Auer Rod-Like Crystal Inclusions in Plasma Cells of Multiple Myeloma Sung-Hee Oh, Chan Jeoung Park

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Auer Rod-Like Crystal Inclusions in Plasma Cells of Multiple Myeloma Sung-Hee Oh, Chan Jeoung Park

DOI: 10.5045/kjh.2010.45.4.222 The Korean Journal of Hematology Volume 45ㆍNumber 4ㆍDecember 2010 Auer rod-like crystal inclusions in plasma cells of multiple myeloma Sung-hee Oh, Chan Jeoung Park Department of Laboratory Medicine, University of Ulsan College of Medicine and Asan Medical Center, Seoul, Korea A 65-year-old man with 10-year history of non-insulin dependent diabetes mellitus presented with anemia and thrombocytopenia, which lasted for 3 months. Blood cell counts were: WBC, 5.1×109/L; hemoglobin, 9.0 g/dL; plate- let, 64×109/L. Peripheral blood film showed no rouleaux formation. Routine chemistry showed: calcium, 9.4 mg/dL; blood urea nitrogen/creatinine, 12/1.1 mg/dL; protein/albumin, 6.3/3.5 g/dL. Radiologic studies showed suspicious os- teolytic lesions on the humerus and distal clavicles. Serum protein electrophoresis revealed M-peak of 0.2 g/dL, and immunofixation electrophoresis showed a zone of restriction in the kappa light chain, suggesting monoclonal component. Urine protein electrophoresis revealed free kappa-type Bence-Jones proteinuria (59.3% of urine protein). Bone marrow aspirates showed many plasma cells (64.0% of nucleated cells) with Auer rod-like crystal inclusions in the cytoplasm. (A) Engulfed Auer rod-like inclusions in numerous histiocytes and free Auer rod-like inclusions in the backgrounds were observed. (B) Bone marrow biopsy showed decreased cellularity with interstitial and nodular infiltration of plasma cells. Immunohistochemical findings confirmed the kappa monoclonality of plasma cells. Despite 2 cycles of dexamethasone treatment without complications, the patient still suffers from Bence-Jones proteinuria and worsened bone pain. 222 This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited..

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