PMC4660938_01
Chest X-ray showing massive left side pleural effusion and right upper zone nodular opacity (small air pocket in left apex is due to previous aspiration).
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It also revealed a small air pocket in the left apex, likely due to previous aspiration (Fig. 1).
Cytological examination of the pleural fluid showing numerous atypical plasma cells with binucleate forms and plasmablasts.
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Cytological analysis of the fluid revealed numerous plasma cells including some binucleate forms and plasmablasts (Fig. 2).
(a) Computed tomography scan of the chest with contrast showing bilateral effusion with pleural infiltration, right upper lobe involvement, soft tissue lesion in the posterior mediastinum. (b) Computed tomography scan of the abdomen showing lytic lesions in pelvis and sacrum.
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There was patchy infiltration in the entire left lung and right upper lobe (Fig. 3a and b). Multiple lytic lesions were seen in pelvis and sacrum (Fig. 3b).
Bone marrow biopsy showing extensive replacement of marrow by sheets of atypical plasma cells, with binucleate and plasmablasts.
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These findings prompted a bone marrow biopsy that demonstrated extensive replacement of marrow by sheets of atypical plasma cells, many of which were immature, binucleate, and plasmablasts (Fig. 4).