#00066179

A 71-year-old woman with IgA lambda plasma cell multiple myeloma on frontline VRd therapy (lenalidomide, bortezomib and dexamethasone) presented with new dysarthria, left facial droop and left upper limb weakness. Baseline assessment included detection of cryptic t(4;14) rearrangement, gain and amplification of 1q and a subclone with gain of 9q22 and 15q22 which was likely representative of a hyperdiploid clone. A lumbar puncture demonstrated numerous immature plasma cells (Fig 1 a-b, MGG x40 objective) which had anaplastic morphology and were monoclonal with aberrant phenotype (black population, Figure 2), consistent with progressive myeloma with central nervous system involvement.