Sandbox/00036: Difference between revisions

Revision as of 01:00, 20 June 2014

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 immunostatining 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.

Autoimmune diseases
Metastatic carcinoma
Chronic liver disease
Acquired immunodeficiency syndrome (AIDS)
Chronic infection

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.

References

↑ Kyle, R A (2009-01). "Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma". Leukemia. 23 (1): 3–9. doi:10.1038/leu.2008.291. ISSN 1476-5551. PMC 2627786. PMID 18971951. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)CS1 maint: PMC format (link)

[1] Kyle, R A (2009-01). "Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma". Leukemia. 23 (1): 3–9. doi:10.1038/leu.2008.291. ISSN 1476-5551. PMC 2627786. PMID 18971951. Unknown parameter |coauthors= ignored (help); Check date values in: |date= (help)CS1 maint: PMC format (link)

[1]

@@ Line 5: / Line 5: @@
 ==Overview==
+Clinical presentations with [[Immunohistochemical|immunohistochemical]] profile from [[flow cytometry]] and [[immunostatining]] may be utilized to differentiate plasma cell neoplasms from other diseases.
 ==Differentiating Plasma Cell Neoplasms from Other Diseases==
-===Plasmacytoma===
+* 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.
-The differential diagnosis of a plasmacytoma includes:
+:* '''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]]'''
-* Plasma cell granuloma
+::* '''[[Metastasis|Metastatic carcinoma]]'''
-:* The plasma cell granuloma shows a balanced proliferation of kappa- and lambda-reacting cells on immunocytochemical evaluation.
+::* '''[[Chronic liver disease]]'''
+::* '''[[AIDS|Acquired immunodeficiency syndrome (AIDS)]]'''
-* Plasmacytoid lymphoma
+::* '''[[Chronic]] [[infection]]'''
-:* The plasmacytoid lymphoma comprises a mixture of lymphocytes and plasma cells.
-* Large cell lymphoma of immunoblastic type
-:* Immunoblastic lymphoma will usually involve lymph nodes in contrast to plasmacytoma.
-:* Immunophenotypic studies: immunoblastic lymphomas have cytoplasmic IgM heavy chain and express pan-B-cell surface antigens such as CD19 and CD20. Plasmacytomas contain IgA or IgG heavy chain and are generally negative for pan-B-surface antigens; approximately 20% of plasmacytomas and myelomas are positive with pan-B-cell antibodies.
-* For a patient presenting with '''M protein''', the major differential dignosis is among
+* 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>
-# [[Myeloma]]
+:* '''[[MGUS|Monoclonal gammopathy of undetermined significance (MGUS)]]'''
-# [[MGUS]]
+:* '''[[multiple myeloma|Smoldering multiple myeloma]]'''
-# Smoldering myeloma
+:* '''[[multiple myeloma|Multiple myeloma]]'''
-# [[Macroglobulinemia]]
+:* '''[[IgM]] [[MGUS|monoclonal gammopathy of undetermined significance]] [[MGUS|(IgM MGUS)]]'''
-# Primary [[amyloidosis]]
+:* '''[[Waldenström macroglobulinemia|Smoldering Waldenström macroglobulinemia]]'''
+:* '''[[Waldenström macroglobulinemia|Waldenström macroglobulinemia]]'''
+:* '''[[Amyloidosis|Systemic AL amyloidosis]]'''
-* In patients suffering from '''Marrow Plasmacytosis''', flow cytometry and immunostaining must be used to  differentiate between
+* For an '''''osteolytic lesion''''', [[multiple myeloma]] may be distinguished from [[metastasis|metastatic carcinoma]] with an unrelated [[MGUS]] by the following findings:
-# Monoclonal plasma cell disorders
+:* '''[[Multiple myeloma]]''' is suggested by the presence of serum and/or urinary [[M protein]] with ≥10% clonal [[bone marrow]] [[plasma cells]].
-# Polyclonal reactive plasmacytosis  found in
+:* '''[[Metastasis|Metastatic carcinoma]] with an unrelated [[MGUS]]''' is suggested by a small [[M protein]] with &lt;10% clonal [[bone marrow]] [[plasma cells]].
-## [[Autoimmune diseases]]
-## Metastatic carcinoma
-## [[Chronic liver disease]]
-## [[AIDS]]
-## Chronic infection
-* '''Bone leisions''' must be biposied to diffentiated between
+* For '''''plasmacytoma''''', the differential diagnoses include:
-# Metastatic cancer to bone
+:* '''[[Plasma cell]] [[granuloma]]''' is suggested by a balanced proliferation of κ– and λ–reacting [[plasma cells]] on [[immunohistochemical|immunohistochemical studies]].
-# [[Multiple myeloma]]
+:* '''[[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==

Sandbox/00036: Difference between revisions

Revision as of 01:00, 20 June 2014

Overview

Differentiating Plasma Cell Neoplasms from Other Diseases

References

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