GPR: 2021 - Week 30

From MGH Learn Pathology

Clinical history

56M with a history of type 2 diabetes presents with sharp pain and paresthesias localized to the plantar aspects of his feet, R>L


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IgA Kappa
  • IgA = 638 mg/dL
  • MGUS <3000 mg/dL M protein
  • No hypercalcemia, renal insufficiency, anemia, or bone lesions
  • No BMBx (<10% plasma cells)
  • Neuropathy
  • Beta 2 < Beta 1



IgA Heavy Chain

  • 10-30 years of age
  • Concentrated in Middle East
  • Aberrant immune response to microorganism
  • Plasma cell infiltration of the jejunal mucosa and villous atrophy +/- infiltration of the mesenteric lymph nodes



IgA Kappa, 2 Clones

  • 4% of patients with clonal plasma cell disorders express 2 or more monoclonal proteins



IgA Kappa and IgG Kappa

  • 4% of patients with clonal plasma cell disorders express 2 or more monoclonal proteins
Mandakolathur Murali, MD
  • Srinivasan, Vishrut K, Bhagat, Priyanka, Bansal, Frainey, & Chhabra, Seema. (2016). Occurrence of Double Monoclonal Bands on Protein Electrophoresis: An Unusual Finding. Indian Journal of Hematology & Blood Transfusion, 32(S1), 184-188.
  • Gastélum-Cano, José María, Fragoso-Flores, Jaime, Noffal-Nuño, Victor Manuel, & Deffis-Court, Marcela. (2021). An unusual pattern in serum protein electrophoresis to take in mind: A case report. Practical Laboratory Medicine, 24, E00200.
  • Van Keer, Jan, Meijers, Björn, Delforge, Michel, Verhoef, Gregor, & Poesen, Koen. (2016). Two Cases of Heavy Chain MGUS. Case Reports in Oncological Medicine, 2016, 8749153-4.

This week's Gross Pathology Roundup was presented by William Rothwell MD on 2021-07-26.