To the Editor.—
In the X-RAY SEMINAR case, "Osteoblastic Lesions of Unusual Nature" (219:377, 1972) several findings cast some doubt on the diagnosis of multiple myeloma, osteosclerotic variant. The presence of multiple, discrete, purely osteosclerotic lesions, absence of dysproteinemia despite extensive disease, and the histopathologic finding of a mixture of plasma cells and lymphoid elements which Vickery noted as being an atypical picture for multiple myeloma seem to point to another diagnosis—plasma cell granuloma.1,2There are few unequivocal cases of untreated myeloma with sclerotic bone lesions, unless complicated by fracture or amyloidosis. The histological features of plasma cell granuloma are the infiltrates of uniformly mature plasma cells with occasional Russell bodies; intermingling of other chronically inflammatory cells, mainly lymphocytes, which tend to occur in aggregates and may be missed in small biopsy specimens; and a background of fibrous tissue. Plasma cell granuloma will not recur if completely excised,
Markel SF. Plasma Cell Granuloma Or Myeloma. JAMA. 1972;220(2):278. doi:10.1001/jama.1972.03200020086028
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