CORRESPONDENCE AND CORRECTIONS Case Report of Plasma Cell Myeloma To the Editor:—Having read with interest the recent description by Zukerberg and colleagues' of plasma cell myeloma with cleaved, multilobated, and monocytoid nuclei, I write to report an additional case with similar plasma cell morphology but with some clinicopathologic features not emphasized in the recent report. CASE REPORT

COMMENTS The striking features of this case at presentation were the development of myeloma several years after detection of a monoclonal gammopathy, the presence of a leucoerythroblastic blood film with bizarre circulating plasma cells and the extensive reticulin fibrosis of the marrow. Unlike the six patients reported by Zukerberg and colleagues, our patient has shown a good response to melphalan and prednisolone over 12 months, suggesting that the outlook in myeloma with cleaved and multilobated plasma cell nuclei may not be uniformly disastrous. J. D. SCARLETT, M.D., F.R.A.C.P.,

F.R.C.P.A. Department of Pathology, The Geelong Hospital Geelong, Victoria, Australia REFERENCE 1. Zukerberg LR, Ferry JA, Conlon M, Harris NL. Plasma cell myeloma with cleaved, multilobated, and monocytoid nuclei. Am J Clin Pathol 1990;93:657-661.

NEWS AND NOTICES The Departments of Pathology, Massachusetts General Hospital May 13-15, 1991 Diagnostic Immunopathology and Molecular and Brigham and Women's Hospital, Harvard Medical School Pathology (Bethesda, Maryland) May 22-24, 1991 Annual AFIP Seminars in Pathology (RockApril 8-12, 1991 Postgraduate Course in Gynecologic and Obville, Maryland) stetric Pathology with Clinical Correlation June 10-14, 1991 Exfoliative and Fine-Needle Cytology (BeThe directors for the course are Drs. Robert E. Scully, Robert H. thesda, Maryland) Young, and Christopher P. Crum. The course is designed for pathologists For further information contact: C. A. Tuchis, American Registry of and obstetrician-gynecologists at resident and practitioner levels. It will Pathology, Armed Forces Institute of Pathology, Washington, DC 20306provide an in-depth review of gynecologic and obstetric pathology with 6000, or call 202-576-4549. emphasis on morphologic diagnostic features and clinicopathologic correlation, including management. Special attention will be paid to recent advances and newly recognized entities. For further information contact: Department of Continuing Education, Harvard Medical School, 25 Shattuck Street, Boston, Massachusetts 02215 (617-432-1525). Eighth International Congress for Stereology The Eighth International Congress for Stereology will take place August 25-30, 1991, on the campus of the University of California, Irvine. There will be courses in basic stereology and mathematical morphology, workshops on current methods in quantitative morphology, as well as plenary Perinatal and Pediatric Pathology (Bethesda, symposia and poster sessions. Detailed information and preregistration Maryland) forms (due June 15, 1991) can be obtained from Paul J. McMillian, Forensic Dentistry (Bethesda, Maryland) Organizer 8th ICS, Anatomy Department, Loma Linda University, Loma Melanocytic Lesions of the Skin (Bethesda, Linda, CA 92350, or call 714-824-4301; fax 714-824-4577. Maryland) Pathology of the Lymph Nodes (Bethesda, Maryland)

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A 66-year-old woman presented with diarrhea and fatigue of several months' duration. She had been noted seven years previously to have a serum monoclonal protein (IgAX, 9 g/ L), but this had not been kept under surveillance. Fecal culture revealed Campylobacter jejuni, and the diarrhea responded to erythromycin therapy. The hemoglobin was found to be 7.2 g/dL, the white blood cell count was 7.2 X 109/U and the platelet count was 82 X 109/ L. Tear drop poikolocytes, nucleated red blood cells, myelocytes, and promylelocytes were seen in the blood film. Atypical plasma cells, including multinucleated forms and forms with

cleaved or multilobated nuclei, also were noted. Bone marrow aspiration resulted in a dry tap. The bone marrow biopsy revealed confluent sheets of plasma cells, including many with cleaved or multilobated nuclei. Reticulin fibers were markedly increased. Lambda light chains, 14.5 g/L, were detected in the urine, and a monoclonal protein of 2 g/L, identified as IgAX, was detected in the serum. Serum levels of IgG and IgM were reduced. The serum creatinine was 148 jimol/L. A skeletal survey was normal, as was the serum calcium concentration. The patient received melphalan and prednisolone therapy, administered in conventional doses at intervals of six weeks. She was transfused at presentation and required four further transfusions of three to four units of blood at intervals of four to six weeks. However, for the past eight months she has not required transfusion, maintaining a hemoglobin concentration of approximately 10 g/dL. Her serum creatinine has improved gradually to 93 jimol/L, and urinary light-chain excretion has fallen. Unfortunately a quantitation of the 24-hour excretion of urinary light chains was not obtained prior to treatment. However, this was 13.3 g/day at four months after the commencement of treatment, and had fallen to 8.0 g/day at 12 months. She remains asymptomatic, on melphalan and prednisolone therapy, 12 months after diagnosis.

Case report of plasma cell myeloma.

CORRESPONDENCE AND CORRECTIONS Case Report of Plasma Cell Myeloma To the Editor:—Having read with interest the recent description by Zukerberg and col...
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