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conferenceseries.com
June 26-27, 2017 San Diego, USA
13th International conference on
Pathology and Molecular Diagnosis
Volume 7, Issue 2 (Suppl) J Clin Exp Pathol, an open access journal
ISSN:2161-0681
Pathology and Molecular Diagnosis 2017
June 26-27, 2017
Multiple myeloma with plasmablastic morphology and central nervous system (CNS) involvement
Mark Podberezin
University of Saskatchewan, Canada
We describe an unusual case of multiple myeloma (MM) with plasmablastic morphology in a young man who, after
chemotherapy and autologous stem cell transplant, developed disease recurrence with isolated CNS involvement.
Plasmablastic type is characterized by immature cells with round nuclei, prominent central nucleoli, and amount of cytoplasm
much smaller than that in mature plasma cell. According to different studies, plasmablastic MM may account for 15-30% of
MMcases and tend to be associated with adverse prognosis. It has been shown to correlate with high proliferation rate, extensive
bone marrow infiltration, but not with high risk chromosomal aberrations. Despite the fact that plasmablastic morphology is
not uncommon in MM patients, CNS involvement in this disease is very rare. Overall, extramedullary involvement is found in
7% of patients with MM upon initial diagnosis, with CNS involvement occurring in less than 1% of patients. Based on Mayo
Clinic study of 4060 MM patients, only 0.7% of all patients had CNS disease. MRI studies demonstrate that predominant
pattern of CNS myelomatous disease is leptomeningeal involvement, with intraparenchymal tumor-like lesions being much less
common. In some patients, dural involvement and/or direct extension of MM into CNS were described. In 82% of patients with
CNS myelomatosis, neoplastic plasma cells were found in CSF, and in those without CSF involvement, the diagnosis was made
by MRI which detected either leptomeningeal or intraparenchymal involvement. It is worth to mention that CNS involvement
in MM tends to occur in younger patients, without evidence of advanced disease, sometime with isolated CNS involvement.
In many of these patients, complete remission can be achieved with the use of systemic, rather than intrathecal, chemotherapy,
particularly with addition of novel agents such as Bortezomib (proteasome inhibitor) and Lenalidomide (immunomodulatory
agent). Diagnostic approach, as well as management of patients with CNS involvement by MM, will be discussed.
Biography
Mark Podberezin completed his Medical School (MD) Degree in Russia where he practiced Clinical Hematology before moving to USA. He performed his PhD
project in Immunohematology in United Kingdom. After moving to USA, he completed his Anatomic and Clinical Pathology Residency, as well as Surgical Pathology
Fellowship training at University of Illinois at Chicago/Cook County Hospital and later completed Hematopathology Fellowship at Texas Methodist Hospital in
Houston. Currently, he is Anatomic Pathologist/Hematopathologist and Assistant Clinical Professor at University of Saskatchewan, Canada.
Mark Podberezin, J Clin Exp Pathol 2017, 7:2 (Suppl)
DOI: 10.4172/2161-0681-C1-034