Pathology · patient case question
Which cell type proliferates in this condition?
Patient case: Bone pain, anemia and an enlarged tongue
Patient: 64-year-old man referred by his physician.
Chief complaint: His tongue feels too big for his mouth and he is exhausted.
History: Six months of back pain, fatigue and recurrent infections. Recent labs show anemia, hypercalcemia and elevated creatinine. Skull radiographs show multiple well-defined punched-out radiolucencies.
Findings: Enlarged tongue with lateral scalloping from tooth indentations. Pallor of the oral mucosa. Working diagnosis: multiple myeloma with systemic AL amyloidosis.
Show answer and explanation
Correct answer: D. Plasma cells
- A. Histiocytes are the proliferating cell in Langerhans cell histiocytosis, which can also produce punched-out lesions but is a different disease.
- B. T-cell malignancies are a separate group of lymphoid neoplasms.
- C. Osteoblasts form bone. In myeloma, osteoclast activity is upregulated and osteoblast activity suppressed, which is why the lesions are purely lytic and bone scans are often falsely negative.
- D. CORRECT. Multiple myeloma is a malignant clonal proliferation of PLASMA CELLS in the bone marrow, secreting a monoclonal immunoglobulin (the M protein).