case_images: PMC9453015_01
case_images: Left paravertebral plasmacytoma biopsy on (a) haematoxylin and eosin (H&E) stain, (b) immunohistochemical (IHC) stain of kappa and lambda light chain, (c) IHC stain of p53, (d) FISH of IGH breakapart, and (e) FISH of TP53 deletion.
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case_images: PMC9453015_01_CRIHEM2022-4081971.001.jpg
case_images: fig1
case_images: CT-guided biopsy of left lower thoracic paravertebral mass showed plasmacytoma with lambda light chain restriction (Figure 1). RVD + Z. Retrospective investigation of the initial paravertebral plasmacytoma sample revealed that about 30% of the tumour cells showed aberrant nuclear p53 protein expression (Figure 1), positivity for fluorescent in situ hybridisation (FISH) TP53 deletion (nuc ish (DLEU x 2,TP53 x 1)(200)) (Figure 1), and positivity for FISH IGH rearrangement (nuc ish (IGH x 3,BCL x 2)(51/200)) (Figure 1).
case_images: Cerebrospinal fluid examination at diagnosis (February 2022): (a) cytology and (b) immunophenotyping (the neoplastic plasma cells CD38+/CD56+/CD138-/lambda-restricted were gated red).
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case_images: PMC9453015_01_CRIHEM2022-4081971.002.jpg
case_images: fig2
case_images: CSF analysis showed protein 1.83 g/L, glucose 3.3 mmol/L, cell count 113 x 106/L with all mononuclear cells, cytology of abundant large atypical plasmacytoid cells in loose clusters along with singly dispersed cells, and immunophenotyping of lambda-restricted plasma cells (Figure2).
case_images: MRI of leptomeningeal myelomatosis at progression of leptomeningeal myelomatosis (March 2022): (a) T1 with contrast, vertex level, (b) T1 with contrast, level at bilateral IAC lesions, and (c) T1 with contrast, cerebellum and cervical spine.
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case_images: PMC9453015_01_CRIHEM2022-4081971.003.jpg
case_images: fig3
case_images: MRI showed worsening of leptomeningeal lesions (Figure 3).