Presentation
Right shoulder pain whilst putting on clothing. Dislocation?
Patient Data
Displaced transverse fracture of the humeral diaphysis. Moth eaten appearance to the underlying medullary bone.
No dislocation.
Case Discussion
A classical history of a pathological fracture. Minimal if any trauma.
Surgical fixation and biopsy undertaken.
Histopathology
Reamings of the medulla of the right humerus.
Multiple bony fragments in aggregate 16 x 7 x 4 mm.
MICROSCOPY All the tissue has been processed and shows cartilage, bone reamings and intratrabecular tissue. The intratrabecular tissue is very sparse but shows infiltration by clusters of pleomorphic plasma cells (expressing CD138 and MUM1). No hematopoietic tissue is included in the sparse intratrabecular tissue. There is another focus of crushed cells expressed CD138 but not MUM1, but as this focus doesnt express AE1/AE, this too is interpreted as a focus of atypical plasma cells.
Conclusion Reamings medulla right humerus - increased numbers of plasma cells with atypical morphology, raising the possibility of a plasma cell myeloma.
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