case_images: PMC6586138_01
case_images: During normal B-cell development, cells acquire expression of CD 138 which is a marker highly specific for terminally differentiated normal plasma cells. Since CD 138 is a specific surface antigen for plasma cells in the bone marrow, a CD 138 immunohistochemical stain can identify plasma cells as seen in our case.
case_images: ZJCH_A_1620092_F0001_PB.jpg
case_images: PMC6586138_01_ZJCH_A_1620092_F0001_PB.jpg
case_images: F0001
case_images: A CD 138 immunohistochemical stain identified plasma cells (see Figure 1).
case_images: Plasma cells are large lymphocytes with a considerable nucleus-to-cytoplasm ratio. They have an eccentric nucleus with chromatin in a characteristic clock-face arrangement. This plasma cell in our patient is seen from the bone marrow touch imprints.
case_images: ZJCH_A_1620092_F0002_PB.jpg
case_images: PMC6586138_01_ZJCH_A_1620092_F0002_PB.jpg
case_images: F0002
case_images: The bone marrow touch imprints (see Figure 2) identify plasma cells.
case_images: EKG shows low voltage criteria in the limb leads. EKG is also significant for anterior pseudo-infarct pattern with Q waves in anterior leads V1 - V3. These two findings have high specificity and high predictive value for cardiac amyloidosis.
case_images: ZJCH_A_1620092_F0003_PB.jpg
case_images: PMC6586138_01_ZJCH_A_1620092_F0003_PB.jpg
case_images: F0003
case_images: ECG at that time showed low voltage criteria and an anterior pseudo-infarct pattern with Q waves in V1, V2, and V3 (see Figure 3).