Coincident multiple myeloma and non-Hodgkin's lymphoma with 2 serum monoclonal immunoglobulins

A case with features of both multiple myeloma and non-Hodgkin's lymphoma at the moment of diagnosis is presented. The patient had lytic bone lesions and biclonal gammopathy, IgM kappa and IgA kappa. In the bone marrow biopsy, there was a diffuse infiltration by atypical plasma cells coexisting with an interstitial and nodular infiltration by poorly differentiated lymphoid cells. Immunofluorescence studies showed positive staining with alpha and kappa antisera in the cytoplasm of plasma cells and with mu and kappa antisera on the surface of lymphoid cells. After the beginning of chemotherapy, the IgA kappa monoclonal protein disappeared and the IgM kappa monoclonal protein remained constant.

[Primary, exclusively gastric localization of alpha-chain disease: anatomo-clinical and immunohistochemical study]

We report the first case of heavy alpha-chain disease exclusively located in the stomach and in the perigastric nodes in a thirty year old Tunisian patient. Both the small bowel and the mesenteric nodes were evaluated histologically and immunochemically and were found to be free of disease. Complete remission was obtained using chemotherapy. The reasons for which the small intestinal mucosa and the mesenteric nodes, nearly constantly involved, in alpha-chain disease were spared in our case, are discussed.

Plasma cell infiltration of the small bowel: lack of evidence for a non-secretory form of alpha-heavy chain disease

Eight patients with diffuse plasma cell infiltration of the small bowel who had the clinical features of immunoproliferative small intestinal disease (IPSID), but whose serum was negative for free alpha-heavy chains, were investigated for evidence of a non-secretory form of alpha-chain disease (alpha-CD). Molecular sieving and immunoblotting of serum, immunoperoxidase staining of biopsy specimens, and in vitro protein synthesis studies utilising an immunoprecipitation technique and polyacrylamide gel electrophoresis, failed to detect any new cases of alpha-CD. Four of the eight cases were found to have diffuse intestinal lymphoma. The remaining four patients, who were unsuccessfully investigated for evidence of a significant abnormality in cellular immunity, have not developed detectable alpha-CD protein or lymphoma over a mean of 143 months. Despite continuing exposure to possible environmental stimuli, it is concluded that not all cases of IPSID elaborate detectable alpha-CD protein or evolve to lymphoma.

A new abnormal variant of spectrin in black patients with hereditary elliptocytosis

Seven black patients with mild hereditary elliptocytosis (HE) from five unrelated families were studied. The erythrocytes of these patients exhibited an abnormal thermal sensitivity (between 45 degrees C and 47 degrees C instead of 49 degrees C). An important defect of spectrin dimer self-association was detected in two ways: (1) the proportions of spectrin dimer (SpD) extracted from membranes at 4 degrees C under low ionic strength conditions were increased between 25% and 56% (normal value 15% +/- 2%); (2) the spectrin dimer----tetramer conversion in solution were defective with an association constant value between 0.4 and 2.4 X 10(5) M-1 for a normal value of 6 +/- 0.4 X 10(5) M-1. Spectrin (Sp) from HE patients and normal volunteers (32 black and 22 white subjects) was submitted to limited tryptic digestion, followed by one- or two-dimensional separation of the peptides. Peptide patterns of crude Sp from all seven HE patients exhibited a marked and reproducible decrease in 80,000-dalton peptide (previously identified as the dimer-dimer interaction domain of the alpha-chain) and a concomitant appearance of a novel 65,000-dalton peptide. A minor fragment at 28,000 daltons was also decreased. Tryptic digestion of HE spectrin dimer and tetramer (SpT), isolated after the SpD self-association procedure in solution, revealed modifications (decrease in the 80,000-dalton peptide and presence of a 65,000-dalton peptide) predominantly in HE SpD when peptide patterns of HE SpT were quite similar to control SpT patterns. Immunoblots with anti-alpha-chain antibodies revealed that the 65,000-dalton peptide derived from the alpha-chain. Kinetic studies of Sp digestion showed that the 65,000-dalton peptide did not result from further digestion of a 74,000 intermediate and was not a precursor of 46,000- to 50,000-dalton peptides. These results show a new structural defect of Sp-alpha-chain, associated with a defective Sp dimer self-association in HE.

Immunoblastic lymphoma involving the bone marrow in a patient with alpha chain disease. Clinical and immunoelectron microscopic study

A patient is reported who had disseminated immunoblastic proliferation that emerged during the course of alpha chain disease. This proliferation was characterized by overt marrow invasion together with osseous and neurologic manifestations. On immunoelectron microscopic study, the malignant immunoblasts displayed varying degrees of cytoplasmic maturation and constituted a morphologic spectrum of alpha-chain-synthesizing cells, ranging from immature blasts without endoplasmic reticulum development to relatively mature plasmablasts; alpha chain was not expressed at the surface of these cells. The general features of the overt malignant stage of alpha chain disease are reviewed in reference to this unusual case. The implications of the cellular findings are discussed with regard to the maturation stage of malignant immunoblasts.

Intracellular J chains in lymphoproliferative diseases

The presence of J or joining chains has been studied in formol-paraffin tissue sections from various lymphoproliferative diseases. The percentages of J chain positivity in 56 cases of multiple myeloma, in 41 of immunocytic malignant lymphoma and 35 of immunoblastic malignant lymphoma were 58.9, 70.7 and 37.1%, respectively. The ratio of kappa to lambda chain types of the monotypic Ig-s was the lowest in multiple myeloma, intermediate in immunocytic and highest in immunoblastic malignant lymphoma (ml). In 8 cases (one local immature plasmocytoma, one non-secretory multiple myeloma, one immunocytic, 4 immunoblastic and one centroblastic malignant lymphoma), only J chains were present in the tumour cells--"J chain disease". A significant difference in survival of J chain positive (26.8 months) and negative (17.7 months) multiple myeloma cases was observed. Myeloma kidney lesions were slightly more frequent in J chain negative cases. In lymphoproliferative disease J chain seems to be associated with early events of Ig synthesis. On the other hand, in two cases with biclonal Ig-s, the IgM positive immunoblastic ml cells and inclusions and the IgA positive multiple myeloma cells and inclusions were J chain positive. The IgG positive cells in both tumours and the IgG positive inclusions in the immunoblastic tumour were negative for J chains.

Immunoproliferative small intestinal disease in Algerians. II. Ultrastructural studies in alpha-chain disease

The plasma cell infiltrate of the small intestine in alpha-chain disease has been studied ultrastructurally in an attempt to determine whether there is a significant nuclear-cytoplasmic asynchrony that could be used as evidence for the neoplastic nature of the disease, even in its early stages. No such asynchrony was identified. In the early stages of the disease, the infiltrate was mainly of slightly immature plasma cells indistinguishable from those of coeliac disease. Later stages were marked by the presence of less differentiated immunoblastic cells arising in the deep mucosa and infiltrating into glands. Multinucleate plasmacytoid cells were thought to be degenerate cells. The significance of these findings is discussed in relation to the nature of alpha-chain disease and immunoproliferative small intestinal disease in general.

Alpha heavy-chain disease presenting as goiter

A patient with alpha heavy-chain disease (alpha HCD) originally had presented with a goiter from an extramedullary plasmacytoma. Alpha HCD was diagnosed by both standard laboratory procedures and high-resolution two-dimensional gel electrophoresis. The fragment of the alpha chain had a molecular weight of 38,000 and consisted of seven major charge forms, with an isoelectric point range of 5.2-5.6. Since alpha HCD usually involves the gastrointestinal tract, the thyroidal involvement in this case is unusual.

Atypical plasma cells in alpha-chain disease

Pathologic features of the jejunal mucosa of a patient with alpha-chain disease in its early transition to malignant stage, are described. Ultrastructural alterations were seen in some plasma cell, close similar to those described in myeloma plasma cells. Ultrastructural studies of biopsy specimens in alpha-chain disease, may permit recognition of its early transition to malignant stage and thereby encourage earlier use of cytotoxic drugs.

Colonic lymphoma producing alpha-chain disease protein

Alpha-chain disease with involvement of small intestine-resulting in characteristic villus atrophy and malabsorption has not been reported in this country. We studied a 57-yr-old male who presented with a polypoid tumor of the hepatic flexure of the colon. There was no evidence of malabsorption as manifested by a normal fat balance, serum carotene, and D-xylose absorption studies and the small bowel biopsy did not show villus atrophy. The tumor in the colon was surgically removed and diagnosed as a malignant lymphoma of lymphocytic type. Tumor tissue infiltrated in the mesentery could not be excised. Alpha-chain disease protein was demonstrated in serum and urine, and also in tumor tissue by immunoperoxidase techniques. The alpha-chain disease protein was further purified and classified as subclass 1. The patient had a good clinical response to cyclophosphamide and prednisone, but still has intraabdominal lymphoma with gastric involvement, and his serum alpha-chain protein persists. This case report may represent a distinct variant of alpha-chain disease.

Receptors for IgA on human thymus cells in myasthenia gravis

Specific surface receptors for the Fc region of human immunoglobulin A (Fc alpha R) were identified on the thymus cells of all 15 patients affected by myasthenia gravis. A large variation of the percentage of Fc alpha R bearing thymus cells was recorded (9 . 5-66 . 0%; mean value 27 . 9 +/- 17 . 8) the high values being associated in most cases with the thymus hyperplasia and the low values with a lipomatosis of the organ. Even the lowest percentage of Fc alpha R bearing cells recorded in myasthenia gravis are considerably higher than those found in normal subjects (0 . 4-4 . 1; mean value 1 . 8) demonstrating that the expression of Fc alpha R on the thymus cells is the consequence of the disease. No attempts were made to identify the cell population bearing Fc alpha R but indirect results indicate that the cells belong to E-rosette forming population, and, in some cases, to a null cell population devoid of the ability to form E and EAC rosettes, Fc alpha R can bind various IgA ligands and the binding is confined to a small fraction of IgA (not more than 5%) considered as cytophilic IgA.

Alpha chain disease in the Thai man

A 61-year-old Thai man presented with a history of chronic diarrhoea of 1-2 years duration. Stool examination revealed a heavy parasitic infection. Several anthelminthics were given without benefit, despite disappearance of the intestinal parasites. Serum protein studies revealed abnormal alpha heavy chain. Two courses of cyclophosphamide, vincristine and prednisolone were followed by a brief remission in his symptoms. A 21 day course of tetracycline was then given, resulting in an improvement in his condition. He is still symptom free nine months after confirmation of the diagnosis, without any further treatment. Serum protein studies should be included in laboratory investigations of a patient with chronic diarrhoea.

Membrane-bound and secreted IgA contain structurally different alpha-chains

Three different forms of alpha-chains are synthesized by BF0.3 and 615.2, two cloned cell lines derived from the murine B lymphoma 1.29. The three forms of alpha-chains differ in size, pI, cellular location, and rate of turnover. They were identified by means of lactoperoxidase-catalyzed radioiodination, internal 14C or 35S labeling, and immunofluorescence techniques as membrane-bound(alpha m), secreted (alpha s), and intracellular (alpha ic) proteins. Comparison of immunoglobulin products of the two lymphoma lines with those of a hybridoma cell line, Id 150, which secretes IgA of the 1.29 idiotype but lacks membrane IgA, confirmed the assignments of alpha m, alpha s, and alpha ic. Results of biosynthetic labeling of BF0.3, 615.2, and Id 150 in the presence and absence of tunicamycin suggest that the difference in m.w. and charge observed between alpha m and alpha s can be attributed to differences in primary amino acid structure rather than different degrees of glycosylation.