title: Myelomatous pleural effusion in a patient with plasmablastic myeloma: a case report.
abstract: Myelomatous pleural effusion is an unusual clinical condition associated with poor outcomes. We report a case with myelomatous pleural effusion upon the presentation of the disease. The patient had multiple risk factors for inferior prognosis of multiple myeloma, including old age, immunoglobulin D (IgD) isotype, high lactate dehydrogenase, C-reactive protein, beta2-microglogulin levels, and a high myeloma cell burden in the bone marrow. The myeloma cells in both bone marrow and pleural effusion had characteristic features of plasmablasts, including gigantic size, large and eccentrically placed nuclei, fine cytoplasm, and prominent nucleoli. Immunophenotypical analysis showed the plasmablastic cells in the pleural effusion were positive for surface CD38, cytoplasmic immunoglobulin, both kappa and lambda light chains but negative for surface CD19 or CD79a. Our experience suggests that the diagnosis of myelomatous pleural effusion should be made with clinical alertness and careful cytological examination, preferably supplemented by immunophenotypical analysis.
authors.affiliation: Division of Hematology-Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taipei, Taiwan, Republic of China.
authors.forename: Hung
authors.initials: H
authors.lastname: Chang
authors.forename: Wen-Chi
authors.initials: WC
authors.lastname: Chou
authors.forename: Shen-Yang
authors.initials: SY
authors.lastname: Lee
authors.forename: Jeng-Yi
authors.initials: JY
authors.lastname: Huang
authors.forename: Yu-Hsin
authors.initials: YH
authors.lastname: Hung
mesh_terms: D051997:ADP-ribosyl Cyclase 1 / Q000378:metabolism; D000369:Aged, 80 and over; D018941:Antigens, CD19 / Q000378:metabolism; D051925:CD79 Antigens / Q000378:metabolism; D005260:Female; D006801:Humans; D007072:Immunoglobulin D / Q000097:blood; D009101:Multiple Myeloma / Q000150:complications* / Q000473:pathology; D010950:Plasma Cells / Q000473:pathology; D016066:Pleural Effusion, Malignant / Q000175:diagnosis* / Q000209:etiology / Q000473:pathology
chemical_list: D018941:Antigens, CD19; D051925:CD79 Antigens; D007072:Immunoglobulin D; D051997:ADP-ribosyl Cyclase 1