A Rare Case of Renal Thrombotic Microangiopathy and Focal Segmental Glomerulosclerosis Secondary to Plasma Cell Leukemia

Figure 1

Renal biopsy revealing TMA and FSGS. (a) Light microscopy of the glomerulus with acute thrombotic occlusion in the capillary wall (horizontal arrow) and capillaries with double contours (vertical arrows; hematoxylin and eosin (H&E); original magnification 400×). (b) Light microscopy of the glomerulus with features of collapsing glomerulopathy including capillary collapse and epithelial enlargement and proliferation (asterisks; periodic acid/Schiff base (PAS); original magnification 400×). (c) Immunofluorescence microscopy for fibrin showing the glomerular segment with fibrin deposition in capillary walls (arrows; original magnification 400×). (d) Electron micrograph showing detached podocytes (P) with subepithelial deposition of loose matrix (asterisks) and capillary with mesangial interposition (arrow; original magnification 1500×).