Pathology cases — sella plasmacytoma in multiple myeloma

Since I am moving things from my NAME-directed activities to more general availability, the NAME-oriented “Billo’s Pretty Pics” series has been discontinued.  Instead, I will be posting cases to this blog.  Over the next few months, I will resurrect the more interesting photos from Billo’s Pretty Pics.

This is the first in the new series.  This is the case of a late-middle-age person who came to the hospital complaining of shortness of breath.  Initial evaluation was suspicious for COVID-19, but initial tests were negative.  Further workup revealed multiple large pulmonary thromboemboli, which were removed.  Nonetheless, the decedent’s respiratory status declined and he or she passed.  An autopsy was requested to determine cause of death.

At autopsy, there were numerous pulmonary infarctions, which, upon histology revealed numerous small pulmonary emboli.  Small fibrin emboli were noted in other organs, but no large infarctions were noted.  The lungs also showed mild emphysematous changes, but no evidence of interstitial pneumonia or diffuse alveolar damage.  Repeat COVID testing was negative.  As an incidental finding, the pituitary was mildly enlarged.  When I looked at it, I didn’t notice a discrete tumor, but I’m sure that if I went back and looked, I likely would.  In any case, on histologic examination there was a proliferation of monotonous looking plasma cells:

Sella plasmacytoma whole slide
Section of pituitary with mass


On closer examination, it appeared to consist of plasma cells:

Plasma cells in mass


At that point I went back and submitted some bone marrow.  Sure enough, his marrow was full of plasma cells:

Bone marrow
Bone marrow with plasma cells


Here’s a closeup:


Bone marrow closeup
Bone marrow higher power

People with multiple myeloma or monoclonal gammopathy are at a much increased risk for deep venous thrombosis and pulmonary thromboemboli.

As always, free for use in lecture, or teaching, with or without attribution (though attribution is appreciated).  If you put these in a publication, please contact me.  Higher resolution images (8Kx5K pixels) are available on request until I lose them, if you need them for a lecture or such.  Email me if you want me to send them to you.

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