Monoclonal Gammopathies

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Monoclonal Gammopathies

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

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