Cutaneous plasmacytoma pathology

Author: Dr Ben Tallon, Dermatologist/Dermatopathologist, Tauranga, New Zealand, December 2016.


Cutaneous plasmacytoma pathology - codes and concepts
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Cutaneous plasmacytoma is a rare (< 1%) manifestation of multiple myeloma or plasma cell leukaemia. It disproportionately affects IgA and IgD proliferations and is associated with a worsened prognosis.

Histology of plasmacytoma

There is a dense cellular infiltrate (Figure1) filling the biopsy specimen. This is comprised of a monotonous population of plasma cells (figure 2).

There are histologic grading criteria described by Bartl et al in 1987. Cases can be classified as well differentiated (grade I), moderately differentiated (grade II), or poorly differentiated (grade III) based on plasma cell morphology.

Cutaneous plasmacytoma pathology

Special stains in plasmacytoma

The plasma cells show a monoclonal profile confirmed by increased kappa or lambda staining on immunohistochemistry (figures 3, 4) or FISH. Plasma cells are also highlighted by CD138 immunostaining (figure 5).

Plasmacytoma special stains

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Related information

 

References               

  • Skin Pathology (3rd edition, 2010). Weedon D
  • Pathology of the Skin (3rd edition, 2005). McKee PH, J. Calonje JE, Granter SR
  • Bartl RFB, Fateh-Moghadam A, Kettner G, Jaeger K, Sommerfeld W: Histologic classification and staging of multiple myeloma: a retrospective and prospective study of 674 cases. Am J Clin Pathol. 1987, 87: 342-355. PubMed.

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