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Ren LY, Chen Q, Qiu FP, Jiang ZY, Wang XY, Zhang XL, Shi ZQ. Proliferative glomerulonephritis with monoclonal IgG Lambda deposits caused by plasmablastic lymphoma: a case report. BMC Nephrol 2023; 24:297. [PMID: 37803288 PMCID: PMC10559464 DOI: 10.1186/s12882-023-03351-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Accepted: 09/25/2023] [Indexed: 10/08/2023] Open
Abstract
INTRODUCTION As a very rare form of B-cell lymphoma, plasmablastic lymphoma (PBL) typically occurs in patients with underlying immunosuppression, including human immunodeficiency virus (HIV), organ transplantation, and autoimmune diseases. For HIV-positive patients, PBL normally originates in the gastrointestinal tract, especially from the oral cavity in most cases. It is extremely rare to find abdominal cavity involvement in PBL, and there has been no previously reported instance of proliferative glomerulonephritis with monoclonal immunoglobulin deposits (PGNMID) attributed to monoclonal IgG (MIgG) lambda secreted by PBL. CASE PRESENTATION We report the case of an HIV-negative female with nephrotic syndrome, renal insufficiency, and multiple swollen lymph nodes. Ascitic fluid cytology revealed a high level of plasmablast-like lymphocytes with the restriction of lambda light chains. Besides, the renal biopsy revealed PGNMID, which could presumably be secondary to MIgG-lambda-secreting by PBL. MIgG-lambda-restricted expression was discovered earlier in the kidney tissue than in the blood. CONCLUSION The diagnostic landscape for PBL is notoriously intricate, necessitating a multifaceted and nuanced approach to mitigate the risks of erroneous identification.
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Affiliation(s)
- Ling-Yan Ren
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Qi Chen
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Feng-Ping Qiu
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Zhen-Yu Jiang
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Xiao-Yi Wang
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Xiao-Lan Zhang
- Department of Pathology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China
| | - Zhan-Qin Shi
- Department of Nephrology, The First Affiliated Hospital of Huzhou Teachers College, the First People's Hospital of Huzhou, Huzhou, 313000, Zhejiang, P.R. China.
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Huang YL, Ueng SH, Chen K, Huang YT, Lu HY, Ng KK, Chang TC, Lai CH, Lin G. Utility of diffusion-weighted and contrast-enhanced magnetic resonance imaging in diagnosing and differentiating between high- and low-grade uterine endometrial stromal sarcoma. Cancer Imaging 2019; 19:63. [PMID: 31514752 PMCID: PMC6739916 DOI: 10.1186/s40644-019-0247-z] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2019] [Accepted: 08/13/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Endometrial stromal sarcoma (ESS) is a rare uterine malignancy that features different prognoses for its high- and low-grade subtypes. We investigated the diagnostic accuracy of magnetic resonance (MR) imaging in diagnosing and differentiating between high- and low-grade ESS. METHODS We retrospectively reviewed the preoperative pelvic MR images of consecutive patients who received histologically confirmed diagnoses of high-grade ESS (n = 11) and low-grade ESS (n = 9) and T2-hyperintense leiomyoma (n = 16). Two radiologists independently evaluated imaging features in T1-, T2-, and diffusion-weighted and contrast-enhanced MR images. Statistical analysis included Mann-Whitney tests and Fisher's exact test, with sensitivity, specificity and diagnostic accuracy of imaging features. RESULTS High-grade ESS was associated with significantly more extensive necrosis and hemorrhage and distinct feather-like enhancement compared with low-grade ESS (P < .05 for all). The feather-like enhancement pattern yielded a diagnostic accuracy of 95%, sensitivity of 91%, and specificity of 100% in differentiating high-grade from low-grade ESS. This imaging characteristic was significantly superior to the necrosis (80%, P = .033) or hemorrhage (75%, P = .007). Both high- and low-grade ESS demonstrated T2 hypointense bands, marginal nodules, intratumoral nodules, and worm-like intra-myometrial nodules, and their tumor apparent diffusion coefficient (ADC) values were significantly lower than those of T2-hyperintense leiomyomas (P < .001). CONCLUSIONS Diffusion-weighted MR imaging is useful in diagnosing ESS against T2-hyperintense leiomyomas, and contrast enhancement aids in further differentiating between high- and low-grade ESS.
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Affiliation(s)
- Yen-Ling Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Shir-Hwa Ueng
- Department of Pathology, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Kueian Chen
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Yu-Ting Huang
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, 222, Maijin Rd, Keelung, Taiwan, 20401
| | - Hsin-Ying Lu
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Koon-Kwan Ng
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Department of Diagnostic Radiology, Chang Gung Memorial Hospital at Keelung, 222, Maijin Rd, Keelung, Taiwan, 20401
| | - Ting-Chang Chang
- Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Chyong-Huey Lai
- Department of Obstetrics and Gynecology and Gynecologic Cancer Research Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.,Clinical Trial Center, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382
| | - Gigin Lin
- Department of Medical Imaging and Intervention, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382. .,Imaging Core Laboratory, Institute for Radiological Research, Chang Gung Memorial Hospital at Linkou and Chang Gung University, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382. .,Clinical Metabolomics Core Laboratory, Chang Gung Memorial Hospital at Linkou, 5 Fuhsing St., Guishan, Taoyuan, Taiwan, 33382.
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Akaishi T, Kuroda H, Tateyama M, Yoshida Y, Otsuki T, Watanabe M, Yaegashi N, Aoki M. Recurrent cerebral infarction synchronous with menorrhagia caused by endometrial stromal sarcoma. J Neurol Sci 2015; 358:509-11. [PMID: 26432578 DOI: 10.1016/j.jns.2015.09.367] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2015] [Revised: 09/03/2015] [Accepted: 09/23/2015] [Indexed: 11/17/2022]
Affiliation(s)
- Tetsuya Akaishi
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Hiroshi Kuroda
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan.
| | - Maki Tateyama
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Yoko Yoshida
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Takeo Otsuki
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Mika Watanabe
- Department of Pathology, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Nobuo Yaegashi
- Department of Gynecology and Obstetrics, Tohoku University Graduate School of Medicine, Sendai, Japan
| | - Masashi Aoki
- Department of Neurology, Tohoku University Graduate School of Medicine, Sendai, Japan
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Abstract
Leiomyosarcoma, the most frequent pure uterine sarcoma, is an aggressive tumor with a tendency toward early relapse. Survival for patients with recurrent disease is poor. In contrast, endometrial stromal sarcoma, the second most common uterine sarcoma, is a more indolent malignancy with a tendency toward recurrence after a long latency period. The relative infrequency of both diseases makes the study and standardization of treatment for recurrent disease challenging. Treatment of recurrence with cytotoxic chemotherapy, radiation therapy, or hormone therapy produces modest to poor response rates. Surgical resection is one treatment modality offering the potential for cure and perhaps a more durable response than is seen with medical management. Although initial studies focused on pulmonary metastasectomy in recurrent soft tissue sarcoma, an increasingly large body of data specifically evaluating outcomes after both thoracic and extrathoracic metastasectomy in patients with recurrent uterine sarcoma is now available. Though no prospective trials have been conducted, retrospective comparisons of chemotherapy or radiation therapy with surgery for recurrent uterine sarcoma suggest improvement in disease-specific survival for the surgery group. Clearly defined factors are associated with better prognosis after surgical resection of recurrence, including a prolonged disease-free interval and complete resection of disease. In properly selected women, surgery and even repeated metastasectomy for recurrent disease may improve survival and should be considered.
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Affiliation(s)
- Sharmilee B Korets
- From the Division of Gynecologic Oncology, New York University School of Medicine, New York, NY
| | - John P Curtin
- From the Division of Gynecologic Oncology, New York University School of Medicine, New York, NY
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Low-grade endometrial stromal sarcoma with inferior vena cava tumor thrombus and intracardiac extension: radical resection may improve recurrence free survival. Surg Oncol 2008; 18:57-64. [PMID: 18708288 DOI: 10.1016/j.suronc.2008.07.003] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2008] [Revised: 06/15/2008] [Accepted: 07/03/2008] [Indexed: 11/23/2022]
Abstract
BACKGROUND Endometrial stromal sarcoma (ESS) represents 0.2% of all uterine malignancies. Based on the mitotic activity, a distinction is made between low and high-grade ESS. Although the overall five-year survival rate for low-grade ESS exceeds 80%, about 50% of the patients show tumor recurrence, mostly after a long latency period. Tumor invasion of the great vessels is extremely rare. We describe a patient with advanced low-grade ESS with tumor invasion of the infrarenal aorta and the inferior vena cava. The patient presented with a large tumor thrombus extending from the inferior vena cava into the right atrium. METHODS Review of literature and identification of 19 patients, including our own case report, with advanced low-grade ESS with invasion of the great vessels and formation of an inferior vena cava tumor thrombus. RESULTS All 19 patients presented with an abdominal tumor mass and a tumor thrombus protruding into the inferior vena cava. The tumor thrombus extended into the right heart cavities in nine patients reaching the right atrium in four, the right ventricle in three and the pulmonary artery in two patients. There were 5 patients with an advanced primary tumor and 14 patients with an advanced recurrent tumor. Seven patients presented with synchronous metastatic disease and six patients with a pelvic tumor infiltrating the bladder, the rectosigmoid colon or the infrarenal aorta. Mean age at surgery was 45.9+/-12.3 years (median 47, range 25-65 years). Tumor thrombectomy was accomplished by cavatomy or by right atriotomy after installation of a cardiopulmonary bypass. There was no peri-operative mortality and a very low morbidity. Radical tumor resections were achieved in 10 patients. The follow-up for these 10 patients was 2+/-1.3 years (median 2, range 0.3-4.5 years). Nine patients remained recurrence free whereas one patient suffered an asymptomatic local recurrence. CONCLUSIONS Low-grade ESS is a rare angioinvasive tumor with a high recurrence rate. Resection of an inferior vena cava tumor thrombus, even with extension into the right heart cavities, can be performed safely. Extensive radical surgery is therefore justified in the treatment of advanced tumor manifestations of a low-grade ESS potentially improving recurrence free survival.
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