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Zafar MH, Gil LC, Karimi S, Arain S, Niravel B, Martinolich J, Galvin J, Murga-Zamolloa CA, Gantt Jr. G. Plasmablastic Lymphoma Presenting With Rectosigmoid Perforation in a Human Immunodeficiency Virus-Positive Patient. Cureus 2022; 14:e24964. [PMID: 35706759 PMCID: PMC9187260 DOI: 10.7759/cureus.24964] [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] [Accepted: 05/13/2022] [Indexed: 11/06/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare variant of diffuse large B-cell lymphoma (DLBCL) associated with human immunodeficiency virus (HIV)-positive patients. It accounts for only 2% of all acquired immune deficiency syndrome (AIDS)-related lymphomas (ARLs). We present the case of a 45-year-old male who presented to the emergency department (ED) with a three-month history of abdominal pain, diarrhea, and unintentional 50-lb weight loss. On an earlier presentation to the ED three months prior, the patient was diagnosed with norovirus and Helicobacter pylori infection and received outpatient treatment without resolution of his symptoms. This prompted further investigation with a CT of the abdomen and pelvis with IV contrast that revealed severe sigmoid colitis with pneumoperitoneum and a pericolonic air-containing fluid collection, consistent with a contained perforation with abscess formation. He was admitted, resuscitated, and initially treated with antibiotics and parenteral nutrition. The patient underwent a laparoscopic converted to open anterior resection with end colostomy. Pathology revealed HIV-related PBL. He was subsequently treated with dose-adjusted etoposide, prednisone, vincristine, cyclophosphamide, doxorubicin, and rituximab (DA-EPOCH-R) chemotherapy regimen and an autologous stem cell transplant. Despite its rare association with HIV, PBL should be considered a differential diagnosis for HIV-positive patients who present with gastrointestinal (GI) pathology, and additional investigations should be conducted if symptoms do not resolve despite appropriate medical management at the time.
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L'Imperio V, Morello G, Vegliante MC, Cancila V, Bertolazzi G, Mazzara S, Belmonte B, Mangogna A, Balzarini P, Corral L, Lopez G, Di Napoli A, Facchetti F, Pagni F, Tripodo C. Spatial transcriptome of a germinal center plasmablastic burst hints at MYD88/CD79B mutants-enriched diffuse large B-cell lymphomas. Eur J Immunol 2022; 52:1350-1361. [PMID: 35554927 PMCID: PMC9546146 DOI: 10.1002/eji.202149746] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2021] [Revised: 03/29/2022] [Accepted: 05/09/2022] [Indexed: 12/02/2022]
Abstract
The GC reaction results in the selection of B cells acquiring effector Ig secreting ability by progressing toward plasmablastic differentiation. This transition is associated with exclusion from the GC microenvironment. The aberrant expansion of plasmablastic elements within the GC fringes configures an atypical condition, the biological characteristics of which have not been defined yet. We investigated the in situ immunophenotypical and transcriptional characteristics of a nonclonal germinotropic expansion of plasmablastic elements (GEx) occurring in the tonsil of a young patient. Compared to neighboring GC and perifollicular regions, the GEx showed a distinctive signature featuring key regulators of plasmacytic differentiation, cytokine signaling, and cell metabolism. The GEx signature was tested in the setting of diffuse large B‐cell lymphoma (DLBCL) as a prototypical model of lymphomagenesis encompassing transformation at different stages of GC and post‐GC functional differentiation. The signature outlined DLBCL clusters with different immune microenvironment composition and enrichment in genetic subtypes. This report represents the first insight into the transcriptional features of a germinotropic plasmablastic burst, shedding light into the molecular hallmarks of B cells undergoing plasmablastic differentiation and aberrant expansion within the noncanonical setting of the GC microenvironment.
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Affiliation(s)
- Vincenzo L'Imperio
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, San Gerardo Hospital, Via G.B. Pergolesi 33, Monza, Italy
| | - Gaia Morello
- Tumor Immunology Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | | | - Valeria Cancila
- Tumor Immunology Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Giorgio Bertolazzi
- Tumor Immunology Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Saveria Mazzara
- Division of Diagnostic Haematopathology, European Institute of Oncology, Milan, Italy
| | - Beatrice Belmonte
- Tumor Immunology Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy
| | - Alessandro Mangogna
- Institute for Maternal and Child Health, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) "Burlo Garofolo", Trieste, 34137, Italy
| | - Piera Balzarini
- Department of Molecular and Translational Medicine, University of Brescia, Piazzale Spedali Civili 1, Brescia, 25123, Italy
| | - Lilia Corral
- Centro Ricerca Tettamanti, Pediatric Clinic, University of Milan Bicocca, San Gerardo Hospital/Fondazione MBBM, Monza, Italy
| | - Gianluca Lopez
- Pathology Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | - Arianna Di Napoli
- Pathology Unit, Sapienza University of Rome, Sant'Andrea Hospital, Rome, Italy
| | | | - Fabio Pagni
- Department of Medicine and Surgery, University of Milano-Bicocca, Pathology, San Gerardo Hospital, Via G.B. Pergolesi 33, Monza, Italy
| | - Claudio Tripodo
- Tumor Immunology Unit, Department of Sciences for Health Promotion and Mother-Child Care "G. D'Alessandro", University of Palermo, Palermo, Italy.,the FIRC Institute of Molecular Oncology, Tumor and Microenvironment Histopathology Unit, IFOM, Milan, Italy
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Mathur A, Bansal S, Sharma U, Talwar A. Auer rod-like inclusions in multiple myeloma: Report of two diagnostically challenging cases. Indian J Cancer 2021; 59:110-114. [PMID: 35017367 DOI: 10.4103/ijc.ijc_741_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Non-immunoglobulin intracytoplasmic inclusions in plasma cells of multiple myeloma are very rare presentation. These are morphologically similar to Auer rods but chemically different from them. We studied two cases of multiple myeloma in a 60-year-old woman and 45-year-old man. In both cases, plasma cells of bone marrow aspirate revealed multiple Auer rod-like inclusions (ARLI). Sudan black B (SBB) and myeloperoxidase (MPO) cytochemistry were negative. Serum protein electrophoresis in both of them showed M spike, one with raised IgA-kappa levels, while the other with raised IgG-kappa levels. Very few case reports have been published in the literature and its prognostic implications are still unknown. Due to its rarity, it is important to distinguish such cases from acute myeloid leukemia and its exact incidence with its therapeutic and prognostic implications.
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Affiliation(s)
- Arpita Mathur
- Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Shashi Bansal
- Department of Pathology-Haematopathology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Upendra Sharma
- Department of Haemato-Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
| | - Amandeep Talwar
- Department of Pathology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India
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Wang W, Li Y, Rivera Rivera X, Zhao L, Mei D, Hu W, Jiang B. Application of CD54 in diagnosing bone marrow involvement by using flow cytometry in patients with diffuse large B-cell lymphoma. BMC Cancer 2021; 21:1011. [PMID: 34503477 PMCID: PMC8431857 DOI: 10.1186/s12885-021-08753-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/01/2021] [Indexed: 11/14/2022] Open
Abstract
Background Flow cytometry plays a key role in detecting bone marrow (BM) involvement in patients with diffuse large B-cell lymphoma (DLBCL). To improve its detection sensitivity, we need to explore novel markers. In this study, we detected the expression CD54 on lymphoma cells in BM specimens from DLBCL patients and clarified its diagnostic significance in BM involvement by DLBCL. Methods We collected BM specimens from 76 patients with DLBCL (germinal center B-cell (GCB) = 25, non-GCB = 51) and 10 control patients without lymphoma. We detected and compared the expression of CD54 on lymphoma cells and normal mature B cells by using 10-color panels. Results Normal plasma cells expressed a higher level of CD54 as compared with hematogones (p < 0.05) and normal mature B cells (p < 0.05). Among 76 patients, 23 of them (GCB = 12, non-GCB = 11) had BM involvement. Lymphoma B cells from 12 cases (GBC = 4, non-GCB = 8) expressed a higher level of CD54 compared to normal mature B cells (p < 0.05). Additionally, lymphoma cells of the non-GCB subtype frequently expressed a higher level of CD54 in comparison to the GCB subtype (p < 0.05). And the high expression of CD54 was not related to plasmacytoid differentiation. Conclusion Aberrant expression of CD54 on lymphoma cells is frequently seen in patients’ BM specimens involved by DLBCL, especially in the non-GCB subtype. CD54 could be used as a new marker to gate on lymphoma cells and improve the detection sensitivity of BM involvement in patients with DLBCL. Supplementary Information The online version contains supplementary material available at 10.1186/s12885-021-08753-0.
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Affiliation(s)
- Wei Wang
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, Texas, USA
| | - Yan Li
- Department of Hematology, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Xavier Rivera Rivera
- Department of Pathology and Laboratory Medicine, The University of Texas Health Science Center at Houston, 6431 Fannin Street, Houston, Texas, USA
| | - Linjun Zhao
- Department of Lymphoma, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Di Mei
- Department of Lymphoma, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Wenqing Hu
- Department of Hematology, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China
| | - Bin Jiang
- Department of Hematology, Peking University International Hospital, Zhong-Guan-Cun Life Science Park Road, Beijing, China.
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Plasmablastic neoplasms with unusual histomorphology: A report of two cases. HUMAN PATHOLOGY: CASE REPORTS 2020. [DOI: 10.1016/j.ehpc.2020.200441] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Al Sbihi AF, Singh P, Manasrah N, Kandah E, Appel J. An HIV Associated Plasmablastic Lymphoma With Spontaneous Tumor Lysis Syndrome. Cureus 2020; 12:e9625. [PMID: 32923226 PMCID: PMC7478934 DOI: 10.7759/cureus.9625] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare and aggressive B-cell Non-Hodgkin lymphoma (NHL) associated with immunocompromised states such as HIV. We present a case of PBL in an HIV patient presenting as spontaneous tumor lysis syndrome and discuss the clinical challenges hence encountered.
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Affiliation(s)
- Ali F Al Sbihi
- Internal Medicine, Detroit Medical Center - Sinai-Grace Hospital, Detroit, USA
| | - Paramveer Singh
- Internal Medicine, Detroit Medical Center - Sinai-Grace Hospital, Detroit, USA
| | - Nouraldeen Manasrah
- Internal Medicine, Detroit Medical Center - Sinai-Grace Hospital, Detroit, USA
| | - Emad Kandah
- Internal Medicine, McLaren Flint, Flint, USA
| | - Joel Appel
- Internal Medicine, Detroit Medical Center - Sinai-Grace Hospital, Detroit, USA
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Mwazha A, Nhlonzi GB, Mazengenya P. Gastrointestinal Tract Plasmablastic Lymphoma in HIV-Infected Adults: A Histopathological Review. Int J Surg Pathol 2020; 28:735-748. [PMID: 32552168 DOI: 10.1177/1066896920932272] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND. Plasmablastic lymphoma (PBL) is an aggressive B-cell lymphoma that is characterized by the expression of plasma cell antigens and loss of pan B-cell antigens. The neoplasm is extensively reported in the oral cavity and anorectal region but rarely in the gastrointestinal tract, where only isolated case reports and small case series have been reported. In the current study, morphologic, immunohistochemical, and molecular features of 17 cases of gastrointestinal tract PBL were reviewed. METHODS. Ten-year retrospective study that reappraised the histomorphological and immunophenotypical profiles of HIV-associated PBLs in the gastrointestinal tract. RESULTS. The mean age of the study patients was 41 years with a 3:1 ratio of males to females. The most common site of tumor origin was the small intestine (42%), followed by the stomach (29%) and the colon (29%). Majority of the cases showed a predominant diffuse (82%) growth pattern. Immunoblasts and plasmablasts were observed in all cases. Plasmacytic differentiation was seen in 5 (29%) cases. Additional observations not previously described or emphasized in literature includes pseudo-alveolar growth pattern, centroblast-predominance, multinucleated giant cells, and clear cell change. Immunohistochemistry revealed absence of pan B-cell antigens and expression of plasma cell antigens in all cases. Epstein-Barr virus-encoded RNA was expressed in 53% of the cases. CONCLUSIONS. This study highlights the spectrum of histopathological features seen in gastrointestinal tract PBLs. Awareness of this entity and its histopathological features in the gastrointestinal tract is essential for making a timely and accurate diagnosis and improving patient outcomes.
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Affiliation(s)
- Absalom Mwazha
- University of KwaZulu-Natal, Durban, South Africa.,National Health Laboratory Services, Durban, South Africa
| | | | - Pedzisai Mazengenya
- University of the Witwatersrand, Johannesburg, South Africa.,Ajman University, Ajman, United Arab Emirates
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Update from the 4th Edition of the World Health Organization of Head and Neck Tumours: Tumours of the Oral Cavity and Mobile Tongue. Head Neck Pathol 2017; 11:33-40. [PMID: 28247230 PMCID: PMC5340733 DOI: 10.1007/s12105-017-0792-3] [Citation(s) in RCA: 66] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2016] [Accepted: 02/02/2017] [Indexed: 12/27/2022]
Abstract
There have been several additions and deletions in Chapter 4 on Tumours of the oral cavity and mobile tongue in the 2017 fourth edition of the World Health Organization Classification of Tumours of the Head and Neck. This chapter excludes the oropharynx, which now is a stand-alone chapter acknowledging the uniqueness of the oropharynx from the oral cavity. New entries in Chapter 4 include rhabdomyoma, haemangioma, schwannoma, neurofibroma and myofibroblastic sarcoma in the section titled Soft tissue and neural tumours. Discussion of salivary gland entities have been reduced and includes mucoepidermoid carcinoma and pleomorphic adenoma as the other salivary gland types are discussed elsewhere. In the Haematolymphoid tumours section, like the salivary gland section, only tumors that commonly present in the oral cavity are discussed in Chapter 4. Excluded entities in the updated classification include papillary hyperplasia, median rhomboid glossitis, keratoacanthoma, focal oral mucinosis, and secondary tumors. This article will summarize the changes in the new classification since the 2005 edition focusing on selected entities that have had significant changes along with new entries.
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