Rapidly Progressing Plasma Cell Leukemia with Underlying Plasmablastic Morphology: A Rare Case Report of a 25-Year Old Male
Abstract
Multiple myeloma constitutes a wide spectrum of diseases ranging from slow-growing monoclonal gammopathy of undetermined significance to rapidly progressing plasma cell leukemia. It is a very rarely diagnosed hematological malignancy in those less than 30 years.
A 25-year-old male presented with complaints of fatigue, and low-grade fever. On investigations, he was found to have bicytopeina and features of tumor lysis syndrome. This was initially thought to be consistent with a diagnosis of acute leukemia. Upon further analysis with bone marrow biopsy, serum protein electrophoresis, and immunofixation, the rare diagnosis of IgG myeloma with plasmablastic morphology was confirmed. However, it rapidly progressed and peripheral smear started showing clusters of plasma cells. Despite aggressive treatment, the patient succumbed to aggressive plasma cell leukemia with an underlying plasmablastic morphology.
This case highlights the possibility of myeloma as one of the differentials in young patients especially the rare plasmablastic variant that can get misdiagnosed as acute leukemia. This aggressive morphology may also show rapid progression to plasma cell leukemia and has an adverse prognosis.
2. Bladé J, Kyle RA. Multiple Myeloma in Young Patients: Clinical Presentation and Treatment Approach. Leuk Lymphoma. 1998;30(5–6):493–501.
3. Myeloma - Cancer Stat Facts [Internet]. SEER. [cited 2020 Jan 29]. Available from: https://seer.cancer.gov/statfacts/html/mulmy.html
4. Bladé J, Kyle RA, Greipp PR. Multiple Myeloma in Patients Younger Than 30 Years: Report of 10 Cases and Review of the Literature. Arch Intern Med. 1996;156(13):1463–8.
5. Usha null, Agarwal N, Kumar P, et al. Myeloma in young age. Indian J Pathol Microbiol. 2005;48(3):314–7.
6. Clough V, Delamore IW, Whittaker JA. Multiple Myeloma in a Young Woman. Ann Intern Med. 1977;86(1):117–8.
7. Costello CL. Multiple Myeloma in Patients Under 40 Years Old Is Associated With High-Risk Features and Worse Outcomes. Blood. 2013;122(21):5359–5359.
8. Huzmeli C, Eliacik E, Saglam M, et al. Spontaneous Tumour Lysis Syndrome in a Multiple Myeloma. Case Rep Med. 2016;2016:9620520.
9. Singh A, Gupta S, Yim B, et al. Tumor Lysis Syndrome in Multiple Myeloma: An Increasingly Recognized Risk—A Report of Seven Cases. Indian J Hematol Blood Transfus. 2017;33(1):41–4.
10. Sawyer JR, Lukacs JL, Munshi N, et al. Identification of new nonrandom translocations in multiple myeloma with multicolor spectral karyotyping. Blood. 1998;92(11):4269–78.
11. Bartl R, Frisch B, Burkhardt R, et al. Bone marrow histology in myeloma: its importance in diagnosis, prognosis, classification and staging. Br J Haematol. 1982;51(3):361–75.
12. Bartl R, Frisch B, Fateh-Moghadam A, et al. Histologic classification and staging of multiple myeloma. A retrospective and prospective study of 674 cases. Am J Clin Pathol. 1987;87(3):342–55.
13. Greipp PR, Raymond NM, Kyle RA, et al. Multiple myeloma: significance of plasmablastic subtype in morphological classification. Blood. 1985;65(2):305–10.
14. Greipp PR, Leong T, Bennett JM, et al. Plasmablastic morphology--an independent prognostic factor with clinical and laboratory correlates: Eastern Cooperative Oncology Group (ECOG) myeloma trial E9486 report by the ECOG Myeloma Laboratory Group. Blood. 1998;91(7):2501–7.
15. Srija M, Zachariah PP, Unni VN, et al. Plasmablastic myeloma presenting as rapidly progressive renal failure in a young adult. Indian J Nephrol. 2014;24(1):41–4.
16. Kyle RA. Multiple myeloma: review of 869 cases. Mayo Clin Proc. 1975;50(1):29–40.
17. Majumdar N, Kumar R, Anand M, et al. Plasma cell leukemia – a study of 28 cases from India. Hematology. 2009;14(4):198–203.
18. Tiedemann R, Gonzalez-Paz N, Kyle R, et al. Genetic aberrations and survival in plasma cell leukemia. Leukemia. 2008;22(5):1044–52.
19. Fernández de Larrea C, Kyle RA, Durie BGM, et al. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the International Myeloma Working Group. Leukemia. 2013;27(4):780–91.
20. Gluzinski A, Reichentein M. Myeloma und leucaemia lymphatica plasmocellularis. Wien Klin Wochenschr. 1906;19:336.
21. Kyle RA, Maldonado JE, Bayrd ED. Plasma cell leukemia. Report on 17 cases. Arch Intern Med. 1974;133(5):813–8.
Files | ||
Issue | Vol 16, No 3 (2022) | |
Section | Case Report(s) | |
DOI | https://doi.org/10.18502/ijhoscr.v16i3.10142 | |
Keywords | ||
Multiple myeloma; Plasmablastic; Plasma cell leukemia |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |