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Braunstein MJ, Petrova-Drus K, Rosenbaum CA, Jayabalan DS, Rossi AC, Salvatore S, Rech K, Pearse RN, Hassane DC, Postley J, Jhanwar YS, Geyer JT, Niesvizky R. Plasma Cell Myeloma Presenting With Amyloid-Laden Crystal-Negative Histiocytosis. Am J Clin Pathol 2020; 154:767-775. [PMID: 32705137 DOI: 10.1093/ajcp/aqaa095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Crystal-storing histiocytosis (CSH) is rare in plasma cell dyscrasias, with only 3 cases reported in the setting of amyloid. No cases of crystal-negative histiocytosis coincident with multiple myeloma and amyloidosis have been reported previously. METHODS A 58-year-old woman presented with pain due to destructive bone lesions and was found to have plasma cell myeloma (PCM) and marrow amyloid deposition associated with crystal-negative histiocytosis. Differential diagnoses included Langerhans cell histiocytosis, Erdheim-Chester disease, and Rosai Dorfman disease. BRAF mutations were negative, and there was no evidence of paraprotein crystals, arguing against typical CSH. RESULTS The patient was treated with bortezomib, cyclophosphamide, and dexamethasone, and she subsequently underwent autologous stem cell transplant and ixazomib maintenance. She achieved complete remission with improvement of her symptoms and preserved remission after following up at 60 months. CONCLUSIONS We describe a case of crystal-negative histiocytosis associated with PCM. CSH is a rare disorder associated with paraprotein-producing conditions in which immunoglobulins aggregate as intracellular crystals in the lysosomes of organ-specific phagocytic macrophages. Light chain tropism in PCM can also lead to the development of amyloid deposition in organs and, in rare cases, is associated with light chain aggregation as intracellular crystals in macrophages.
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Affiliation(s)
- Marc J Braunstein
- Department of Medicine, Division of Oncology-Hematology, NYU Long Island School of Medicine, NYU Winthrop Hospital, Mineola, NY
| | | | - Cara A Rosenbaum
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - David S Jayabalan
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Adriana C Rossi
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Steven Salvatore
- Department of Medicine, Division of Nephrology, Weill Cornell Medicine, New York, NY
| | - Karen Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Roger N Pearse
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Duane C Hassane
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - John Postley
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yuliya S Jhanwar
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Julia T Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Ruben Niesvizky
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
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Boulos NM, Gardin JM, Malik S, Postley J, Wong ND. Carotid Plaque Characterization, Stenosis, and Intima-Media Thickness According to Age and Gender in a Large Registry Cohort. Am J Cardiol 2016; 117:1185-91. [PMID: 26869392 DOI: 10.1016/j.amjcard.2015.12.062] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/28/2015] [Accepted: 12/28/2015] [Indexed: 12/20/2022]
Abstract
Carotid intima-media thickness (CIMT) is a well-established predictor of cardiovascular disease events. Not well described, however, is the prevalence of plaque and stenosis severity and how this varies according to extent of CIMT, age, and gender. We evaluated the extent of carotid plaque and stenosis severity according to CIMT, age, and gender in a large CIMT screening registry. We studied 9,347 women and 12,676 men (n = 22,023) who received carotid ultrasound scans. The presence and severity of both carotid plaque and stenosis was compared according to extent of CIMT (≥1 mm vs <1 mm), age, and gender using the chi-square test of proportions. Among those aged <45 to ≥80 years, the prevalence of CIMT ≥1 mm ranged from 0.13% to 29.3% in women and 0.6% to 40.1% in men, stenosis ≥50% from 0.1% to 14.9% in women and 0.1% to 13.2% in men, and mixed and/or soft plaque from 7.1% to 66.5% in women, and 9.2% to 65.8% in men (all p <0.001 across age groups). Even when CIMT levels were <1 mm, >30% of patients demonstrated mixed or soft plaque potentially prone to rupture. Of those with CIMT ≥1 mm, more than 70% had such mixed or soft plaque and more than 40% demonstrated stenoses of 30% or greater. In conclusion, we describe in a large CIMT registry study a substantial age-related increase in both men and women of increased CIMT, plaque presence, and severity, and stenosis. Even in those with normal CIMT, mixed or soft plaque was common, further demonstrating the value in assessing for plaque when doing carotid ultrasound.
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Postley J, Luo Y, Wong N, Gardin J. LIFETIME RISK ALGORITHM IDENTIFIES MORE PATIENTS WITH CAROTID AND FEMORAL PLAQUES THAN 10 YR OR 30 YR FRAMINGHAM RISK ALGORITHMS. J Am Coll Cardiol 2012. [DOI: 10.1016/s0735-1097(12)61715-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Korcarz CE, DeCara JM, Hirsch AT, Mohler ER, Pogue B, Postley J, Tzou WS, Stein JH. Ultrasound detection of increased carotid intima-media thickness and carotid plaque in an office practice setting: does it affect physician behavior or patient motivation? J Am Soc Echocardiogr 2008; 21:1156-62. [PMID: 18558473 DOI: 10.1016/j.echo.2008.05.001] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2007] [Indexed: 12/31/2022]
Abstract
BACKGROUND The aim of this multicenter study was to determine if identifying increased carotid intima-media thickness (CIMT) or carotid plaque during office-based ultrasound screening examinations could alter physicians' treatment plans and patients' motivation regarding health-related behaviors. METHODS Carotid ultrasound studies were performed by a nonsonographer clinician using a handheld system. Changes in physicians' treatment plans and patients' motivation on the basis of scan results were analyzed using multivariate regression. RESULTS There were 253 subjects (mean age, 58.1 +/- 6.6 years). When increased CIMT or carotid plaque was detected, physicians were more likely to prescribe aspirin and lipid-lowering therapy (P < .001). Subjects were more likely to report increases in plans to take cholesterol-lowering medication (P = .002) and the perceived likelihood of having or developing heart disease (P = .004). CONCLUSIONS Findings from office-based carotid ultrasound studies can influence physicians' prescriptions of evidence-based interventions. Patients with abnormal ultrasound findings recognize their increased cardiovascular risk and plan to take cholesterol-lowering medication.
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Affiliation(s)
- Claudia E Korcarz
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin, USA
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Korcarz CE, Hirsch AT, Bruce C, DeCara JM, Mohler ER, Pogue B, Postley J, Tzou WS, Stein JH. Carotid Intima-Media Thickness Testing by Non-Sonographer Clinicians: The Office Practice Assessment of Carotid Atherosclerosis Study. J Am Soc Echocardiogr 2008; 21:117-22. [PMID: 17904806 DOI: 10.1016/j.echo.2007.08.038] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/23/2007] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study was to determine whether a non-sonographer clinician (NSC) could obtain ultrasound images of the carotid artery, measure carotid intima-media thickness (CIMT), and identify findings indicating increased cardiovascular risk in an office setting. METHODS Eight NSCs from five sites were trained to use a handheld ultrasound device to screen the carotid arteries for plaques and to measure CIMT. RESULTS NSCs scanned 150 subjects who provided 900 images, of which 873 (97%) were interpretable. Differences between NSCs and the core laboratory were small (0.002 +/- 0.004 mm) and bioequivalent (P(TOST) < 0.05) with a low coefficient of variation (3.9% +/- 0.5%). There was > or = 90% agreement on the presence of CIMT > or = 75th percentile and > or = 80% agreement on plaque presence. CONCLUSIONS This is the first multicenter study to show that NSCs can obtain images of the carotid arteries using a handheld ultrasound device, accurately measure CIMT, and identify findings indicating increased cardiovascular risk.
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Affiliation(s)
- Claudia E Korcarz
- University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin 53792, USA
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