Abstract
Background : Myelomatous pleural effusion is a rare clinical condition associated with a pessimistic clinical outcome. We report cytological findings for two such cases.
Cases : Case 1 involved gamma immunoglobulin (IgG) myeloma with myelomatous pleural effusion in initial clinical presentation. Cytological pleural fluid specimens showed scattered plasmacytoid lymphocytes (plasmablasts) with numerous mature plasma cells. Plasmablasts were two to three times larger than red blood cells and showed moderate basophilic cytoplasm, along with large, eccentrically placed nuclei with prominent nucleoli with fine nuclear chromatin. The subject died 11 months after onset. Case 2 involved alpha immunoglobulin (IgA) myeloma with a 10-year history of multiple myeloma. Cytological pleural fluid specimens showed numerous immature and mature plasma cells. Immature plasma cells had broad basophilic cytoplasm with large, eccentrically placed nuclei with one to three prominent nucleoli and coarse nuclear chromatin, together with some vacuoles. The subject died 11 months after myelomatous effusion developed.
Conclusions : As indicated, our two subjects had advanced disease and a pessimistic prognosis. Giemsa-stained specimens are important in evaluating plasma cell differentiation when pleural effusion contains numerous anaplastic myeloma cells.
