White rodlike crystals in multiple myeloma cells

Abstract

Objective: Several intracytoplasmic morphological changes in the plasma cells of multiple myeloma have been described previously, especially the Auer rod-like inclusions, but no studies focusing on white rodlike crystal inclusions have been reported to date. In this paper, we intend to report a rare case of inclusions in multiple myeloma.Methods: Bone marrow aspiration from the right superior iliac spine was examined. Cells were stained with "Wright-Giemsa" method and also analyzed by flow cytometry, immunohistochemical staining and fluorescence in situ hybridization(FISH). Bone scan, complete blood count, serum chemistry and coagulation tests were also examined.Results: Bone marrow aspirate from the right superior iliac spine at the time of myeloma diagnosis showed about 26.5% of all nucleated cells being plasma cells, of which many had white rodlike crystal inclusions. Repeat bone marrow biopsy later showed persistence of these morphological findings. All of Flow cytometry, immunohistochemistry and FISH examination support the diagnosis of multiple myeloma. Conclusion:This is the first time to report a multiple myeloma case with such white rodlike crystal inclusions. It is a rare and unique case. Due to its rarity, it remains unknown whether this morphological finding confers any prognostic implication.

Myeloma's multiple morphologies

“…Over the years, a number of different intracytoplasmic crystalline inclusions have been reported (reviewed in Ref. [2]).…”

“…As with intracytoplasmic immunoglobulin aggregates, the presence of Auer rod‐like inclusions does not appear to affect the prognosis of affected patients or to be associated with specific cytogenetic or immunophenotypic features [2].…”