PMC6586138_01
During normal B-cell development, cells acquire expression of CD 138 which is a marker highly specific for terminally differentiated normal plasma cells. Since CD 138 is a specific surface antigen for plasma cells in the bone marrow, a CD 138 immunohistochemical stain can identify plasma cells as seen in our case.
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A CD 138 immunohistochemical stain identified plasma cells (see Figure 1).
Plasma cells are large lymphocytes with a considerable nucleus-to-cytoplasm ratio. They have an eccentric nucleus with chromatin in a characteristic clock-face arrangement. This plasma cell in our patient is seen from the bone marrow touch imprints.
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The bone marrow touch imprints (see Figure 2) identify plasma cells.
EKG shows low voltage criteria in the limb leads. EKG is also significant for anterior pseudo-infarct pattern with Q waves in anterior leads V1 - V3. These two findings have high specificity and high predictive value for cardiac amyloidosis.
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ECG at that time showed low voltage criteria and an anterior pseudo-infarct pattern with Q waves in V1, V2, and V3 (see Figure 3).