PMC9389174_01
Abdominal computed tomography scan showing wall circumferential thickening (delimited by the pointer) at terminal ileum.
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A computed tomography (CT) scan of the abdomen showed a small bowel circumferential wall thickening (Figure 1), for which the patient underwent an urgent ileal resection by laparoscopy.
Histological and immunohistochemical features of ileal resection specimen. Hematoxylin-eosin staining (A) shows ileal wall infiltrated by a proliferation of pleomorphic plasma cells. Immunohistochemical staining presented CD138+
(B), MUM1+
(C), IgA+
(D), and monoclonal restriction for Kappa light chain of Ig (E), whereas Lambda light chains of Ig tested negative (F). The proliferative index (Mib1/Ki67) was around 40% (G).
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Microscopic analysis of the specimen (Figure 2) revealed a dense trans-parietal pleomorphic proliferation of mature plasma cells, consisting of small to large and multinucleated elements, some with Russel or Dutcher bodies, with ulceration of the bowel mucosa and infiltration of the perivisceral adipose tissue.
Histological and immunohistochemical features of bone marrow biopsy. Hematoxylin-eosin staining (A) shows a plasma cell infiltrate, accounting for 15% of bone marrow cellularity. Immunohistochemical staining presented CD138+
(B), with restriction for Kappa light chain of Ig (C). Neoplastic plasma cells also aberrantly expressed CD56 (D), whereas immunohistochemistry for Lambda light chain resulted completely negative (E).
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Moreover, microscopic analysis of the bone marrow biopsy (Figure 3) showed a clonal plasma cell infiltrate (15% of bone marrow cellularity), consisting of small- to medium-sized plasma cells with aberrant expression of CD56 and monoclonal restriction for kappa light chain of Ig, without amyloid deposits.