The many faces of Mott cells

Multiple Myeloma with Foamy Mott Cells

Intracytoplasmic assorted vacuoles containing immunoglobulin collections are occasionally seen in multiple myeloma. When abundant, they impart a foamy appearance to the tumor cells, which is a potential source for diagnostic pitfalls. Herein, we report the case of a patient who presented with skeletal pain and CT confirmed lytic lesions. A bone marrow biopsy revealed multiple myeloma with unusual foamy Mott cells. The patient was subsequently treated with four cycles of cyclophosphamide, bortezomib, and dexamethasone induction therapy, followed by 3 cycles of lenalidomide with dexamethasone. A biopsy performed following initial biological and immunomodulatory drugs revealed different morphological and clonal characteristics. These features were modified again, five years later, and again, after two years of close monitoring. Hematopathologists should be aware of this morphologic variant of myeloma as well as for the capacity of clonal characteristics, such as light chain monotype, to fluctuate subsequent to treatment.

Lymphoma with Mott cell differentiation and validation of immunohistochemical lymphoid markers in an African pygmy hedgehog (Atelerix albiventris)

A 2-year-old female intact African pygmy hedgehog was presented for diagnostic investigation of a 2-month reduction in appetite, with weight loss and recent vomiting. Clinical examination revealed a large, firm mass originating from the left cranial abdomen. Ultrasound-guided fine-needle aspirates of the mass, liver, and mesenteric lymph nodes revealed a population of pleomorphic round cells, some of which contained variable numbers of round, clear vacuoles, consistent with a diagnosis of lymphoma with Mott cell differentiation. At postmortem examination, there was marked diffuse splenic enlargement, with infiltration by a soft tissue mass. There were multiple coalescing liver masses, kidney pallor, and mesenteric lymph node enlargements. On histologic examination, the spleen, lymph nodes, and masses in the liver were extensively infiltrated by proliferating lymphoid cells that had plasmacytoid and Mott cell differentiation. Cells with Mott cell morphology had an accumulation of periodic acid-Schiff-positive material in cytoplasmic inclusions and were positive for cytoplasmic nucleic acids when stained with methyl green pyronin. In the population of neoplastic lymphoid cells, a majority of cells expressed the transcription factor Pax5, which drives B-cell differentiation, and a minority expressed transcription factor IRF4/MUM-1, which drives plasma cell differentiation, indicating B-cell lymphoma with plasmacytoid differentiation.

PCV3-associated disease in the United States swine herd

Porcine circovirus-associated disease encompasses multiple disease syndromes including porcine circovirus 2 systemic diseases, reproductive failure, and porcine dermatitis and nephropathy syndrome. Until recently, porcine circovirus 2 was the only species associated with the porcine circovirus-associated disease. In this report, diagnostic investigations of thirty-six field cases submitted from multiple production systems, numerous sites and varied geographic locations demonstrated porcine circovirus 3 within lesions by in situ hybridization including fetuses with myocarditis, weak-born neonatal piglets with encephalitis and myocarditis, from cases of porcine dermatitis and nephropathy syndrome, and in weaned pigs with systemic periarteritis. Porcine circovirus 3 was detected by PCR in numerous fetuses and perinatal piglets at high viral loads (trillions of genome copies per mL of tissue homogenate). Samples from all cases in this study were assayed and found negative for porcine circovirus 2 by PCR. Metagenomic sequencing was performed on a subset of reproductive cases, consisting of sixteen fetuses/fetal sample pools. PCV3 was identified in all pools and the only virus identified in fourteen pools. Based on these data, porcine circovirus 3 is considered a putative cause of reproductive failure, encephalitis and myocarditis in perinatal piglets, porcine dermatitis and nephropathy syndrome, and periarteritis in swine in the United States.