Plasma Cell Neoplasms

Question 1

What is a plasma cell neoplasm?

Answer 1

Proliferation of a single clone of an Ig-secreting plasma cell

Question 2

What Ig are the most commonly secreted in plasma cell neoplasms?

Answer 2

IgG and IgA

Question 3

What assays could be used to diagnose plasma cell neoplasms?

Answer 3

Serum/ urine protein electrophoresis, serum/urine immunofixation and Ig quant.; Radiographic skeletal survey, or bone marrow examination?

Question 4

Why is a radiographic skeletal survey be used to diagnose Myelomas?

Answer 4

Lytic bone lesions are characteristic of symptomatic myelomas

Question 5

To what region will Ig migrate in serum protein electrophoresis?

Answer 5

The gamma region

Question 6

What is an exaggerated M-spike?

Answer 6

The diagrammatic representation of the distinct band in the gamma region that corresponds to monoclonal Ig in myeloma

Question 7

What is the utility of immunofixation?

Answer 7

Identifies or subtypes the M-spike component

Question 8

If a patient is diagnosed with Monoclonal Gammopathy of Undetermined Significance what percentage of the plasma cells in the marrow are part of the myeloma?

Answer 8

Less than 10% clonal plasma cells in marrow

Question 9

What is the most common lymphoid malignancy in black patients in the US?

Answer 9

Multiple Myeloma

Question 10

What are the two subtypes of Multiple Myeloma?

Answer 10

Symptomatic PLasma Cell Myeloma and Asymptomatic (smouldering) Myeloma

Question 11

What is the related organ or tissue impairment seen in symptomatic plasma cell myeloma?

Answer 11

CRAB- hypercalcemia, renal insufficiency, anemia, bone lesions; amyloidosis, infection

Question 12

How can MGUS be distinguished from asymptomatic myeloma?

Answer 12

MGUS will have less than 10% clonal plasma cells while asymptomatic myeloma will have >10% clonal plasma cells

Question 13

What abnormal PBS finding is seen in Multilple Myeloma?

Answer 13

Rouleaux

Question 14

What is the presentation of Osteosclerotic Myeloma?

Answer 14

Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, skin changes

Question 15

What are the two types of plasmacytoma and describe the relevant differences?

Answer 15

Solitary Plasmacytoma of Bone is localized and will present as only one lytic bone lesion present; Extraosseous plasmacytoma are tumors of soft tissue and mostly occur in the upper respiratory tract

Question 16

What is the etiology of Primary Amyloidosis?

Answer 16

An immunoglobulin deposition disease caused by plasma cell or rarely, a lymphoplasmacytic neoplasm that secretes light chains or heavy chains which can deposit into tissue in the form of beta-pleated sheets

Question 17

How can primary amyloidosis lead to bleeding problems?

Answer 17

Factor X can bind to the amyloid

Question 18

What stain is used to visualize the amyloid beta?

Answer 18

Congo red stain

Question 19

What kind of cancer is Waldenstrom’s macroglobulinemia according to the WHO?

Answer 19

Lymphoplasmacytic Lymphoma

Question 20

What cells are involved in Lymphoplasmacytic lymphoma?

Answer 20

Small B cells, plasmacytoid lymphocytes, and plasma cells

Question 21

What is the etiology of Waldenstrom’s macroglobulinemia?

Answer 21

MYD88 mutation

Question 22

How does lymphoplasmacytic lymphoma cause hyperviscosity syndrome?

Answer 22

Due to high levels of aggregating paraprotein (IgM)