PMC5994292_01
(a) Ultrasound of the liver showing 5 cm enlarged perihepatic lymph node with multiple hypoechoic nodules in the liver (red arrows); (b, c) CT scan showing multiple hypodense nodules in the liver parenchyma (red arrows) with marked enlarged perihepatic lymph nodes.
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Esophagogastroduodenoscopy revealed gastric and jejunal ulcer while ultrasound of the hepatobiliary tract showed multiple hypoechoic liver nodules occupying at least 50% of the parenchyma and perihepatic lymphadenopathy (Figure 1(a)). CT abdomen and pelvis confirmed the innumerable liver lesions without any colonic mass and perihepatic lymphadenopathy (Figures 1(b) and 1(c)).
(a) Liver fine-needle aspirate (FNA) and core biopsy (400x objective) showing a monomorphic population of plasma cells with eccentric nuclei and clock-faced chromatin. Hepatocytes are not present. (b) Liver FNA immunohistochemical staining (400x objective) revealed CD138, highlighting plasma cells. (c) Kappa light surface antigen showing all plasma cells positive for stain and proving clonality.
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Percutaneous biopsy of the liver nodule and perihepatic lymph node both confirmed the CD138 and kappa light chain-restricted positive cells consistent with plasmacytoma (Figure 2).
(a) Bone marrow (objective 400x) showing increased cellularity with increased scattered plasma cells intermixed with hematopoietic elements. (b, c) Bone marrow immunohistochemical staining showing CD138 and kappa light surface antigen (200x objective), highlighting scattered clonal plasma cells occupying 30-40% of total cellularity.
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Bone marrow biopsy showed at least 30-40% kappa clonal plasma cells with positive CRAB criteria (hemoglobin and creatinine) confirming the diagnosis of light chain multiple myeloma (Figure 3).