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==Overview==
==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==
==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==
==References==

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.
  • For a patient with monoclonal (M) proteins, the differential dignoses include: (click here for detailed criteria)[1]
  • For plasmacytoma, the differential diagnoses include:

References

  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)