped and rhomboidal crystals present within the cell cytoplasm as well as extracellularly [Figure 2]. Based on these findings the diagnosis made was an unusual plasmacytoma with extensive, intra and extracellular, kappa light chain crystals. Postoperative radiotherapy was planned for the patient. There were no postoperative complications and patient was discharged after a few days.

Though crystal formation has been observed in multiple myeloma, it is extremely rare in a solitary plasmacytoma. The needle-shaped crystals in a plasmacytoma if extensive may sometimes obscure the underlying plasma cell morphology and need to be differentiated from striated muscle tumor as in the present case.

 
   References Top

1.El-Naggar AK, Ordonez NG, Batsakis JG. Parotid gland plasmacytoma with crystalline deposits. Oral Surg Oral Med Oral Pathol 1991;71:206-8.  Back to cited text no. 1  [PUBMED]  
2.Hailemariam S, Engeler DS, Koller TL, Sulser T, Spycher M, Schneider J. Unusual crystalline inclusions in plasmacytoma cells of the testis in primary medullary plasmacytoma. Pathologie 1996;17:455-8.  Back to cited text no. 2    
3.Das S, Kakkar N, Ahuja B, Lal M. Auer rod-like inclusions in myeloma cells in a patient with IgG multiple myeloma. Indian J Pathol Microbiol 2006;49:561-3.  Back to cited text no. 3  [PUBMED]  Medknow Journal

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Correspondence Address:
Amanjit Bal
Department of Histopathology, PGIMER, Sector 12, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.55033

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