Bronchoalveolar Lavage Plasmacytosis in a Patient with a Plasma Cell Dyscrasia

Menashe, Phillip I.; Stenson, William F.; Reynoso, Gustavo; Keane, Margaret G.; Nair, Kesav G.; Nelson, G. S.

doi:10.1378/chest.95.1.226

Cited by 8 publications

(4 citation statements)

References 11 publications

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“…The percentage (8%) was higher than other reported lung diseases (1‐2%) 3,4 . A very high percentage of 47% was reported in plasma cell dyscrasia 12 . This might suggest that plasma cell proportion in IgG4 plasma cell‐related lung disease is intermediate.…”

Section: Discussionmentioning

confidence: 67%

Plasma cell‐rich bronchoalveolar lavage fluid: Could be a first clue to IgG4 plasma cell‐related lung disease

AbdullGaffar

Abdelkareem

2021

Diagnostic Cytopathology

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Plasma cells are usually absent in normal bronchoalveolar lavage (BAL) fluids. Frequent plasma cells in BAL are always pathologically significant. They raise a rather narrow differential diagnosis, predominantly extrinsic allergic alveolitis and few other interstitial lung diseases. BAL is a key diagnostic procedure for certain lung diseases. Because plasma cells are uncommon in BAL fluids and usually associated with limited conditions compared to other more common interstitial lung diseases, the focus of cell count differentials in BAL fluids was on other mononuclear and granulocytic inflammatory cells. Recently, cases of IgG4 positive plasma cell‐related lung diseases have been reported in tissue specimens. This may raise the importance of cytologically recognizing plasma cells in BAL fluids. We report a case of a 16‐year‐old boy with clinical and radiologic features of diffuse interstitial lung disease. His BAL cytology showed frequent plasma cells. Endobronchial biopsy showed substantial infiltration by plasma cells confirmed by immunohistochemistry. After excluding other lung diseases, the possibility of IgG4 plasma cell‐related disease was raised. Blood tests showed elevated serum levels of IgG4. This case emphasizes the importance of including of IgG4 plasma cell‐related lung disease as a possible differential diagnosis. This should prompt proper serologic tests for confirmation and appropriate management. With increasing reports of IgG4‐related lung disease, cytopathologists should be aware of this possibility when examining BAL fluids. Measurement of IgG levels in BAL fluids and plasma cell immunophenotyping might be promising tools.

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Section: Discussionmentioning

confidence: 67%

Plasma cell‐rich bronchoalveolar lavage fluid: Could be a first clue to IgG4 plasma cell‐related lung disease

AbdullGaffar

Abdelkareem

2021

Diagnostic Cytopathology

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“…Recently, plasmacytosis has been demonstrated in bronchoalveolar lavage in a patient with a plasma cell dyscrasia [6]. Diffuse lung involvement rarely occurs in myeloma, except in aggressive or terminal phases of the disease or in plasma cell leukaemia [7].…”

Section: Discussionmentioning

confidence: 99%

Alveolar haemorrhage as a presenting feature of myeloma

Russi¹,

Odermatt²,

Joller-Jemelka³

et al. 1993

Eur Respir J

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“…Lediglich bei 4 Patienten bestand der Verdacht auf eine Infiltration mit Plasmazellen, der letztlich nur bei einem Patienten überzeugend bewiesen wurde [8]. Kasuistisch wurde über eine Plasmozytose in der BAL bei Patienten mit einem Plasmozytom berichtet [9]. Eine diffuse pulmonale Beteiligung tritt selten im Krankheitsverlauf eines Plasmozytoms auf, mit Ausnahme von aggressiven oder terminalen Phasen der Erkrankung oder bei einer Plasmazellleukämie [10], kann jedoch auch die klinische Erstmanifestation darstellen [11].…”

Section: Kardiopulmonale Beteiligung Beim Multiplen Myelomunclassified

A rare cause of diffuse pulmonary hemorrhage in a 45 year-old man

et al. 2006

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Diffuse pulmonary hemorrhage denotes a diffuse bleeding into the alveoli as a result of severe damage of the alveolocapillary membrane. Autoimmune diseases, toxic injury and hemodynamic changes are the most frequent causes. A 45 year old male patient presented with diffuse alveolar hemorrhage. An Immunoglobulin A (IgA) paraprotein secreting myeloma was found to be the underlying cause. Immunohistochemistry revealed dense pericapillary and perivascular deposits of IgA, indicating a paraprotein mediated damage of the alveolocapillary membrane. The predominantly vascular pattern of damage was regarded as the most likely cause of the pulmonary hypertension in this patient. The diffuse pulmonary bleeding stopped after initiation of treatment consisting of vincristine, adriamycine and dexamethasone.

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Bronchoalveolar Lavage Plasmacytosis in a Patient with a Plasma Cell Dyscrasia

Cited by 8 publications

References 11 publications

Plasma cell‐rich bronchoalveolar lavage fluid: Could be a first clue to IgG4 plasma cell‐related lung disease

Plasma cell‐rich bronchoalveolar lavage fluid: Could be a first clue to IgG4 plasma cell‐related lung disease

Alveolar haemorrhage as a presenting feature of myeloma

A rare cause of diffuse pulmonary hemorrhage in a 45 year-old man

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