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==Overview== | ==Overview== | ||
Clinical presentations with [[Immunohistochemical|immunohistochemical]] profile from [[flow cytometry]] and [[immunostaining]] may be utilized to differentiate [[plasma cell neoplasm]]s from other diseases. | |||
==Differentiating Plasma Cell Neoplasms from Other Diseases== | ==Differentiating Plasma Cell Neoplasms from Other Diseases== | ||
* For a patient with '''''marrow plasmacytosis''''', based upon the kappa (κ) and lambda (λ) expression on [[immunostaining]] or [[flow cytometry]], the differential dignoses include: | |||
:* '''Monoclonal plasma cell disorders''' is suggested by a markedly abnormal κ : λ ratio (>4 : 1 or <1 : 2) since plasma cells express either κ or λ. | |||
:* '''Polyclonal reactive plasmacytosis''' is suggested by the presence of both κ-staining plasma cells and λ-staining [[plasma cells]], usually in a κ : λ ratio of 2 : 1. | |||
::* '''[[Autoimmune diseases]]''' | |||
::* '''[[Metastasis|Metastatic carcinoma]]''' | |||
:* | ::* '''[[Chronic liver disease]]''' | ||
::* '''[[AIDS|Acquired immunodeficiency syndrome (AIDS)]]''' | |||
::* '''[[Chronic]] [[infection]]''' | |||
:* | |||
* | |||
:* | |||
:* | |||
* For a patient | * For a patient with '''''monoclonal (M) proteins''''', the differential dignoses include: (click <u>'''[[Plasma cell neoplasm classification#Diagnostic Criteria for Plasma Cell Disorders|here]]'''</u> for detailed criteria)<ref>{{Cite journal | doi = 10.1038/leu.2008.291 | issn = 1476-5551 | volume = 23 | issue = 1 | pages = 3–9 | last = Kyle | first = R A | coauthors = S V Rajkumar | title = Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma | journal = Leukemia | date = 2009-01 | pmid = 18971951 | pmc = PMC2627786 }}</ref> | ||
:* '''[[MGUS|Monoclonal gammopathy of undetermined significance (MGUS)]]''' | |||
:* '''[[multiple myeloma|Smoldering multiple myeloma]]''' | |||
:* '''[[multiple myeloma|Multiple myeloma]]''' | |||
:* '''[[IgM]] [[MGUS|monoclonal gammopathy of undetermined significance]] [[MGUS|(IgM MGUS)]]''' | |||
:* '''[[Waldenström macroglobulinemia|Smoldering Waldenström macroglobulinemia]]''' | |||
:* '''[[Waldenström macroglobulinemia|Waldenström macroglobulinemia]]''' | |||
:* '''[[Amyloidosis|Systemic AL amyloidosis]]''' | |||
* | * For an '''''osteolytic lesion''''', [[multiple myeloma]] may be distinguished from [[metastasis|metastatic carcinoma]] with an unrelated [[MGUS]] by the following findings: | ||
:* '''[[Multiple myeloma]]''' is suggested by the presence of serum and/or urinary [[M protein]] with ≥10% clonal [[bone marrow]] [[plasma cells]]. | |||
:* '''[[Metastasis|Metastatic carcinoma]] with an unrelated [[MGUS]]''' is suggested by a small [[M protein]] with <10% clonal [[bone marrow]] [[plasma cells]]. | |||
* ''' | * For '''''plasmacytoma''''', the differential diagnoses include: | ||
:* '''[[Plasma cell]] [[granuloma]]''' is suggested by a balanced proliferation of κ– and λ–reacting [[plasma cells]] on [[immunohistochemical|immunohistochemical studies]]. | |||
:* '''[[Plasmacytoid]] [[lymphoma]]''' is suggested by a mixture of [[lymphocyte]]s and [[plasma cell]]s. | |||
:* '''[[lymphoma|Large cell lymphoma]] of [[immunoblast|immunoblastic]] type''' is suggested by the predominat [[lymph node]] involvement with expression of [[cytoplasm|cytoplasmic]] [[IgM]] heavy chain and pan–[[B-cell]] surface antigens, whereas [[plasmacytoma]] typically has [[IgA]] or [[IgG]] heavy chain and is negative for pan–[[B-cell]] surface antigens. | |||
==References== | ==References== | ||
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[[Category:Disease]] | [[Category:Disease]] | ||
[[Category:Hematology]] | [[Category:Hematology]] | ||
Latest revision as of 12:09, 28 August 2015
Template:Plasma cell neoplasm Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Ammu Susheela, M.D. [2]
Overview
Clinical presentations with immunohistochemical profile from flow cytometry and immunostaining may be utilized to differentiate plasma cell neoplasms from other diseases.
Differentiating Plasma Cell Neoplasms from Other Diseases
- For a patient with marrow plasmacytosis, based upon the kappa (κ) and lambda (λ) expression on immunostaining or flow cytometry, the differential dignoses include:
- Monoclonal plasma cell disorders is suggested by a markedly abnormal κ : λ ratio (>4 : 1 or <1 : 2) since plasma cells express either κ or λ.
- Polyclonal reactive plasmacytosis is suggested by the presence of both κ-staining plasma cells and λ-staining plasma cells, usually in a κ : λ ratio of 2 : 1.
- For a patient with monoclonal (M) proteins, the differential dignoses include: (click here for detailed criteria)[1]
- For an osteolytic lesion, multiple myeloma may be distinguished from metastatic carcinoma with an unrelated MGUS by the following findings:
- Multiple myeloma is suggested by the presence of serum and/or urinary M protein with ≥10% clonal bone marrow plasma cells.
- Metastatic carcinoma with an unrelated MGUS is suggested by a small M protein with <10% clonal bone marrow plasma cells.
- For plasmacytoma, the differential diagnoses include:
- Plasma cell granuloma is suggested by a balanced proliferation of κ– and λ–reacting plasma cells on immunohistochemical studies.
- Plasmacytoid lymphoma is suggested by a mixture of lymphocytes and plasma cells.
- Large cell lymphoma of immunoblastic type is suggested by the predominat lymph node involvement with expression of cytoplasmic IgM heavy chain and pan–B-cell surface antigens, whereas plasmacytoma typically has IgA or IgG heavy chain and is negative for pan–B-cell surface antigens.