Multinucleated Plasma Cells Research Articles

Giant multinucleated plasma cells in relapsed plasma cell myeloma.

A 47-year-old woman was diagnosed with plasma cell myeloma in 2018, received first-line induction chemotherapy, and made a partial response. She then received two cycles of DT-PACE chemotherapy. Her paraprotein levels remained static and a repeat bone marrow test in February 2019 revealed persistent bone marrow involvement by plasma cell myeloma showing usual (mononuclear) morphology with no multinucleated giant cells. She was treated with daratumumab as a bridge to an autologous stem cell transplant in June 2019. Her day 100 post autograft bone marrow trephine biopsy contained a plasma cell population making up 10% of all nucleated cells. More than 95% of the atypical plasma cells showed multinucleated giant cell morphology containing up to 40 nuclei. On immunohistochemistry, these multinucleated giant cells showed positive staining for CD138, CD38, and CD56 and were lambda restricted. CD45 was negative. Bone marrow trephine sections stained (clockwise from top left) with H&E, and for CD138, lambda light chains, and CD38. Multinucleated tumor giant cells are thought to form by two mechanisms: by cell-cell fusion via syncytins or as a result of a failure of cytokinesis at the end of the anaphase stage of mitosis. Occasional case reports of giant multinucleated plasma cells have been published since the 1970s. However, the presence of giant plasma cells with more than 10 nuclei is extremely rare. One previous case had also been treated with daratumumab, an IgG1k monoclonal antibody directed against cell surface CD38 (Guijarro F, Rozman M, Matutes E. Multinucleated giant myeloma cells after failure of daratumumab therapy. Br J Haematol 2018;181:432). Plasma cell membrane alterations promoting cell-cell fusion may be a side effect of immunotherapies targeting cell surface molecules. Giant multinucleated plasma cells may be observed more frequently as such immunotherapies become increasingly used.

Bi-Multilobulated Plasma Cells: Aggressive for Multiple Myeloma?

Multiple Myeloma (MM) is a malignant disease of plasma cells characterized by the accumulation of monoclonal plasma cells (PC) in the bone marrow. We report a case of an 84-year-old woman patient with no significant past medical history, presenting with back pain. This rare case reminds us that an atypical morphological presentation of MM. Our case is remarkable as aggressive course and rare morphological type. Prompt recognition of this rare morphology is important because patient’s prognosis is associated with high mortality rate. In addition to morphologic assessment of the plasma cells, multinucleated PC and changes in the cell nucleus-nuclei are also essential parts of the overall evaluation.

Multiple myeloma with multilobated plasma cell nuclei.

Address for Correspondence: Dr. Mehmet Sonmez, Department of Haematology, School of Medicine, Karadeniz Technical University, 61080 Trabzon, Turkey Phone: +90 462 377 58 48 Fax: +90 462 328 07 04 E-mail: mesonmez@yahoo.com doi:10.5152/tjh.2011.38 A 61-year-old male patient was admitted to our hospital with backache and fatigue. Physical examination was normal, except for pallor. Laboratory results at initial evaluation were as follows: hemoglobin: 105 g L; hematocrit: 0.31%; white blood cell (WBC) count: 6.3x109 L; platelet count: 200x109 L; blood urea nitrogen (BUN): 22.1 mmol L; creatinine: 477.3 μmol L; calcium: 2.8 mmol L; total protein: 74 g L; albumin: 43 g L; erythrocyte sedimentation rate (ESR): 44 mm h-1. A monoclonal spike was present on protein electrophoresis. Protein studies (by nephelometry) showed a kappa light chain of 5.97 g L (reference range: 1.7-3.7 g L) and low levels of IgG, IgM, and IgA (8.84 g L, 0.30 g L, 0.53 g L, respectively). Beta 2 microglobulin was 1.2 mg dL (reference range: 0.07-0.19 mg dL). Urine immunoelectrophoresis showed that the patient had a kappa monoclonal light chain. Bone X-rays showed multiple osteolytic lesions. The bone marrow aspirate and biopsy specimen morphology showed infiltration by atypical and multilobated plasma cell nuclei (Figures 1 and 2). The bone marrow biopsy specimen stained positive with CD138 (Figure 3). Multiple myeloma with multinucleated plasma cells is a rare morphological variant, which usually presents with light chain expression, and is characFigure 1. Atypical and multinucleated plasma cell infiltration in bone marrow aspirate

The Presence of Multinuceated Plasma Cells in Bone Marrow Aspirates Has No Clinical Significance.

Abstract 4904There is no published literature on the clinical significance of multinucleated plasma cells in bone marrow aspirates. The few references in the literature that mention multinucleated plasma cells imply that their presence is pathologic. We decided to investigate the clinical significance of these cells. All bone marrow aspirates done at the Atlanta VAMC from 1/1/99 until 8/1/99 were examined by a skilled hematopathology technician for 2 minutes. The presence of multinucleated plasma cells were recorded if they were identified. We then determined clinical characteristics of the patients and compared the characteristics of those with multinucleated plasma cells and those without. RESULTS. There were a total of 61 aspirates for review. 34 of these had identified multinucleated plasma cells MNPCs. The average age of the group with MNPC was 58.7 years (SD 15.4) and the group without MNPC was 61.6 (SD 12.4). 11 of the 27 patients without MNPC were alive at 10 years (41%) while 14 of the 34 patients with MNPC were alive at 10 years (also 41%). Among the group with MNPC who were still alive at 10 years the average change in serum creatinine over the 10 year period was .23 mg/dl. Among the group without MNPCs the average change in serum creatinine over the 10 year period was .26 mg/dl. Finally, 12 of the 34 patients (35%)with MNPCs were found to have a clonal lymphoid disorder sometime over the 10 year period after their aspirate, while 10 of the 27 patients (37%, a nonsignificant difference)without MNPCs were found to have a clonal lymphoid disorder. CONCLUSIONMNPC have no impact on survival or changes in renal function over a 10 year period. Furthermore, their incidence is not impacted by age. Finally, they do not predict the occurrence of clonal lymphoid disorders. We conclude that MNPC are likely a normal variant of plasma cells DisclosuresNo relevant conflicts of interest to declare.

Binucleated and multinucleated forms of plasma cells in synovia from patients with rheumatoid arthritis.

A morphological examination of synovial tissue from 25 patients with rheumatoid arthritis revealed that binucleated or multinucleated plasma cells were present in all samples and absent in synovia obtained from 16 control patients. Plasma cells containing two, three of four nuclei constitute a mean 3% of the total plasma cell population. They were always found amongst plasma cell infiltrates and in close association with small blood vessels. Ultrastructural analysis found no evidence of cellular membranes separating the individual nuclei in binucleated or multinucleated plasma cells, suggesting that the cells did not arise from fusion. Some of these plasma cells had a diameter approaching 100 microns, and many were in intimate contact with macrophages. The demonstration of a few cells with mitotic figures within the infiltrates suggests that the maintenance of plasma cell numbers in rheumatoid synovium may depend, in part, upon their local proliferation.