PMC7762630_01
Pathological and immunohistochemical findings of bone marrow clot samples. (a) Hematoxylin and eosin staining showing infiltration of small-sized atypical plasma cells with eccentric nuclei. (b) Plasma cells were strongly positive for cyclin D1. (c) Plasma cells exhibited partial and weak MYC expression. Magnification: 400x.
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fig1
On immunohistochemistry, atypical plasma cells were strongly positive for cyclin D1 and partially weakly positive for MYC (Figure 1).
Karyotype of metaphase chromosomes and interphase fluorescence in situ hybridization (FISH) analysis obtained from the bone marrow. (a) The following complex karyotypes were observed at diagnosis: 47, Y, t (X; 8; 14) (q24; q24; q32), t (11; 14) (q13; q32), and +18. The arrows indicate the abnormal chromosomes. (b) Additional karyotype aberrations, including der (11)t (11; 14) and der (14)t (8; 14), were observed after IRd therapy. (c) FISH analysis was performed using a vysis LSI IGH/CCND1 dual color, dual fusion translocation probe. The orange signal represents CCND1, and the green signal represents IGH. Four fusion signals were observed. (d) FISH analysis was performed using a vysis LSI IGH/MYC/CEP 8 tri-color dual fusion probe. The orange signal represents MYC, the green signal represents IGH, and the aqua signal represents alpha satellite sequences on 8q11.1. Two fusion signals were visible.
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fig2
We confirmed IGH/MYC and IGH/CCND1 translocations by fluorescence in situ hybridization (FISH) analysis at the first relapse (Figure 2). Thereafter, bone marrow examination was performed, which revealed increased atypical plasma cells, and additional aberrations, including der (11)t (11; 14) and der (14)t (8; 14), were found on cytogenetic analysis (Figure 2(b) and Table 1).