The patient is a eighty-year-old man who presented initially two years ago with iron deficiency anemia without improvement on iron supplementation. He was noted three months after presentation with large lytic left scapular bone lesion (shown below) that was initially thought to represent lymphoplasmacytic lymphoma. There was extensive bone marrow involvement at the time. There was evidence of markedly elevated serum free lambda light chain. Cytogenetic studies revealed evidence of t(11;14) involving IGH and cyclin D1 (CCND1) with monosomy 13. This was reclassified and treated as plasma cell myeloma.

Learning points:
1. Plasma cell myeloma with underlying t(11;14) have been described.
2. This myeloma is often positive for CD20 with expression of cyclin D1
3. Plasma cells exhibit "lymphocyte-like" cytomorphology, raising diagnostic confusion with lymphoplasmacytic lymphoma.