bromochloroacetic-acid and Multiple-Myeloma

Non-secretory multiple myeloma is a rare form of the disease that presents a diagnostic challenge. A 69-year-old woman presented to the emergency department with a pathological fracture of the right clavicle, along with a history of asthenia and middle back pain in the preceding three months. Workup revealed multiple focal lytic bone lesions in the clavicles, ribs, skull and thoracic- lumbar-sacral spine, without evidence of anemia, hypercalcemia or renal failure, with no abnormal immunofixation in the serum or urine and with normal serum free light chain ratios. The Iliac crest bone marrow aspiration and biopsy revealed a scarcely involved marrow, However, biopsy of one of the focal bone lesions revealed a hypercellular bone marrow with phenotypically abnormal plasmocytes, along with an intriguing, albeit aberrant, cytokeratin expression. Non-secretory multiple myeloma is in itself a rare diagnosis. However, the combination of a patchy marrow involvement and aberrant cytokeratin expression makes this a noteworthy presentation.. O mieloma múltiplo não-secretor é uma forma rara da doença e um desafio diagnóstico. Uma mulher de 69 anos recorreu ao serviço de urgência com uma fratura patológica da clavícula direita e uma história de astenia e dorsalgia com três meses de evolução. A investigação revelou múltiplas lesões ósseas focais osteolíticas nas clavículas, costelas, crânio e coluna dorso-lombo-sagrada, sem evidência de anemia, hipercalcemia ou insuficiência renal, sem imunofixação anormal no soro ou na urina e com rácios de cadeias leves livres normais. O aspirado e biópsia de medula óssea da crista ilíaca revelou um escasso envolvimento por plasmócitos. No entanto, a biópsia de uma das lesões focais revelou uma medula hipercelular com plasmócitos fenotipicamente anormais e com uma aberrante expressão de citoqueratinas. O mieloma múltiplo não-secretor é por si só um diagnóstico raro. Contudo, a combinação de envolvimento irregular da medula e a expressão aberrante de citoqueratinas são merecedoras de atenção.

Topics: Aged; Bone Marrow; Clavicle; Female; Humans; Hypercalcemia; Keratins; Multiple Myeloma

Multiple myeloma is a monoclonal proliferation of plasma cells with common involvement of vertebrae, ribs and skull vault. However, involvement of skull base is relatively uncommon and myeloma manifesting initially as a petrous apex mass is distinctly rare. We report a rare case of non-secretory multiple myeloma in a 52-year-old Egyptian male presenting primarily as a right petrous apex mass with abducens nerve palsy. Additionally, neoplastic cells aberrantly expressed cytokeratin. Although rare, plasma cell myeloma should be considered in the differential diagnosis of petrous apex masses.

Topics: Abducens Nerve Diseases; Diagnosis, Differential; Humans; Keratins; Middle Aged; Multiple Myeloma; Petrous Bone; Tomography, X-Ray Computed

Reactive and neoplastic plasma cells can display considerable morphological anaplasia as well as variable immunoreactivity for epithelial markers including epithelial membrane antigen, pan-cytokeratin (panCK) and high-molecular-weight cytokeratin, potentially creating diagnostic dilemmas. We describe the case of a 51-year-old male, previously treated for IgGλ plasma cell myeloma, whose bone marrow biopsy showed focal replacement by sheets of pleomorphic malignant cells and grade 3 myelofibrosis, raising the morphological possibility of a carcinomatous infiltration. First-line immunohistochemistry revealed strong panCK as well as CD138 positivity. However, subsequent MUM-1 and CD38 stains were also positive, clinching the diagnosis of relapsed plasma cell myeloma with anaplastic morphology and aberrant strong cytokeratin expression. The case warns of the perils of using limited immunohistochemical panels in poorly differentiated metastatic neoplasms and the importance of providing a complete clinical background to the reporting pathologist.

Topics: Antineoplastic Combined Chemotherapy Protocols; Biomarkers, Tumor; Bone Marrow; Humans; Keratins; Male; Middle Aged; Multiple Myeloma; Neoplasm Recurrence, Local

During the preoperative diagnostics of an 80-year-old male patient prior to a planned endarterectomy, an unclear space-occupying lesion was detected in the right nasopharyngeal cavity. It proved to be a dense soft tissue space-occupying lesion of the right maxillary sinus. The histological investigations revealed a partially necrotically decomposed malignant tumor below normal respiratory mucosa free from dysplasia. This case demonstrates the difficulties in differential diagnostics, particularly involving (aberrant) expression of cytokeratin.

Topics: Aged; Biomarkers, Tumor; Carotid Stenosis; Cell Nucleus; Diagnosis, Differential; Endarterectomy, Carotid; Humans; Immunohistochemistry; Incidental Findings; Keratins; Male; Maxillary Sinus; Maxillary Sinus Neoplasms; Multiple Myeloma; Necrosis; Tomography, X-Ray Computed

Extramedullary plasmacytoma of the pancreas is a rare entity. Although this condition is uncommon, it should be considered in the differential diagnosis of solid mass in the pancreas, especially in patients with underlying multiple myeloma. We report a case of pancreatic plasmacytoma in a 56-year-old woman with newly diagnosed multiple myeloma. We highlight this rare manifestation of multiple myeloma among other better recognised presentations.

Topics: Diagnosis, Differential; Female; Humans; Immunohistochemistry; Keratins; Middle Aged; Multiple Myeloma; Pancreas; Pancreatic Neoplasms; Plasmacytoma; Syndecan-1

The use and limitations of fine-needle aspiration (FNA) of lesions of the parotid gland are known, but those of nonparotid lesions of the head have been described only sporadically. We conducted this study to evaluate the utility of FNA and to analyze the causes of diagnostic discrepancies for these lesions. A total of 6,898 FNAs of different sites was performed at our institutions between January 1991-August 1998, and 214 (3.1%) of the cases were FNAs of nonparotid lesions of the head. The most common diagnosis of nonparotid lesions was squamous-cell carcinoma, in 22% (n = 48), and the most common site aspirated was the scalp, in 34% (n = 73). Lipomas and keratinous cysts comprised 5% (n = 9) of the total. A statistical analysis was conducted on 98 paired cytology and histology (n = 83) and cytology and flow cytometry (n = 15) specimens (70 malignant and 28 benign). FNA recognized the malignant and benign nature of the lesion in 60 and 26 cases, respectively with 86% sensitivity 93% specificity and 88% accuracy. Causes of false-negative FNA diagnoses (n = 10) included sampling error (n = 6), bloody smears with scant cellularity (n = 3), and bland cytomorphology (n = 1). Florid granulation tissue and a mucocele of the tongue accounted for the two false-positive cases. We conclude that FNA is an effective tool for triage of surgery candidates with nonparotid lesions of the head. Adequate samples with sufficient cellularity are required for avoiding false-negative diagnoses. Occasionally, tissue biopsy is needed for diagnosis of equivocal cases.

Topics: Adult; Aged; Aged, 80 and over; Biopsy, Needle; Carcinoma, Squamous Cell; Epidermal Cyst; Evaluation Studies as Topic; Female; Head and Neck Neoplasms; Humans; Keratins; Lipoma; Male; Middle Aged; Multiple Myeloma; Scalp; Sensitivity and Specificity

Topics: Adult; Humans; Keratins; Male; Microscopy, Electron; Multiple Myeloma; Vacuoles

Fourteen plasma cell tumours, including examples of solitary plasmacytoma and multiple myeloma, were studied with a panel of antibodies reactive in formalin-fixed, paraffin wax-embedded tissue. Each case showed immunoglobulin light chain restriction. Five tumours were reactive with antibodies to cytokeratin. Of these five cases, four were negative with antibodies to leucocyte common antigen and only one was weakly positive. Anti-cytokeratin reactivity by plasma cell tumours is more common than was originally anticipated and represents an important diagnostic pitfall.

Topics: Humans; Immunohistochemistry; Keratins; Lymphoma; Multiple Myeloma; Plasmacytoma

The histogenesis of the multinucleated cells that characterize myeloma cast nephropathy ("myeloma kidney") has long been a subject of debate. Recent studies have implicated monocyte/macrophage-derived cells rather than tubular epithelial cells as the progenitors of these multinucleated cells. In this study a panel of antibodies including one with high specificity for macrophages was used to study four cases of myeloma cast nephropathy. The authors' findings extend previous observations of others to confirm the macrophage origin of the multinucleated cells in this form of renal injury.

Topics: Antibodies, Monoclonal; Antigens; Humans; Immunohistochemistry; Keratins; Kidney Diseases; Macrophages; Membrane Glycoproteins; Mucin-1; Multiple Myeloma

Topics: Adult; Histocompatibility Antigens; Humans; Immunoglobulin D; Keratins; Leukocyte Common Antigens; Lymphoma, Non-Hodgkin; Male; Multiple Myeloma

A monoclonal antibody (SBU-1) was raised to sheep thymic rudiment by fusion of NSI myeloma cells with spleen cells from BALB/c mice immunized with thymic rudiment isolated from fetal sheep between 25-30 days of gestation. By employing the indirect immunoperoxidase technique the antigen recognized by SBU-1 was found to be present in the epithelial reticular cells of the fetal sheep thymus. The intensity of staining decreased as gestation progressed. In the adult thymus the antigen was mainly restricted to Hassall's corpuscles and occasional epithelial cells in the medulla. In addition, the antigen was also shown to be present in epithelial cells of the small intestine, the bronchiole, the keratinized epithelium of the rumen, and the epithelial cells of the kidney tubules. By use of immunofluorescence the antigen was shown to be present in most of the cells of wool follicles and the cortex of developing wool fibers. Western blotting of SBU-1 against the low-sulfur alpha-keratin proteins of wool confirmed that the antigen recognized by SBU-1 belongs to a family of keratins. It was concluded that SBU-1 was raised against alpha-keratin expressed by the epithelial cells of the thymic rudiment and that the expression of this antigen on the reticular network of the thymus declined with advancement of pregnancy.

Topics: Animals; Antibodies, Monoclonal; Cell Fusion; Female; Fluorescent Antibody Technique; Immunoenzyme Techniques; Keratins; Mice; Mice, Inbred BALB C; Multiple Myeloma; Pregnancy; Sheep; Spleen; Thymus Gland

Mouse monoclonal antibodies to various human epidermal and basement membrane components were formed by immunizing Balb/c mice with ME-180, a line of human cervical carcinoma cells. The spleen cells from hyperimmunized mice were fused with a nonsecreting mouse myeloma cell line using polyethylene glycol. The resulting hybrids were selected by growth in media containing 20% fetal calf serum, hypoxanthine, thymidine, and methotrexate in RPMI-1640 in 24-well Linbro plates. Wells producing antibodies of interest were grown and eventually cloned over an HGPRT- rat fibroblast feeder layer. These cultures were expanded and recloned. Two cloned antibodies of interest are DUX 5.2 and DUX 1.1.3. DUX 5.2 is the mouse IgG1 subclass and reacts with the membranes of ME-180 cells and the human skin epidermal basement membrane zone as shown by direct immunofluorescent microscopy. Ultrastructural localization using electron microscopic immunoperoxidase techniques showed localization of the DUX 5.2 antigen to be beneath the lamina densa; the reaction product may include the anchoring fibrils. Although DUX 5.2 reacts with the normal human basement membrane zone and the basement membrane zone in several diseases, there is no reactivity in the normal, never-blistered skin of patients with dystrophic epidermolysis bullosa (DEB). This suggests that the increased collagenase in the disease may be destroying antigenicity of the antigen recognized by DUX 5.2 or that the antigen may not be present in DEB. This antibody will thus allow early neonatal and prenatal diagnosis in DEB and allow isolation of the structural moiety which is deficient in DEB. DUX 1.1 is an IgM mouse immunoglobulin specific for the cytoplasm of human basal cells. Its reactivity with upper epidermis is significantly less than that seen in the basal layer. All cells of the basal layer stain uniformly. The slight amount of staining in upper cells probably represents dilution of antigen which is not synthesized beyond the basal layer. Basal cells of hair follicles and sweat glands are stained to some degree.

Topics: Animals; Antibodies, Monoclonal; Cell Fusion; Clone Cells; Epithelium; Female; Fluorescent Antibody Technique; Immunoglobulin G; Immunoglobulin M; Keratins; Mice; Mice, Inbred BALB C; Multiple Myeloma; Skin; Skin Diseases

Amyloid of localized cutaneous amyloidosis and systemic amyloidosis were subjected to study with an indirect immunofluorescence technique using anti-keratin antiserum. Anti-keratin antiserum was prepared ad modum Sun & Green. Amyloid of localized cutaneous amyloidosis was positively stained for the antiserum, whereas amyloid of systemic amyloidosis (primary and multiple myeloma-associated) was negative. There was no difference between primary localized cutaneous amyloidosis (lichen amyloidosus and macular amyloidosis) and secondary localized cutaneous amyloidosis (amyloidosis associated with skin tumor). These results indicate that amyloid of localized cutaneous amyloidosis contains components derived from epidermal fibrous protein, probably tonofilaments of keratinocytes.

Topics: Amyloid; Amyloidosis; Fluorescent Antibody Technique; Humans; Immune Sera; Keratins; Multiple Myeloma; Skin; Skin Diseases