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  #1  
Old 06-16-2011
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Blood Hematology question

A 62 year old female undergoes biopsy of a nasopharyngeal mass. Histologic examination of the mass shows plasma cells. Serum electrophoresis shows a small monoclonal IgG spike. Bone marrow does not show plasma cell proliferation and no lesions are seen on X rays. What is the diagnosis ?
a) Heavy chain disease
b) Monoclonal gammopathy of undermined significance
c) Multiple myeloma
d) Plasmacytoma
e) Waldenstrom Macroglobulinemia
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Old 06-16-2011
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A 62 year old female undergoes biopsy of a nasopharyngeal mass. Histologic examination of the mass shows plasma cells. Serum electrophoresis shows a small monoclonal IgG spike. Bone marrow does not show plasma cell proliferation and no lesions are seen on X rays. What is the diagnosis ?
a) Heavy chain disease
b) Monoclonal gammopathy of undermined significance
c) Multiple myeloma
d) Plasmacytoma
e) Waldenstrom Macroglobulinemia
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Old 06-16-2011
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Could you please elaborate.
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Old 06-16-2011
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Quote:
Originally Posted by mayursn39 View Post
Could you please elaborate.
not much to elaborate here though:

mass in the upper respiratory track w/ plasma cells and normal x-ray & bone marrow = plasmacytoma
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Old 06-16-2011
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MGUS: Look for monoclonal IgG spike with no symptoms (no renal damage, hypercalcemia, lytic lesions, etc)

MM: Monoclonal IgG spike (kappa light chain) with hypercalcemia, anemia, renal damage, lytic lesions

Plasmacytoma: localized mass of plasma cells with no bone involvement (increases risk for MM)

Waldenstrom's: Look for IgM monoclonal spike with some nonspecific symptoms such as hepatosplenomegaly, fatigue, night sweats, etc.
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Old 06-16-2011
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Please help me clear this.
The electrophoretic studies shows elevated M spike of IgG in multiple myeloma. What is this M spike.Is it in anyway related to IgM?
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Quote:
Originally Posted by mayursn39 View Post
Please help me clear this.
The electrophoretic studies shows elevated M spike of IgG in multiple myeloma. What is this M spike.Is it in anyway related to IgM?
"M spike" means Monoclonal Spike. This is referring to the fact that there is one (mono) clone of proteins that is in excess. In Multiple Myeloma, this monoclonal spike is of IgG kappa light chains

In Waldenstroms, the Monoclonal protein is IgM
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Old 06-17-2011
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Haha. How foolish of me.
Thanks. I kept wondering what the M spike was though i knew that in multiple myeloma there is monoclonal proliferation of light chains.
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