PMC9966564_01
Renal biopsy revealing TMA and FSGS. (a) Light microscopy of the glomerulus with acute thrombotic occlusion in the capillary wall (horizontal arrow) and capillaries with double contours (vertical arrows; hematoxylin and eosin (H&E); original magnification 400x). (b) Light microscopy of the glomerulus with features of collapsing glomerulopathy including capillary collapse and epithelial enlargement and proliferation (asterisks; periodic acid/Schiff base (PAS); original magnification 400x). (c) Immunofluorescence microscopy for fibrin showing the glomerular segment with fibrin deposition in capillary walls (arrows; original magnification 400x). (d) Electron micrograph showing detached podocytes (P) with subepithelial deposition of loose matrix (asterisks) and capillary with mesangial interposition (arrow; original magnification 1500x).
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fig1
TMA as well as collapsing FSGS (Figure 1). The biopsy was negative for cast nephropathy, monoclonal immune deposition, and amyloid.
Bone marrow biopsy and peripheral blood flow cytometry revealing plasma cell leukemia. (a) Flow cytometry of peripheral blood demonstrates a discrete population of CD38 positive plasma cells with aberrant loss of CD19; this population of cells is also positive for CD138 and is lambda restricted. (b) Light microscopy of peripheral blood demonstrates leukemic plasma cells with a bizarre bilobed and multilobed nuclear phenotype (original magnification 100x). (c) Light microscopy of bone marrow biopsy demonstrates atypical plasma cells with similar bilobed nuclear morphology (arrows; original magnification 60x).
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fig2
A bone marrow biopsy was performed which in conjunction with peripheral blood flow cytometry was diagnostic for plasma cell leukemia with 10% circulating plasma cells (Figure 2).