ISSN: 2455-5282
Global Journal of Medical and Clinical Clinical Image
Clinical Image       Open Access      Peer-Reviewed

Cloverleaf plasma cell nuclei in multiple myeloma

Mahjouba Baiya*, Hicham Yahyaoui, Ibtissam Mhirig, Imane El Khannouri, Mustapha Ait Ameur and Mohamed Chakour

Faculty of Medicine and Pharmacy of Marrakech, Mohamed VI University Hospital of Marrakech, Morocco
*Corresponding author: Mahjouba Baiya, Faculty of Medicine and Pharmacy of Marrakech, Mohamed VI University Hospital of Marrakech, Morocco, Tel: 0618029081; E-mail:
Received: 11 March, 2022 |Accepted: 17 March, 2022 | Published: 18 March, 2022
Keywords: Multiple myeloma; Atypical plasma cell morphology; Cloverleaf

Cite this as

Baiya M, Yahyaoui H, Mhirig I, Khannouri IE, Ameur MA, et al. (2022) Cloverleaf plasma cell nuclei in multiple myeloma. Glob J Medical Clin Case Rep 9(1): 021-022. DOI: 10.17352/2455-5282.000150

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© 2022 Baiya M, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

A 65-year-old man was diagnosed with multiple myeloma (IgG-Lambda) and was treated with high-dose dexamethasone as induction therapy followed by thalidomide-based regimens. About 18 months after the initial diagnosis, the patient presented a first relapse which was treated with the LCD protocol (Lenalidomide, Cyclophosphamide, Dexamethasone).

Twenty months later, a check-up was carried out. Complete blood count showed moderate anemia (hemoglobin at 10g/dl) isolated. The blood smear showed the presence of rolled red blood cells. Protein electrophoresis showed a rising monoclonal peak (monoclonal gammopathy at 48.2g/l) and immunofixation revealed a monoclonal band of immunoglobin G Lambda (Figure 1). A myelogram was performed confirming the second relapse. Bone marrow smears stained with May-Gr├╝nwald Giemsa (MGG) showed cell-rich bone marrow with highly atypical plasma cell infiltration (30%), namely a cloverleaf-shaped multilobed nucleus with nuclear budding (Figure 2). This atypia were absent at the time of diagnosis and only appeared at the second relapse. The diagnosis of anaplastic multiple myeloma was retained.

Plasma cell morphology can vary during the evolution of multiple myeloma, with the appearance of atypia posing a certain diagnostic difficulty. This phenomenon has been reported by other studies [1]. Advances in knowledge of chromosomal and genetic rearrangements involved in the development of this disease allow a better understanding of the pathophysiological mechanisms involved and better management of patients [2].

  1. Fujimi A, Nagamachi Y, Yamauchi N, Kanisawa Y (2017) Morphological Transformation of Myeloma Cells into Multilobated Plasma Cell Nuclei within 7 Days in a Case of Secondary Plasma Cell Leukemia That Finally Transformed as Anaplastic Myeloma. Case Rep Hematol 2017: 5758368. Link:
  2. Bastard C (2003) Cytogenetic abnormalities in malignant lymphoma and multiple myeloma. Pathologie Biologie 51: 375-381. Link:

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Creative Commons License This work is licensed under a Creative Commons Attribution 4.0 International License.