{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:29:22Z","timestamp":1760146162179,"version":"build-2065373602"},"reference-count":12,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T00:00:00Z","timestamp":1728864000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100001691","name":"Japan Society for the Promotion of Science (JSPS)","doi-asserted-by":"publisher","award":["21K16248"],"award-info":[{"award-number":["21K16248"]}],"id":[{"id":"10.13039\/501100001691","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Takeda Science Foundation","award":["21K16248"],"award-info":[{"award-number":["21K16248"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diagnostics"],"abstract":"<jats:p>Background: Flower-shaped nuclei in plasma cells are rare in multiple myeloma. Case presentation: We report on an 88-year-old male who presented with a mass lesion in the clavicular region. A biopsy of the mass revealed an increase in mature plasma cells with round nuclei. In contrast, a bone marrow examination showed increased plasma cells with flower-shaped nuclei. The patient tested negative for human T-lymphotropic virus type-1 and was diagnosed with multiple myeloma. Conclusions: While multiple myeloma is known for intra-tumor heterogeneity, reports of morphological heterogeneity based on the site of tumor sampling are limited. In this case, the presence of plasma cells with flower-shaped nuclei enabled the identification of site-dependent morphological tumor heterogeneity.<\/jats:p>","DOI":"10.3390\/diagnostics14202285","type":"journal-article","created":{"date-parts":[[2024,10,14]],"date-time":"2024-10-14T07:47:05Z","timestamp":1728892025000},"page":"2285","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Flower-Shaped Plasma Cells in Multiple Myeloma with Morphological Heterogeneity"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8682-7476","authenticated-orcid":false,"given":"Hiroki","family":"Hosoi","sequence":"first","affiliation":[{"name":"Department of Hematology\/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan"},{"name":"Department of Transfusion Medicine, Wakayama Medical University Hospital, Wakayama 641-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Misato","family":"Tane","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Makiko","family":"Sogabe","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ryuta","family":"Iwamoto","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Wakayama Medical University, Wakayama 641-8509, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoto","family":"Minoura","sequence":"additional","affiliation":[{"name":"Department of Clinical Laboratory, Wakayama Medical University Hospital, Wakayama 641-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8060-6683","authenticated-orcid":false,"given":"Shogo","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Toshiki","family":"Mushino","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9286-6909","authenticated-orcid":false,"given":"Akinori","family":"Nishikawa","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan"},{"name":"Division of Medical Information, Wakayama Medical University Hospital, Wakayama 641-8510, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shin-Ichi","family":"Murata","sequence":"additional","affiliation":[{"name":"Department of Human Pathology, Wakayama Medical University, Wakayama 641-8509, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Takashi","family":"Sonoki","sequence":"additional","affiliation":[{"name":"Department of Hematology\/Oncology, Wakayama Medical University, Wakayama 641-8509, Japan"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2024,10,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1802","DOI":"10.1002\/ajh.27422","article-title":"Multiple myeloma: 2024 update on diagnosis, risk-stratification, and management","volume":"99","author":"Rajkumar","year":"2024","journal-title":"Am. J. Hematol."},{"key":"ref_2","first-page":"32","article-title":"The many faces of plasma cell neoplasms: Morphological and immunophenotypical variants of the great imitator","volume":"54","author":"Medeiros","year":"2022","journal-title":"Pathology"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"e270","DOI":"10.1016\/S2352-3026(20)30037-5","article-title":"Plasma cell leukaemia presenting as flower-shaped plasma cells mimicking adult T-cell leukaemia or lymphoma","volume":"7","author":"Shibusawa","year":"2020","journal-title":"Lancet Haematol."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"689","DOI":"10.1111\/bjh.17320","article-title":"Primary plasma cell leukaemia presenting with flower-shaped nuclei","volume":"193","year":"2021","journal-title":"Br. J. Haematol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"657","DOI":"10.1093\/ajcp\/93.5.657","article-title":"Plasma cell myeloma with cleaved, multilobated, and monocytoid nuclei","volume":"93","author":"Zukerberg","year":"1990","journal-title":"Am. J. Clin. Pathol."},{"key":"ref_6","first-page":"283","article-title":"A case of aggressive multiple myeloma with cleaved, multilobated, and monocytoid nuclei, and no serum monoclonal gammopathy","volume":"30","author":"Yeh","year":"2000","journal-title":"Ann. Clin. Lab. 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Hematol."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"153","DOI":"10.4274\/tjh.galenos.2020.2020.0471","article-title":"Flower-Like Plasma Cell Nuclei in Multiple Myeloma","volume":"38","author":"Sall","year":"2021","journal-title":"Turk. J. Haematol."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"425","DOI":"10.1111\/ijlh.14229","article-title":"Primary plasma cell leukemia presented with atypical flower-like morphology","volume":"46","author":"Jakovic","year":"2024","journal-title":"Int. J. Lab. Hematol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1002\/ajh.27327","article-title":"High-risk multiple myeloma: Redefining genetic, clinical, and functional high-risk disease in the era of molecular medicine and immunotherapy","volume":"99","author":"Rees","year":"2024","journal-title":"Am. J. 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