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Presented by Jonathan Epstein, M.D. and prepared by Jospeh Kronz, M.D.
Case 6: 43-year-old male with a lesion involving the skull
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Question 1 of 1
1. Question
Week 2: Case 6
43-year-old male with a lesion involving the skull
Correct
Answer: Plasmacytoma
Histology: The lesion consists of sheets of a monotonous population of loosely cohesive cells. The nuclei appear fairly uniform and round. The chromatin either has a speckled appearance or small nucleoli are visible. The cytoplasm appears eccentric, with in some areas a paranuclear hof typical of plasma cell differentiation. Focally, there is a greater degree of cytologic atypia.
Discussion: Pituitary adenomas may also have a very plasmacytoid appearance, although the current case shows unequivocal plasma cell differentiation. Location of the tumor and immunohistochemical stains for light chains can help distinguish these two entities. Although immunoblastic lymphomas demonstrate plasmacytoid differentiation, its histology is that of a large cell lymphoma with plasmacytoid features, whereas case 6 demonstrates a predominance of mature plasma cells with focal atypia. Metastatic carcinoma should always be considered in a lesion involving the skull, although the histological features in this case are quite typical of a plasma cell lesion. Immunohistochemical stains for cytokeratin and light chains readily differentiate these two lesions.
Incorrect
Answer: Plasmacytoma
Histology: The lesion consists of sheets of a monotonous population of loosely cohesive cells. The nuclei appear fairly uniform and round. The chromatin either has a speckled appearance or small nucleoli are visible. The cytoplasm appears eccentric, with in some areas a paranuclear hof typical of plasma cell differentiation. Focally, there is a greater degree of cytologic atypia.
Discussion: Pituitary adenomas may also have a very plasmacytoid appearance, although the current case shows unequivocal plasma cell differentiation. Location of the tumor and immunohistochemical stains for light chains can help distinguish these two entities. Although immunoblastic lymphomas demonstrate plasmacytoid differentiation, its histology is that of a large cell lymphoma with plasmacytoid features, whereas case 6 demonstrates a predominance of mature plasma cells with focal atypia. Metastatic carcinoma should always be considered in a lesion involving the skull, although the histological features in this case are quite typical of a plasma cell lesion. Immunohistochemical stains for cytokeratin and light chains readily differentiate these two lesions.
