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Ramos CA. Marginal Zone Lymphomas (Extranodal/Malt, Splenic, and Nodal). Hematology 2018. [DOI: 10.1016/b978-0-323-35762-3.00079-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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Bolaman Z, Yavasoglu I, Sargin G, Kadikoylu G, Doğer FK. Bone marrow involvement in a patient with alpha heavychain disease: response to tetracycline treatment. Mediterr J Hematol Infect Dis 2012; 4:e2012034. [PMID: 22708049 PMCID: PMC3375673 DOI: 10.4084/mjhid.2012.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2012] [Accepted: 04/17/2012] [Indexed: 11/23/2022] Open
Abstract
A 28-year-old man from East Mediterranean area admitted with abdominal pain, weight loss and diarrhea. Barium x-ray studies showed segmentation, dilatation of bowel loops, mucosal folds thickening and delayed intestinal transit. Histological examination of biopsy specimens revealed villous atrophy and plasmacytic infiltration limited to mucosa and submucosa. Computed tomography showed multiple lymphadenopathy in the abdomen. Serum protein electropheresis and immunoelectropheresis indicated elevated IgA concentration. Bone marrow aspiration and biopsy revealed presence of lymphoplasmacytic infiltration. Immunohistochemical analysis of the intestine, lymph nodes showed positivity for CD45, CD-79, CD-20. After tetracycline treatment the patient's symptoms, abdominal lymphadenopathy and bone marrow infiltration disappeared and IgA concentration decreased to normal levels.
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Affiliation(s)
- Zahit Bolaman
- Adnan Menderes University, Faculty of Medicine, Division of Hematology, Aydin, Turkey
| | - Irfan Yavasoglu
- Adnan Menderes University, Faculty of Medicine, Division of Hematology, Aydin, Turkey
| | - Gokhan Sargin
- Adnan Menderes University, Faculty of Medicine, Division of Hematology, Aydin, Turkey
| | - Gurhan Kadikoylu
- Adnan Menderes University, Faculty of Medicine, Division of Hematology, Aydin, Turkey
| | - Firuzan Kaçar Doğer
- Adnan Menderes University, Faculty of Medicine, Department of Pathology, Aydin, Turkey
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Yamamoto S, Nakase H, Yamashita K, Matsuura M, Takada M, Kawanami C, Chiba T. Gastrointestinal follicular lymphoma: review of the literature. J Gastroenterol 2010; 45:370-88. [PMID: 20084529 DOI: 10.1007/s00535-009-0182-z] [Citation(s) in RCA: 77] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2009] [Accepted: 11/23/2009] [Indexed: 02/04/2023]
Abstract
Gastrointestinal follicular lymphoma (GI-FL) is a relatively rare disease, accounting for only 1%-3.6% of gastrointestinal non-Hodgkin's lymphoma. Although the duodenum and terminal ileum are considered to be the most common sites of origin, the development of wireless capsule endoscopy and double-balloon enteroscopy has increased the detection of GI-FL in every part of the small intestine. Approximately 70% of patients with GI-FL are estimated to have multiple lesions throughout the entire gastrointestinal tract. FL is a low-grade lymphoma that usually develops very slowly. If the lymphoma causes no symptoms, immediate treatment may not be necessary. Standard therapy has not yet been established for GI-FL, but chemotherapy, radiotherapy, monoclonal antibody therapy, or a combination of these therapies, is sometimes performed based on the therapeutic regimens for nodal FL. Regimens including conventional chemotherapy with rituximab, which achieve high response rates in nodal FL, are commonly used for GI-FL. The long-term clinical outcome of GI-FL is unclear. The results of a few series on the long-term outcomes of patients with GI-FL treated with conventional therapy indicate a median relapse-free time ranging from 31 to 45 months. On the other hand, in patients with GI-FL who were followed without treatment, the median time to disease progression was 37.5 months. Thus, whether to initiate aggressive therapy or whether to continue watchful waiting in patients with GI-FL is a critically important decision. Ongoing research on biomarkers to guide individualized GI-FL therapy may provide invaluable information that will lead to the establishment of a standard therapeutic regimen.
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Affiliation(s)
- Shuji Yamamoto
- Department of Gastroenterology and Hepatology, Graduate School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan
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Regression of Immunoproliferative Small Intestinal Disease After Eradication of Helicobacter pylori. J Gastrointest Cancer 2010; 41:212-5. [DOI: 10.1007/s12029-010-9138-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Abstract
Heavy chain diseases (HCDs) are rare B-cell lymphoplasma-cell proliferative disorders characterized by production of truncated monoclonal immunoglobulin heavy chains without associated light chains. HCDs involving the three main immunoglobulin classes have been described; alpha-HCD is the most common and has the most uniform presentation, gamma- and mu-HCDs have variable clinical presentations and histopathologic features. HCDs can be thought of as variant types of non-Hodgkin lymphoma: alpha-HCD presents as an extranodal marginal-zone lymphoma of mucosa-associated lymph-node tissue, gamma-HCD as lymphoplasmacytoid non-Hodgkin lymphoma, and mu-HCD as small lymphocytic non-Hodgkin lymphoma or chronic lymphocytic leukemia. Diagnosis of HCD requires documentation of a deleted immunoglobulin heavy chain without a bound light chain in the serum or urine. Prognosis is variable, and no standardized effective treatment programs are available except for alpha-HCD, which in its early stage may respond to antibiotics.
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Kim SK, Park IK, Park BH, Park W, Lee HS, Kim TH, Jun JB, Bae SC, Yoo DH, Uhm WS. A case report: isolated a heavy chain monoclonal gammopathy in a patient with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin change syndrome. Int J Clin Pract 2005:26-30. [PMID: 15875614 DOI: 10.1111/j.1368-504x.2005.00343.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
A 45-year-old South-Korean man presented with abdominal distension, progressive paresthesia and motor weakness of both lower extremities. Our case was identified as polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy and skin change (POEMS) syndrome based on diagnostic criteria. Circulating M components of POEMS syndrome consist mainly of IgG or IgA-lambda and rarely IgM-lambda, IgG-kappa or isolated light chains. In this case, the M-band on serum protein electrophoresis and isolated IgA heavy chain on serum immunofixation electrophoresis were demonstrated, but there was no abnormal light chain. We suggest that this case may be associated with a pattern of abnormal secretion of monoclonal protein or a coincidence of a heavy chain disease in POEMS syndrome, even though the latter possibility may be very rare.
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Affiliation(s)
- S K Kim
- Department of Internal Medicine, The Hospital for Rheumatic Diseases, Seoul, South Korea
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Al-Saleem T, Al-Mondhiry H. Immunoproliferative small intestinal disease (IPSID): a model for mature B-cell neoplasms. Blood 2004; 105:2274-80. [PMID: 15542584 DOI: 10.1182/blood-2004-07-2755] [Citation(s) in RCA: 145] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Immunoproliferative small intestinal disease (IPSID) was recently added to the growing list of infectious pathogen-associated human lymphomas. Molecular and immunohistochemical studies demonstrated an association with Campylobacter jejuni. IPSID is a variant of the B-cell lymphoma of mucosa-associated lymphoid tissue (MALT), which involves mainly the proximal small intestine resulting in malabsorption, diarrhea, and abdominal pain. Geographically, IPSID is most prevalent in the Middle East and Africa. IPSID lymphomas reveal excessive plasma cell differentiation and produce truncated alpha heavy chain proteins lacking the light chains as well as the first constant domain. The corresponding mRNA lacks the variable heavy chain (V(H)) and the constant heavy chain 1 (C(H)1) sequences and contains deletions as well as insertions of unknown origin. The encoding gene sequence reveals a deletion of V region and parts of C(H)1 domain. Cytogenetic studies demonstrated clonal rearrangements involving predominantly the heavy and light chain genes, including t(9;14) translocation involving the PAX5 gene. Early-stage IPSID responds to antibiotics (30%-70% complete remission). Most untreated IPSID patients progress to lymphoplasmacytic and immunoblastic lymphoma invading the intestinal wall and mesenteric lymph nodes, and may metastasize to a distant organ. IPSID lymphoma shares clinical, morphologic, and molecular features with MALT lymphoma, lymphoplasmacytic lymphoma, and plasma cell neoplasms.
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MESH Headings
- Adolescent
- Adult
- Africa
- Campylobacter Infections/complications
- Campylobacter Infections/genetics
- Campylobacter Infections/immunology
- Campylobacter Infections/pathology
- Campylobacter Infections/therapy
- Campylobacter jejuni
- Child
- Chromosomes, Human, Pair 14
- Chromosomes, Human, Pair 9/genetics
- Chromosomes, Human, Pair 9/immunology
- Female
- Humans
- Immunoglobulin Light Chains/genetics
- Immunoglobulin Light Chains/immunology
- Immunoglobulin Variable Region/genetics
- Immunoglobulin Variable Region/immunology
- Immunoglobulin alpha-Chains/genetics
- Immunoglobulin alpha-Chains/immunology
- Immunoproliferative Small Intestinal Disease/etiology
- Immunoproliferative Small Intestinal Disease/genetics
- Immunoproliferative Small Intestinal Disease/immunology
- Immunoproliferative Small Intestinal Disease/pathology
- Immunoproliferative Small Intestinal Disease/therapy
- Intestine, Small/immunology
- Intestine, Small/pathology
- Lymph Nodes/immunology
- Lymph Nodes/pathology
- Lymphoma, B-Cell, Marginal Zone/etiology
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/therapy
- Male
- Mesentery/immunology
- Mesentery/pathology
- Middle East
- PAX5 Transcription Factor/genetics
- PAX5 Transcription Factor/immunology
- Plasma Cells/immunology
- Plasma Cells/pathology
- Sequence Deletion/genetics
- Sequence Deletion/immunology
- Translocation, Genetic/genetics
- Translocation, Genetic/immunology
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Affiliation(s)
- Tahseen Al-Saleem
- Department of Pathology, Fox Chase Cancer Center, 333 Cottman Ave, Philadelphia, PA 19111, USA.
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Abstract
The heavy chain diseases (HCDs) are rare B-cell malignancies that are distinguished by the production of a monoclonal immunoglobulin heavy chain (HC) without an associated light chain by the malignant B-cells. There are three types of HCD defined by the class of immunoglobulin (Ig) HC produced: IgA (alpha-HCD), IgG (gamma-HCD), and IgM (mu-HCD). Alpha-HCD is the most common and occurs most commonly as intestinal malabsorption in a young adult from a country bordering the Mediterranean Sea. Treatment consists of antibiotics and improved nutrition and hygiene. Surgery is occasionally required for patients with bulky masses at risk for bowel perforation. If there is no response to antibiotics or if aggressive non-Hodgkin's lymphoma (NHL) is diagnosed, the patient should be treated with chemotherapy. Gamma- and mu-HCD are rare and essentially are found in patients with a B-cell NHL that produces an abnormal Ig heavy chain. These patients occasionally may be diagnosed with a monoclonal gammopathy of undetermined significance (MGUS). Patients with MGUS with NHL should be administered chemotherapy. Screening the serum and urine of patients with lymphoplasmacytoid NHL would likely identify more patients with gamma- or mu-HCD.
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Affiliation(s)
- Thomas E Witzig
- Division of Hematology, Mayo Clinic and Mayo Foundation, 200 SW First Street, Rochester, MN 55905, USA.
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Lin OS, Gray GM. Immunoproliferative small intestinal disease: prolonged 30-year course without development of lymphoma. Am J Gastroenterol 2001; 96:2769-74. [PMID: 11569710 DOI: 10.1111/j.1572-0241.2001.04114.x] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Immunoproliferative small intestinal disease (IPSID) is mostly found in young adults of low socioeconomic class in developing countries. This condition is characterized by a dense lymphoplasmacytic infiltrate beneath the epithelium in the duodenal and proximal jejunal mucosa and in the mesenteric lymph nodes. In two thirds of cases, the involved lymphocytes elaborate an anomalous alpha-heavy chain protein. The etiology of this disease is unclear, although various parasitic, genetic, and toxic mechanisms have been proposed. Half of all IPSID patients will be found at diagnosis to have a concurrent intestinal B-cell lymphoma, and most of the remaining patients develop frank lymphoma within a few years. Although most reports of IPSID are from developing nations or indigent immigrant populations within Western countries, four cases of an IPSID-like condition have been documented in white women. Furthermore, although many IPSID patients progress to high grade indeterminate-type lymphoma within a few years of initial presentation, there have been occasional reports of long term survival without lymphomatous conversion. Here, we present an atypical case of IPSID--a California native who, though of Mexican heritage, had resided in the United States his entire life and did not belong to an indigent population. This patient had biopsy-proven IPSID that progressed over 30 yr but never exhibited lymphomatous conversion despite end stage intestinal stasis and recurrent obstruction, culminating in death. Our case calls into question some current assumptions about the prelymphomatous nature of this disease.
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Affiliation(s)
- O S Lin
- Division of Gastroenterology and Digestive Diseases Center, Stanford University Medical Center, California 94305-5487, USA
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Abstract
This review underscores the diversity of the structural and genetic abnormalities of HCD proteins and of the clinicopathologic features of the underlying lymphoproliferative disorders. Cells producing HCD may, however, all derive from a common normal precursor, which could be a rare B cell in the process of immunoglobulin gene somatic mutation within the germinal center.
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Affiliation(s)
- J P Fermand
- Department of Immuno-Hematology, Hôpital Saint-Louis, Paris, France.
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Baddoura FK, Unger ER, Mufarrij A, Nassar VH, Zaki SR. Latent Epstein-Barr virus infection is an unlikely event in the pathogenesis of immunoproliferative small intestinal disease. Cancer 1994; 74:1699-705. [PMID: 8082070 DOI: 10.1002/1097-0142(19940915)74:6<1699::aid-cncr2820740610>3.0.co;2-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
BACKGROUND The observed seasonal and geographic variations in the incidence of immunoproliferative small intestinal disease (IPSID) suggest that environmental factors contribute to its pathogenesis. One such environmental factor, the Epstein-Barr virus (EBV), has been associated with other B-cell lymphoproliferative disorders. METHODS IPSID tissues obtained at the time of initial diagnosis were retrieved from the American University of Beirut pathology archives (1972-1983) and examined for EBV genetic information by colorimetric in situ hybridization (ISH) and polymerase chain reaction (PCR). Eight patients were identified, four of whom also had serologic and immunohistochemical evidence of alpha-heavy chain disease. Thirteen tissue samples from these eight patients were available for study: eight were intestinal and five were nodal. Non-Hodgkin's B-cell lymphoma cases (nine) were randomly selected from the same archive to serve as a control for EBV in that geographic location. The ISH method used a probe to the "W" repetitive region of EBV, with the human placental DNA probe as a control for sample preparation. The PCR method amplified a 110 base pair region in the long internal direct repeat with amplification of beta-actin as control for DNA preservation. Both assays used formalin fixed paraffin embedded Raji cells as a positive control. RESULTS Neither ISH nor PCR demonstrated EBV in any of the eight patients with IPSID: The results for one of seven control blocks with adequate DNA preservation were positive when PCR was used but were negative when ISH was used. CONCLUSIONS These findings do not support a role for EBV in the induction of B-cell proliferation in IPSID:
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Affiliation(s)
- F K Baddoura
- Department of Pathology and Laboratory Medicine, Emory University School of Medicine, Atlanta, Georgia
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Fakhfakh F, Dellagi K, Ayadi H, Bouguerra A, Fourati R, Ben Ayed F, Brouet JC, Tsapis A. Alpha heavy chain disease alpha mRNA contain nucleotide sequences of unknown origins. Eur J Immunol 1992; 22:3037-40. [PMID: 1425927 DOI: 10.1002/eji.1830221141] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Human alpha heavy chain disease is characterized by the production of abnormally short alpha IgH chains. In previously published cases it has been found that the malignant cells produce abnormal alpha mRNA, lacking VH and CH1 sequences and composed of a leader sequence peptide, sequences of variable length (69 to 84 bp) and of unknown origin, followed by normal CH2 and CH3 sequences. In this study we established the nucleotide sequence of alpha mRNA for six cases of alpha heavy chain disease. We observed that all six alpha mRNA lack the VH and CH1 sequences as do those previously described. They also contain in-frame inserts of unknown origin between the leader peptide and the normal CH2 and CH3 coding sequences. These inserts are of variable length (42 to 105 bp) and they are unrelated. These results suggest the existence of a common mechanism defect leading to deletions/insertions in alpha heavy chain disease rather than a specific interaction between alpha 1 IgH gene with a unique defined molecular species.
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Affiliation(s)
- F Fakhfakh
- Laboratory of Immunology, Faculty of Medicine, Sfax, Tunis, France
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Rambaud JC, Halphen M, Galian A, Tsapis A. Immunoproliferative small intestinal disease (IPSID): relationships with alpha-chain disease and "Mediterranean" lymphomas. SPRINGER SEMINARS IN IMMUNOPATHOLOGY 1990; 12:239-50. [PMID: 2205943 DOI: 10.1007/bf00197509] [Citation(s) in RCA: 26] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Affiliation(s)
- J C Rambaud
- Service de Gastroentérologie, Hôpital Saint-Lazare, Paris, France
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