Cellfie of the Day: Surbhi Singh on How Small-Cell Myeloma Hides in Plain Sight
Surbhi Singh, Consultant Haematopathology at Agilus Diagnostics and Fortis Hospital Gurugram, shared a post on LinkedIn:
”Cellfie Of The Day: Small Cell Variant of Myeloma – a morphological Masquerader
Morphology:
Plasma cells with small morphology, mature-appearing nuclei, condensed chromatin, and narrow rim of basophilic cytoplasm, often resembling small lymphocytes, occasional peri-nuclear hoff. Nucleoli are inconspicuous – may mimic a mature B cell neoplasm.
Immunophenotype:
• CD38+, CD138+
• Cytoplasmic light chain I restriction (κ or λ)
• Frequently CD56+, CD19–, CD45 variable, may show CD20+
• Cyclin D1 positive → reflects underlying t(11;14)(q13;q32) (IGH-CCND1 translocation)
Key clue:
Small cell morphology + Cyclin D1 positivity strongly suggests t(11;14) myeloma
Differential diagnoses:
• CLL/SLL → CD5+, CD23+, negative for CD138
• Lymphoplasmacytic lymphoma (LPL) → CD5-CD10- clonal B cells along with plasma cells, MYD88 L265P mutation, IgM paraprotein
• Mantle cell lymphoma with plasmacytic differentiation → CD5+, Cyclin D1+, SOX11+ (vs strong CD138, lack of CD45)
Takeaway:
Always correlate clinically + morphology + immunophenotype + immunohistochemistry + cytogenetics – small lymphoid-appearing cells can hide a Cyclin D1–driven plasma cell neoplasm.”
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