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IMAGES
IN HEMATOLOGY
Flame cell in IgA monoclonal gammopathy of
undetermined significance
c Ranjit Nair and Shereen Gheith, Lehigh Valley Health Network
56-year-old diabetic woman presented with significant proteinuria. Serum protein electrophoresis demonstrated an elevated a2
region. Immunofixation confirmed immunoglobulin A-l (IgA-l) monoclonal protein (unquantifiable). The serum IgA level
was 763 mg/dL (normal range, 83-407 mg/dL). The serum k/l free light chain ratio was 0.5 (normal range, 0.26-1.76). The result
of urine protein electrophoresis was negative for monoclonal proteins. Blood counts, blood chemistry, and skeletal survey findings
were normal. The bone marrow aspirate smear showed plasma cells with abundant eosinophilic cytoplasm consistent with flame
cells (panels A-B; original magnification 3100; Wright-Giemsa stain). There was a l light chain (dim) restricted plasma cell
population (;5% on bone marrow core biopsy specimen) (panel C; original maginification 340; CD138 immmunohistochemistry
stain). Overall, findings were consistent with IgA monoclonal gammopathy of undetermined significance.
A
Historically, flame cells were used to identify IgA monoclonal proteins and are more often reported in association with IgA
myeloma. The “flaming” phenomenon can be uncommonly seen in other myeloma types and in reactive inflammatory states. There
is no definitive evidence to suggest an association with myeloma progression or aggressiveness. The deeply stained pinkish
hue at the cell periphery is thought to be the result of precipitated carbohydrate-rich IgA in the endoplasmic reticulum, which
appears in stark contrast to the perinuclear halo of the Golgi apparatus. The patient continues to receive follow-up care and has
stable renal function, which is now presumed to be diabetes related.
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DOI 10.1182/blood-2016-09-724633
1402
© 2017 by The American Society of Hematology
BLOOD, 9 MARCH 2017 x VOLUME 129, NUMBER 10
From www.bloodjournal.org by guest on June 17, 2017. For personal use only.
2017 129: 1402
doi:10.1182/blood-2016-09-724633
Flame cell in IgA monoclonal gammopathy of undetermined significance
Ranjit Nair and Shereen Gheith
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