Monoclonal Gammopathies

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  • 1. Monoclonal gammopathies Physical, radiological, immunological and cytological aspects
  • 2. Monoclonal gammopathies – physical aspects
    • Plasmacytoma of the nose – bone and surrounding tissue plasma cell infiltration in a case of IgA multiple myeloma (MM).
    • IgA secreting myeloma cells have a propensity to invade ENT – related areas
  • 3. Monoclonal gammopathies – physical aspects
    • Swollen tongue, due to amyloidosis in a case of light-chain multiple myeloma (MM).
    • The amyloid protein in these cases is composed of monoclonal immunoglobulin light chain (AL amyloidosis).
  • 4. Monoclonal gammopathies – radiological aspects
    • The typical “moth-eaten” radiologic aspect of the bones in multiple myeloma (MM): multiple, usually small-size, osteolytic lesions.
    • Osteolytic lesions in MM should be differentiated from those occurring in solid tumor bone metastasis. In these cases, the lesions are fewer, larger and have a surrounding denser area of osteogenesis.
  • 5. Extensive osteolytic lesions in various areas of the skeleton in cases of multiple myeloma (MM)
  • 6. Multiple myeloma – radiological aspects
    • Collapsed vertebra, leading to spinal compression syndrome in a case of multiple myeloma.
  • 7. Multiple myeloma – radiological aspects
    • MRI scan: collapsed vertebra and spinal compression leading to serious neurological impairment in a case of multiple myeloma.
  • 8. Multiple myeloma – radiological aspects
    • Plasmacytoma of the thoracic wall, with contiguous pulmonary infiltration in a case of multiple myeloma.
  • 9. Monoclonal gammopathies – immunological aspects
    • Hyperproteinemia with monoclonal peak in the gamma region due to excess production of monoclonal IgG in a case of multiple myeloma.
    • The detection of a monoclonal peak on protein electrophoresis should be followed by immunoglobulin dosage, and immunofixation.
  • 10. Monoclonal gammopathies – cytological aspects
    • Red cell rouleaux formation on the peripheral smear of a patient with MM.
    • Rouleaux formation correlates with very high erythrocyte sedimentation rate (ESR).
  • 11. Monoclonal gammopathies – cytological aspects
    • The typical picture of massive bone marrow plasma cell infiltration in multiple myeloma (MM) .
    • Normally, plasma cells comprise less than 5% of bone marrow cellularity.
    • Plasma cells are easily recognizable as large cells, with abundant blue cytoplasm and round, off-center placed nucleus.
  • 12. Monoclonal gammopathies – cytological aspects
    • Massive bone marrow infiltration with lymphoid cells with a tendency towards plasma cell differentiation (lymphoplasmacytoid cells) in a case of Waldenstrom’s macroblubulinemia (WM).
    • Lymphoplasmacytoid cells (red arrows) should be differentiated from basophilic erythroblasts (blue arrows).
    • These cells produce monoclonal IgM in excess.