t(11;14) Plasma Cell Disorder Presents as a True Nonsecretory, Nonproducer Multiple Myeloma

We describe an extremely rare case of so-called nonsecretory, nonproducer myeloma in an 80-year-old man who presented with weight loss and anemia. The patient's serum protein electrophoresis was negative for M protein spike, and quantitation of his immunoglobulin level was far below the normal range. The bone marrow biopsy showed a sheet-like diffuse plasmacytic infiltrate with essential absence of trilineage hematopoiesis. Flow cytometry analysis and immunohistochemical study demonstrated a strong CD38/CD138/immunoglobulin G heavy chain—positive plasma cell population but failed to detect either cytoplasmic κ or λ light chain expression. Chromosomal analysis and dual fluorescence in situ hybridization studies clearly demonstrated the presence of t(11;14)(q13;q32) translocation in the neoplastic plasma cells.