Blood Research Educational Material
BLOOD RESEARCH
Volume 48ㆍNumber 3ㆍSeptember 2013
http://dx.doi.org/10.5045/br.2013.48.3.169
Multiple myeloma with spindle-like cell morphology
Joowon Park
Department of Laboratory Medicine, Dankook University Hospital, Cheonan, Korea
Correspondence to Joowon Park, M.D., Department of Laboratory Medicine, Dankook University Hospital, San 16-5, Anseo-dong, Cheonan 330-715,
Korea, E-mal: [email protected]
A 43-year-old man presented with lower abdominal pain. Initial values of laboratory examinations were as follows:
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white blood cells (WBC), 8.62×10 /L; hemoglobin (Hb), 11.4 g/dL; platelets, 268×10 /L; serum calcium, 9.1 mg/dL;
protein/albumin, 6.7/4.5 g/dL; and creatinine, 3.4 mg/dL. Abdominopelvic computed tomography (CT) revealed
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osteolytic lesions in the right 6 rib and right ilium. Serum protein electrophoresis (PEP) showed no specific finding,
but urine PEP revealed Bence-Jones proteinuria (M-protein of 5.2 g/24 h). Serum and urine immunofixation
electrophoresis showed a zone of restriction in the kappa light chain. In a concurrent bone marrow (BM) study,
BM aspirate revealed a diluted feature with no remarkable finding. BM biopsy, however, showed aggregates of
atypical spindle-like cells (A). With immunohistochemical staining, the spindle-shaped cells showed positive reaction
to kappa light chain (B) and negative reaction to lambda light chain (C). Cytogenetic testing showed normal
karyotype. The patient was diagnosed with multiple myeloma (MM) of light chain type. BM examination is a
fundamental element in the diagnosis of MM, and the knowledge of unusual presentation of plasma cells such as
spindle-like cell morphology would be helpful for a proper hematologic diagnosis.
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