FNA cytology revealed several flame cells and plasmablasts suggestive of myelomatous lesion. Bone marrow biopsy of the rib lesion ( see above pictures) showed focal replacement by anaplastic cells considered anaplastic carcinoma.

Iliac crest marrow aspiration showed large numbers of plasma cells and plasmablasts, several with the same flame cell morphology seen in the rib lesion FNA. (see above)

Serum immune-electrophoresis revealed a monoclonal IgA type of peak. Immune-histochemistry of the bone biopsy was negative for epithelial and leukocyte markers ("bald cells"). The thyroid nodule FNA revealed a plasmacytoma type of lesion. The patient had a bad response to chemotherapy, developed renal insufficiency and died of the disease three months later.

Hospital de Clínicas de Porto Alegre, Cytopathology Laboratory
Porto Alegre, RS Brazil