title: Synchronous Plasma Cell Myeloma and Acute Myeloid Leukemia in a Therapy-Naïve Patient: A Rare Occurrence.
abstract: Plasma cell proliferations in patients with acute myeloid leukemia (AML) are rare, whether at presentation or during or after therapy. Interpretation requires correlation with the clinical background, drug history as well as inputs from tests for monoclonal gammopathy and end-organ damage. The major diagnostic issues stem from excluding myeloma alone with a plasmablastic morphology that mimics AML as well as reactive or polyclonal plasmacytosis occurring in a bonafide case of AML alone before rendering a rare diagnosis of true dual pathologies. We report a rare case of concurrent AML and plasma cell myeloma in a 55-year-old lady that posed a significant diagnostic challenge. The patient had significant co-morbidities complicating the clinical picture and was treatment-naïve at the time of diagnosis. Our approach to confirming the diagnosis, as well the challenges faced in flow cytometric analyses are highlighted. The pathogenesis of such dual pathologies remains unresolved, although various conjectures and theories have been propounded in literature.
authors.affiliation: Pathology Group Departments, Postgraduate Institute of Medical Education and Research (PGIMER), Research Block A, Chandigarh, 160012 India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
authors.affiliation: Pathology Group Departments, Postgraduate Institute of Medical Education and Research (PGIMER), Research Block A, Chandigarh, 160012 India.
authors.forename: Vishrut K
authors.initials: VK
authors.lastname: Srinivasan
authors.affiliation: Department of Hematology, Research Block-A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012 India.
authors.forename: Prashant
authors.identifier: 0000-0003-4741-3403
authors.initials: P
authors.lastname: Sharma
authors.affiliation: Department of Immunopathology, Postgraduate Institute of Medical Education and Research (PGIMER), Research Block A, Sector 12, Chandigarh, 160012 India.
authors.forename: Ritu
authors.initials: R
authors.lastname: Aggarwal
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Nehru Hospital, Chandigarh, 160012 India.
authors.forename: Gaurav
authors.initials: G
authors.lastname: Prakash
authors.affiliation: Department of Internal Medicine, Postgraduate Institute of Medical Education and Research (PGIMER), Nehru Hospital, Chandigarh, 160012 India.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Malhotra
authors.affiliation: Department of Hematology, Research Block-A, Postgraduate Institute of Medical Education and Research (PGIMER), Sector-12, Chandigarh, 160012 India.
authors.forename: Neelam
authors.initials: N
authors.lastname: Varma
keywords: Acute myeloid leukemia; Multiple myeloma; Plasma cell myeloma; Plasmacytosis