Pathology Conference Corner

Chemistry - Case # 1

By: Anirban Maitra, M.D. and Terri Crook, M.D.

Case Report

A 66 year old BF presented to her physician with complaints of weakness and fatigue for 4 months, progressive nausea and vomiting for the same duration and an increasingly severe back ache for 1 month.

On physical examination, she had grade 2 pallor. Palpation over the spine evoked severe localized tenderness over T6-T8. There was no organomegaly, no palpable breast lesions, and no focal neurological deficit.

Selected Laboratory Results:

Analyte	Value	Reference Range
Hemoglobin	11.3 g/dl	(13.5 - 18 g/dl)
Calcium	9.9 mg/dl	(9.2 - 11.0 mg/dl)
Creatinine	7.8 mg/dl	(0.6 - 1.2 mg/dl)
BUN	54 mg/dl	(8 - 23 mg/dl)
Uric acid	11.5 mg/dl	(4.0 - 8.5 mg/dl)
Total protein	6.8 mg/dl	(6.0 - 7.8 mg/dl)
Serum albumin	3.5 mg/dl	(3.2 - 4.5 mg/dl)
Serum globulin	1.2 mg/dl	(0.7 - 1.5 mg/dl)
Erythrocyte Sedimentation Rate	not done	not done
Urine protein	100 mg/dl	(Negative)
24 hr urine protein	1.7gms	(40 - 150 mg/24hrs)

Pathology

Specimen #1 "Serum and Urine Electrophoresis"

Specimen #2 "Serum and Urine Immunofixation Electrophoresis"

Specimen #3"Bone Marrow Aspirate (40x Oil)"

Aspirate

Specimen #4 "Renal Biopsy"

(100x)

Specimen #4 "Renal Biopsy"

(400x)