case_images: PMC7187674_01
case_images: Plasma cells of bone marrow on May-Giemsa staining (original magnification, x1000).. Plasma cells are large with a high nucleus-to-cytoplasm ratio and clear nucleoli, classified as plasmablastoid cells (A). Some of them have pleomorphic nuclei such as multinucleated (B, C), cleaved (D), or irregularly lobulated (E) nuclei.
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case_images: Examination of bone marrow aspirate demonstrated increased plasma cells (22.6%) on May-Giemsa staining (Figure 1A). A small but significant minority had pleomorphic nuclei such as multinucleated (Figure 1B, 1C), cleaved (Figure 1D), or irregular lobulated (Figure 1E) nuclei.
case_images: Histological findings of bone marrow on hematoxylin-eosin staining and immunostaining.. Plasma cells form clusters. Immunohistochemically, the plasma cells are positive for CD138 and kappa, but negative for lambda, and the MIB-1 index for plasma cells is 80%.
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case_images: In addition, the MIB-1 index for plasma cells was 80% (Figure 2).
case_images: Chromosomal analysis by G-banding of the bone marrow.. G-banding of the bone marrow shows 43, X, -X, add(1)(q11), add(3)(p21), -13, add(14)(q32), der(15)t(1;15)(q12;q26), -16, add(16)(q22), -17, add(19)(q11), add(20)(q11.2), +mar1 in nineteen-twentieths of the cells in the mitotic phase.
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case_images: Chromosomal analysis by G-banding of the bone marrow demonstrated a hypodiploid complex karyotype, including monosomy 13 and 17 in nineteen-twentieths of the cells in the mitotic phase (Figure 3).
case_images: The patient's clinical course from admission to death.. PLT: platelet count, beta2-MG: beta-2-microglobulin, UP: urine protein, FLC: free-light chain, BM: bone marrow, Bor: bortezomib, DEX: dexamethasone, Dara: daratumumab, Car: carfilzomib, Vd: bortezomib/dexamethasone, DVd: daratumumab/bortezomib/dexamethasone, Kd: carfilzomib/dexamethasone.
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case_images: The patient was treated using Vd (bortezomib and dexamethasone) and hemodialysis three times a week (Figure 4).