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Year : 2011  |  Volume : 54  |  Issue : 4  |  Page : 836-837
Cystalline inclusions in plasma cells


1 Department of Hematology, Clinical Lab, Medanta The Medicity, Gurgaon, Haryana, India
2 Institute of Medical Oncology and Hematology, Medanta The Medicity, Gurgaon, Haryana, India

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Date of Web Publication6-Jan-2012
 

How to cite this article:
Gupta A, Gupta M, Handoo A, Vaid A. Cystalline inclusions in plasma cells. Indian J Pathol Microbiol 2011;54:836-7

How to cite this URL:
Gupta A, Gupta M, Handoo A, Vaid A. Cystalline inclusions in plasma cells. Indian J Pathol Microbiol [serial online] 2011 [cited 2019 Oct 22];54:836-7. Available from: http://www.ijpmonline.org/text.asp?2011/54/4/836/91545


A 67-year-old patient, follow-up case of hypertension on treatment, presented with a history of weight loss. No fever or bone pain was reported. He had an episode of hyponatremia in January 2010 and had been having raised gamma globulins persistently for the past few months. On investigation, he was found to have Hb of 12 gm/dL, ESR 32 mm at 1 h, normal serum calcium levels and raised β-2 microglobulin levels (4492 μg/L). His serum protein electrophoresis showed presence of a monoclonal band. His peripheral smear showed predominantly normocytic normochromic red blood cell morphology with increased rouleaux formation. Bone marrow aspiration smears revealed the presence of 15.5% plasma cells along with many binucleate, trinucleate and multinucleate forms, many of which showed the presence of intracytoplasmic eosinophilic crystalline inclusions [Figure 1], [Figure 2], [Figure 3] and [Figure 4]. These inclusions varied in shape from "Auer rod like" rods, rectangular, square and also resembling amorphus debris as well. Periodic acid schiff (PAS) stain and Perls' prussian blue reaction were negative. ANAE/Sudan black/MPO reactions showed refractile bodies.
Figure 1: Plasma cells showing crystalline immunoglobulin inclusions, (Geimsa stain, ×1000)

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Figure 2: Binucleate plasma cell showing crystalline inclusions, (Geimsa stain, ×1000)

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Figure 3: A trinucleate plasma cell showing intracytoplasmic crystalline inclusions, (Geimsa stain, ×1000)

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Figure 4: Multinucleate plasma cell with intracytoplasmic crystalline inclusions, (Geimsa stain, ×1000)

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Crystalline inclusions in the cytoplasm of lymphoid cells are an uncommon but well-documented finding in B-cell lymphoproliferative disorders, including plasmacytoma, multiple myeloma, chronic lymphocytic leukemia, lympho-plasmacytic lymphoma, mucosa-associated lymphoid tissue lymphomas and, rarely, high-grade lymphomas. The presence of crystalline inclusions in plasma cell myeloma is an uncommon phenomenon. These crystals have variable light microscopic appearances and may exhibit rectangular, elongated, needle-shaped or rhomboid morphology, and they are believed to be due to the accumulation of cytoplasmic immunoglobulins secondary to a block in the protein synthetic pathway. [1] These crystals can also be seen in the extracellular location, and have also been reported in histiocytes in a condition referred to as crystal-storing histiocytosis. [1],[2] Cases of multiple myeloma showing the presence of azurophilic granules have been reported where these granules were occasionally positive for PAS stain and MUM 1 on immunohistochemistry, but negative for Sudan black. [3]

 
   References Top

1.Stewart CJ, Spagnolo DV. Crystalline plasma cell inclusions in helicobacter-associated gastritis. J Clin Pathol 2006;59:851-4.  Back to cited text no. 1
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2.Zioni F, Giovanardi P, Bozzoli M, Artusi T, Bonacorsi G, Sighinolfi P. Massive bone marrow crystal storing histiocytosis in a patient with IgA- Lambda multiple myeloma and extensive extramedullary disease. A case report. Tumori 2004;90:348-51.  Back to cited text no. 2
[PUBMED]    
3.Ali N, Moiz B. Azurophilic inclusions in plasma cells. Singapore Med J 2009;50:e114-5.  Back to cited text no. 3
[PUBMED]  [FULLTEXT]  

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Correspondence Address:
Anil Handoo
Department of Hematology, Clinical Lab, Medanta The Medicity, Gurgaon, Haryana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.91545

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    Figures

  [Figure 1], [Figure 2], [Figure 3], [Figure 4]



 

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