PMC5862910_01
Chest X-ray with large left malignant pleural effusion immediately after pigtail catheter placement but before fluid drainage
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Fig1
It was then in September 2017 that the patient presented to the hospital with dyspnea and was found to have bilateral pleural effusion on chest radiography (Fig. 1).
Chest computed tomography (CT) with intravenous contrast demonstrating malignant left pleural effusion with left lower lobe collapse and segmental atelectasis in left upper lobe
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Fig2
His chest computed tomography (CT) was significant for left lower lobe collapse with basilar opacities as well as patchy ground glass opacities and interlobular septal thickening (Fig. 2).
Chest X-ray post placement of left hemithorax pigtail catheter with drainage and significant decrease in large left pleural effusion
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Fig3
Chest X-ray imaging post drainage showed diminished left lobe opacity (Fig. 3).
A cell block preparation of pleural fluid shows a prominent plasma cell concentration by hematoxylin and eosin staining
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Fig4
Pleural fluid immunohistochemical stains were performed (Figs. 4, 5, 6 and 7). Figs. 4, 5, 6 and 7.
Numerous atypical plasma cells with increased mitotic activity by Diff Quik air-dried stained slide
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Fig5
Pleural fluid immunohistochemical stains were performed (Figs. 4, 5, 6 and 7). Figs. 4, 5, 6 and 7.
The CD138 immunostain highlights numerous clonal atypical plasma cells
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Fig6
Pleural fluid immunohistochemical stains were performed (Figs. 4, 5, 6 and 7). Figs. 4, 5, 6 and 7.
The kappa in situ hybridization stained slide shows that a majority of the CD138 plasma cells are positive for kappa light chains
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Fig7
Pleural fluid immunohistochemical stains were performed (Figs. 4, 5, 6 and 7). CD138 immunostaining demonstrated atypical plasma cells with kappa restriction (Fig. 7). Figs. 4, 5, 6 and 7.