Aggressive multiple myeloma with lymph node involvement, loss of CD138, and adipophilin-positive cytoplasmic vacuolization: a case report.
Yoshihiko Kondo, Seiichiro Nakabeppu, Hiromu Yano et al.
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Case in brief
An 83-year-old woman presented with painless cervical lymphadenopathy and widespread osteolytic lesions, leading to a diagnosis of multiple myeloma (MM). Lymph node biopsy revealed atypical lymphoid cell infiltration, initially resembling high-grade lymphoma. Immunophenotyping indicated loss of CD138 expression and the presence of adipophilin-positive vacuolization. Despite treatment, the disease progressed rapidly, resulting in the patient's death within two months.
What made this case unusual
The case is notable for the loss of CD138 expression and the presence of adipophilin-positive cytoplasmic vacuolization in lymph node lesions, which are atypical features in multiple myeloma.
Diagnostic / clinical pearl
Clinicians should be aware that loss of CD138 expression in multiple myeloma may indicate dedifferentiation and poor prognosis, particularly in cases with lymph node involvement.
Why it matters
This case highlights the potential role of altered lipid metabolism in the aggressiveness of metastatic multiple myeloma, suggesting a need for further investigation into metabolic pathways in this disease.