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CC BY-NC-ND 4.0 · South Asian J Cancer 2019; 08(01): 60-64
DOI: 10.4103/sajc.sajc_64_17
ORIGINAL ARTICLE: Hematolymphoid Malignancies

Role of CD138, CD56, and light chain immunohistochemistry in suspected and diagnosed plasma cell myeloma: A prospective study

Jasmita Dass
Department of Hematology, Sir Ganga Ram Hospital, New Delhi
,
Sudheer Arava
Department of Pathology, All India Institute of Medical Sciences, New Delhi
,
Pravas Chandra Mishra
Department of Hematology, All India Institute of Medical Sciences, New Delhi
,
Amit Kumar Dinda
Department of Pathology, All India Institute of Medical Sciences, New Delhi
,
Hara Prasad Pati
Department of Hematology, All India Institute of Medical Sciences, New Delhi
› Author Affiliations Financial support and sponsorship: Nil.
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Abstract

Introduction: Plasma cells (PCs) have conventionally been counted on the bone marrow aspirate, and small focal involvement may be missed even on bone marrow biopsy sections. Material and Methods: We aimed to study the role of CD138, CD56, anti-κ, and anti-λ immunohistochemistry (IHC) to separate PC myeloma from reactive plasmacytosis and to study the utility of these in cases suspected as myelomas and lacking >10% PCs on bone marrow aspirate. The study comprised 35 diagnosed myelomas, 20 reactive plasmacytosis, and 19 M-band positive suspected myelomas. CD138 IHC was performed on all cases along with CD56, anti-κ, and anti-λ IHC. PCs were counted on CD138-immunostained sections by manual count and by image analysis. In addition, CD56 expression was correlated with clinical features in diagnosed myeloma group. Results: In all cases, both manual counts and image analysis, PC counts were significantly higher on the CD138 stained sections than bone marrow aspirates. It was seen that the manual PC counts and image analysis counts were equivalent in diagnosed myeloma cases. CD56 expression was seen in ~62.85% diagnosed myeloma cases while it was negative in cases of reactive plasmacytosis. CD56 expression was significantly higher in patients with lytic lesions (78.26% vs. 21.74%). CD138, anti-κ, and anti-λ IHC also helped classify 11/19 (57.8%) cases correctly. Conclusion: The use of CD138 along with the light chain and CD56 IHC adds a high diagnostic value in myeloma patients and suspected myeloma cases. The PCs can be counted manually on the CD138-immunostained sections and correlate well with the counts obtained by image analysis.

Key words

CD138 - CD56 - lytic lesions - myeloma - plasma cell percentage - reactive plasmacytosis - suspected myeloma


Publication History

Article published online:
21 December 2020

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  • References

  • 1 McKenna RW, Kyle RA, Kuehl WM, Grogan TM, Harris NL, Coupland RW. Plasma cell neoplasms. In: Swerrdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al., editors. WHO Classification of Tumors of Haematopoietic and Lymphoid Tissues. 4th ed. Lyon: International Agency for Research on Cancer; 2008. p. 200-13.
  • 2 Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos MV, et al. International myeloma working group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol 2014;15:e538-48.
  • 3 Ely S. Using aspirates for multiple myeloma research probably excludes important data. Br J Haematol 2006;134:245-6.
  • 4 Ng AP, Wei A, Bhurani D, Chapple P, Feleppa F, Juneja S, et al. The sensitivity of CD138 immunostaining of bone marrow trephine specimens for quantifying marrow involvement in MGUS and myeloma, including samples with a low percentage of plasma cells. Haematologica 2006;91:972-5.
  • 5 Wei A, Juneja S. Bone marrow immunohistology of plasma cell neoplasms. J Clin Pathol 2003;56:406-11.
  • 6 Subramanian R, Basu D, Dutta TK. Prognostic significance of bone marrow histology in multiple myeloma. Indian J Cancer 2009;46:40-5.
  • 7 O'Connell FP, Pinkus JL, Pinkus GS. CD138 (syndecan-1), a plasma cell marker immunohistochemical profile in hematopoietic and nonhematopoietic neoplasms. Am J Clin Pathol 2004;121:254-63.
  • 8 Al-Quran SZ, Yang L, Magill JM, Braylan RC, Douglas-Nikitin VK. Assessment of bone marrow plasma cell infiltrates in multiple myeloma: The added value of CD138 immunohistochemistry. Hum Pathol 2007;38:1779-87.
  • 9 Smith FB, Elnawawi A. A counting strategy for estimating plasma cell number in CD138-stained bone marrow core biopsy sections. Ann Clin Lab Sci 2008;38:138-42.
  • 10 Ioannou MG, Stathakis E, Lazaris AC, Papathomas T, Tsiambas E, Koukoulis GK, et al. Immunohistochemical evaluation of 95 bone marrow reactive plasmacytoses. Pathol Oncol Res 2009;15:25-9.
  • 11 Van Camp B, Durie BG, Spier C, De Waele M, Van Riet I, Vela E, et al. Plasma cells in multiple myeloma express a natural killer cell-associated antigen: CD56 (NKH-1; leu-19). Blood 1990;76:377-82.
  • 12 Ely SA, Knowles DM. Expression of CD56/neural cell adhesion molecule correlates with the presence of lytic bone lesions in multiple myeloma and distinguishes myeloma from monoclonal gammopathy of undetermined significance and lymphomas with plasmacytoid differentiation. Am J Pathol 2002;160:1293-9.
  • 13 Naresh KN, Lampert I, Hasserjian R, Lykidis D, Elderfield K, Horncastle D, et al. Optimal processing of bone marrow trephine biopsy: The Hammersmith protocol. J Clin Pathol 2006;59:903-11.
  • 14 Deshmukh M, Elderfield K, Rahemtulla A, Naresh KN. Immunophenotype of neoplastic plasma cells in AL amyloidosis. J Clin Pathol 2009;62:724-30.
  • 15 Kyle RA, Rajkumar SV. Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma. Leukemia 2009;23:3-9.
  • 16 Stifter S, Babarovi E, Valkovi T, Seili-Bekafigo I, Stemberger C, Nacinović A, et al. Combined evaluation of bone marrow aspirate and biopsy is superior in the prognosis of multiple myeloma. Diagn Pathol 2010;5:30.
  • 17 Dunphy CH, Nies MK, Gabriel DA. Correlation of plasma cell percentages by CD138 immunohistochemistry, cyclin D1 status, and CD56 expression with clinical parameters and overall survival in plasma cell myeloma. Appl Immunohistochem Mol Morphol 2007;15:248-54.
  • 18 Martín P, Santón A, Bellas C. Neural cell adhesion molecule expression in plasma cells in bone marrow biopsies and aspirates allows discrimination between multiple myeloma, monoclonal gammopathy of uncertain significance and polyclonal plasmacytosis. Histopathology 2004;44:375-80.
  • 19 Chang H, Samiee S, Yi QL. Prognostic relevance of CD56 expression in multiple myeloma: A study including 107 cases treated with high-dose melphalan-based chemotherapy and autologous stem cell transplant. Leuk Lymphoma 2006;47:43-7.