PMC5768267_01
(a) Right eye swelling, (b) resolution of eye swelling after 2 months of chemotherapy, and (c) MRI of head and neck showing T2 hyperintensities in the calvarium.
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Physical examination included diffuse right eyelid edema and right frontal tenderness (Figure 1(a)). However, a magnetic resonance imaging (MRI) of the brain showed hyperintense foci in the right frontal calvarium leading to the eye swelling (Figure 1(b)).
Bone marrow biopsy stained with hematoxylin and eosin showing a solid proliferation of mature appearing plasma cells. Left: objective 200x; right: objective 400x.
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Bone marrow biopsy demonstrated a hypercellular marrow comprised at least 70% mature appearing plasma cells staining positive for CD138 (Figures 2 and 3).
Bone marrow biopsy immunohistochemical stain CD138 used to highlight plasma cells. Objective 400x.
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Bone marrow biopsy demonstrated a hypercellular marrow comprised at least 70% mature appearing plasma cells staining positive for CD138 (Figures 2 and 3).
Flow cytometry showing plasma cells isolated with CD38 and CD138 antigens. They are kappa clonal and express CD56. Both markers indicate a malignancy.
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There is no evidence of increased blasts (Figure 4).
Fluorescence in situ hybridization (FISH) test was performed using dual color, dual fusion probes to detect the translocation between the CCND1 gene located at 11q (orange probe) and the IGH@ gene located at 14q (green probe). Signal that has joined orange and green color confirms presence of translocation (11;14)(q13.3;q32.3).
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Fluorescence in situ hybridization (FISH) test was positive for IGH@ gene rearrangement involving 14q32.3, CCND1/IGH@ gene for translocation (11;14)(q13.3;q32.3), and deletion 13q (RB1) (Figure 5).