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82Abnormalities of the White Cell SeriesMonoclonal Gammopathy (Hypergammaglobulinemia),Multiple Myeloma*, Plasma Cell Myeloma, PlasmacytomaPlasmacytoma is the result of malignant transformation of the mostmature B-lymphocytes (Fig. 1, p. 2). For this reason the diagnostics of thisdisease will be discussed here, even though migration of its specific cellsinto the blood stream (plasma cell leukemia) is extremely rare (1–2%).Immunoelectrophoresis of serum and urine is performed when electrophoresisshows very discrete gammaglobulin, or globulin, fractions, orwhen hypogammaglobulinemia is found (in light-chain plasmacytoma). Awide range of possibilities arises for the differential diagnosis of monoclonaltransformed cells (Table 10).The presence of more than 10% of plasma cells, or atypical plasma cellsin the bone marrow, is an important diagnostic factor in the diagnosis ofplasmacytoma. For more criteria, see p. 84.Table 10Differential diagnosis of monoclonal hypergammaglobulinemiaTypeBenign disorders➤ Essential hypergammaglobulinemia= MGUS (monoclonal gammopathyof unknown significance)➤ Symptomatic hypergammaglobulinemia,secondary to– Infections– Tumors– Autoimmune diseaseMalignant diseases➤ Plasmocytoma(usually IgG, A or light-chain[Bence Jones protein], rarely IgM,D, E) 90% disseminated (multiplemyeloma), 5% solitary, 5%extramedullary (like a lymphomaor ENT tumor)➤ Lymphomae. g., immunocytoma, CLL(potentially all lymphomas of theB-cell series)CharacteristicsUsually in advanced age 10%, plasma cells found in thebone marrow, no progression,normal polyclonal IgAll ages (otherwise as above)– Osteolysis or X-ray with severeosteoporosis– Plasmocytosis of the bone marrow 10%– Monoclonal gammaglobulin inserum/urine with progression– Enlarged lymph nodes– Usually blood lymphocytosis– Monoclonal immunoglobulin,usually IgM* The current WHO classification suggests “multiple myeloma” (MM) for generalizedplasmacytoma and “plasmacytoma” only for the rare solitary or nonosseous form ofplasmacytoma.
Plasmacytoma cannot be diagnosed without bone marrow analysisabFig. 27 Reactive plasmacytosis and plasmacytoma. a Bone marrow cytologywith clear reactive features in the granulocyte series: strong granulation of promyelocytes(1) and myelocytes (2), eosinophilia (3), and plasma cell proliferation(4): reactive plasmacytosis (magnification 630). b Extensive (about 50%) infiltrationof the bone marrow of mostly well-differentiated plasma cells: multiplemyeloma (magnification 400).83
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iiiColor Atlas of HematologyPractic
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vPrefaceOur Current EditionAlthough
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viiContentsPhysiology and Pathophys
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ContentsixAcute Lymphoblastic Leuke
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2Physiology and Pathophysiology of
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Normal Cells of the Blood andHemato
Page 41: Normally erythropoiesis takes place
Page 44 and 45: 34Normal Cells of the Blood and Hem
Page 49 and 50: Advancing nuclear contraction and s
Page 51: Note the granulations, inclusions,
Page 71 and 72: Abnormalities of the White Cell Ser
Page 73 and 74: Predominance of Mononuclear Round t
Page 77 and 78: During lymphatic reactive states, v
Page 79 and 80: Extreme transformation of lymphocyt
Page 85 and 86: Monotonous proliferation of small l
Page 87 and 88: Atypical lymphocytes are not part o
Page 89 and 90: Deep nuclear indentation suggests f
Page 91: Cytoplasmic processes the main feat
Page 95 and 96: Atypias and differential diagnoses
Page 97 and 98: Bone marrow diagnosis is indicated
Page 99 and 100: Conspicuously large numbers of mono
Page 107 and 108: Fundamental characteristic of acute
Page 109 and 110: The diagnosis of acute leukemia is
Page 111 and 112: Acute leukemias may also derive fro
Page 113 and 114: New WHO classification: AML with dy
Page 115 and 116: The cells in acute lymphocytic leuk
Page 117 and 118: In unexplained anemia and/or leukoc
Page 119 and 120: The classification of myelodysplasi
Page 121 and 122: Prevalence of Polynuclear (Segmente
Page 123 and 124: Predominance of the granulocytic li
Page 125 and 126: Prevalence of Polynuclear (Segmente
Page 127 and 128: Left shift as far as myeloblasts, p
Page 129 and 130: Bone marrow analysis is not obligat
Page 131 and 132: In the course of chronic myeloid le
Page 133 and 134: Enlarged spleen and presence of imm
Page 135 and 136: Eosinophilia and basophilia are usu
Page 137 and 138: Erythrocyte and ThrombocyteAbnormal
Page 139 and 140: Hypochromic Anemias129Insufficient
Page 141 and 142: Hypochromic Anemias131BSGIron Ferri
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Small, hemoglobin-poor erythrocytes
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Hypochromic erythrocytes of very va
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Hypochromic Anemias137Hypochromic S
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Hypochromic anemia without iron def
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Consistently elevated “young” e
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Distribution pattern and shape of e
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Conspicuous erythrocyte morphology
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Unexplained decrease in cell counts
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Hypochromic Anemias149Differential
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Thrombocytopenia with leukocytosis
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Conspicuous large erythrocytes sugg
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In older patients, myelodysplastic
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Small inclusions are usually a sign
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PlasmodiumfalciparumPlasmodiumvivax
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Conspicuous erythrocyte inclusions
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Bone marrow analysis contributes to
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Thrombocytes: increases, reductions
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Thrombocytes: increases, reductions
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Variant forms of thrombocyte and me
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Thrombocyte proliferation with larg
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Cytology of Organ Biopsiesand Exuda
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Lymph Node Cytology175Anamnesis- su
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Reactive lymph node hyperplasia and
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Lymph Node Cytology179Contact witha
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Epithelioid cells dominate the lymp
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In cases of non-Hodgkin lymphoma an
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Accessible cysts (e.g., branchial c
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Tumor cells can be identified in pl
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Viral, bacterial, and malignant men
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191IndexAActinomycosis 179Addison d
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Index193Disseminated intravascularc
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Index195blast crisis 120-121bone ma
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Index197in hemolytic anemia 140orth
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