Blood, Vol. 94 No. 3 (August 1), 1999:
pp. 913-913
PHOTOGRAPH
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Crystalloid cytoplasmic inclusions in myeloma marrow. A
70-year-old woman was diagnosed with indolent multiple myeloma (IgG,
kappa) in 1994. She had been followed without treatment, but recently
developed mild azotemia. Bone marrow examination revealed 17%
plasmacytosis. The light (original magnification × 1,000) and
electron (original magnification × 13,680) microscopic photographs
of marrow plasma cells showed crescent-like cytoplasmic inclusions. The
patient had low serum bicarbonate and uric acid levels as well as
elevated urine lysozyme. These findings suggested an acquired Fanconi
syndrome that has been reported in association with deposition of
crystallized immunoglobulin light chain in the proximal tubular cells
of the kidney. Costanza and Smoller (Am J Med 34:125, 1963)
presented the first electron micrographs of renal proximal tubules from
a myeloma patient with the acquired Fanconi syndrome. Cytoplasmic
inclusions similar to those above were present in the plasma cells and
kidney of their patient. (Courtesy of Sabrina D. Phillips, MD, Joseph
T. Newman, PhD, and Marvin J. Stone, MD, Baylor-Sammons Cancer Center,
Dallas, TX.)
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