A 93-year-old man presented with lower extremity pain, and during evaluation for possible deep vein thrombosis, he was found to be pancytopenic. Four years earlier, macrocytic anemia and an immunoglobulin G-κ (IgG-κ) monoclonal protein had been noted but the IgG level was only minimally elevated and the skeletal survey was negative. He subsequently developed thrombocytopenia and had been receiving monthly darbepoietin alfa but was lost to follow-up after the anemia had resolved. Bone marrow examination revealed 50% to 60% plasma cells and scattered cells containing hypergranular cytoplasm or multiple rod-shaped crystalline structures (panel A arrows).
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Simultaneous presentation of plasma cell myeloma and acute promyelocytic leukemia
Source: Blood
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