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Montesdeoca S, García-Gisbert N, Calvo X, Arenillas L, Román D, Fernández-Rodríguez C, Navarro R, Costan B, Vela MDC, Camacho L, Abella E, Colomo L, Salido M, Puiggros A, Florensa L, Espinet B, Bellosillo B, Ferrer del Álamo A. Leukemic Involvement Is a Common Feature in Waldenström Macroglobulinemia at Diagnosis. Cancers (Basel) 2023; 15:4152. [PMID: 37627180 PMCID: PMC10452547 DOI: 10.3390/cancers15164152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 08/09/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
Waldenström Macroglobulinemia (WM) is a lymphoplasmacytic lymphoma with bone marrow (BM) involvement and IgM monoclonal gammopathy. To date, no studies have focused specifically on peripheral blood (PB) involvement. In this study, 100 patients diagnosed with WM according to the World Health Organization (WHO) criteria were included based on the demonstration of MYD88mut in BM and the availability of PB multiparametric flow cytometry (MFC) analysis. Leukemic involvement by MFC was detected in 50/100 patients. A low percentage of mature small lymphocytes in PB smears was observed in only 15 cases. MYD88mut by AS-qPCR was detected in PB in 65/100 cases. In cases with leukemic expression by MFC, MYD88mut was detected in all cases, and IGH was rearranged in 44/49 cases. In 21/50 patients without PB involvement by MFC, molecular data were consistent with circulating disease (MYD88mut by AS-qPCR 3/50, IGH rearranged 6/50, both 12/50). Therefore, PB involvement by standard techniques was detected in 71/100 patients. MYD88mut was detected in PB by dPCR in 9/29 triple negative cases. Overall, 80% of the patients presented PB involvement by any technique. Our findings support the role of PB MFC in the evaluation of patients with IgM monoclonal gammopathy and provide reliable information on correlation with molecular features. The development of a feasible MFC assay may stand as an objective tool in the classification of mature B cell neoplasms presenting with IgM monoclonal gammopathy.
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Affiliation(s)
- Sara Montesdeoca
- Laboratori d’Hematologia, Servei Diagnòstic de Laboratori, Hospital Sant Joan de Déu, Esplugues de Llobregat, 08950 Barcelona, Spain;
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
| | - Nieves García-Gisbert
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Xavier Calvo
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Leonor Arenillas
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - David Román
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Concepción Fernández-Rodríguez
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Rosa Navarro
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Beatriz Costan
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - María del Carmen Vela
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Laura Camacho
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Eugènia Abella
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
- Servei d’Hematologia Clínica, Hospital del Mar, 08003 Barcelona, Spain
| | - Lluís Colomo
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Marta Salido
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citogenètica Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Anna Puiggros
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citogenètica Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Lourdes Florensa
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Blanca Espinet
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citogenètica Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
| | - Beatriz Bellosillo
- Laboratori de Biologia Molecular, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain; (N.G.-G.); (C.F.-R.); (M.d.C.V.); (L.C.); (B.B.)
- Grup de Recerca Clínica Aplicada en Neoplàsies Hematològiques, Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain;
| | - Ana Ferrer del Álamo
- Grup de Recerca Translacional en Neoplasies Hematològiques (GRETNHE), Hospital del Mar Research Institute (IMIM), 08003 Barcelona, Spain; (X.C.); (L.A.); (D.R.); (R.N.); (B.C.); (L.C.); (M.S.); (A.P.); (L.F.); (B.E.)
- Laboratori de Citologia Hematològica, Servei de Patologia, Hospital del Mar, 08003 Barcelona, Spain
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Palić J, Heier A, Lehmbecker A, Baumgärtner W, Turba ME. A challenging case of lymphoproliferative disease in a cat. Vet Clin Pathol 2022; 51:263-268. [PMID: 35181934 DOI: 10.1111/vcp.13062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Revised: 07/05/2021] [Accepted: 07/20/2021] [Indexed: 11/28/2022]
Abstract
A 7-year-old male castrated Maine Coon cat presented with edema of the right hindlimb and a markedly enlarged right popliteal lymph node. A CBC showed a neutropenia of 1.5 × 103 /μL. Radiographs and ultrasonographic examination were unremarkable. Cytology of the right popliteal lymph node revealed a mixed population of cells, consisting predominantly of medium to large plasmacytoid lymphocytes, low to moderate numbers of well-differentiated plasma cells and low numbers of small lymphocytes. Plasmacytoid lymphocytes had round nuclei with finely stippled chromatin and one prominent round nucleolus. Low numbers of binucleated cells and bizarre mitotic figures, and rare multinucleated cells were observed. Histopathologic examination of the lymph node showed effacement of the normal lymph node architecture by dense sheets of neoplastic cells. Round to polygonal tumor cells of intermediate size had a low to moderate amount of cytoplasm. Round to indented hyperchromatic nuclei were often eccentrically located and contained one distinct nucleolus. Anisocytosis and anisokaryosis were moderate and 21 mitoses/10 high power field (HPF) were present. Congo red staining was negative. High numbers of tumor cells were positive for lambda light chain immunoglobulin; moderate numbers stained positive for MUM-1. A clonal BCR gene rearrangement was detected with an immunoglobulin heavy chain target (IGH), immunoglobulin lambda light chain (IgL), and kappa deleting element (Kde). Differential diagnoses for the lymphoproliferative disease in this cat included lymphoplasmacytic lymphoma and myeloma-related disorder.
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Affiliation(s)
- Jelena Palić
- Vet Med Labor GmbH Division of IDEXX Laboratories, Kornwestheim, Germany
| | - Annabelle Heier
- Vet Med Labor GmbH Division of IDEXX Laboratories, Kornwestheim, Germany
| | - Annika Lehmbecker
- Department of Pathology, University of Veterinary Medicine, Foundation, Hannover, Germany
| | - Wolfgang Baumgärtner
- Department of Pathology, University of Veterinary Medicine, Foundation, Hannover, Germany
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Kelley JT, Brown NA, Hristov AC, Bresler SC. Primary cutaneous follicle center lymphoma with extensive plasmacytic differentiation and t(14;18) in both the lymphoid and plasma cell components. J Cutan Pathol 2021; 48:969-974. [PMID: 33786907 DOI: 10.1111/cup.14020] [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] [Received: 01/31/2021] [Revised: 03/16/2021] [Accepted: 03/24/2021] [Indexed: 12/11/2022]
Abstract
Primary cutaneous follicle center lymphoma (PCFCL) is the most common cutaneous B-cell lymphoma. The typical immunophenotype includes expression of both CD20 and BCL6, with the majority of cases lacking expression of CD10, BCL2, and the characteristic t(14;18)/IGH-BCL2 rearrangement seen in systemic follicular lymphoma (FL). Plasmacytic differentiation (PD) is an uncommon finding in both systemic and cutaneous FLs and presents a diagnostic challenge when present, leading to the potential for misdiagnosis as marginal zone lymphoma (MZL). Limited reports have described light chain restriction in the plasma cell component of FLs with PD, and rare cases of PCFCL with PD have been described. While the IGH-BCL2 translocation has been identified in a subset of FLs with PD, the presence of the BCL2 translocation in monotypic plasma cells of PCFCL has not been previously described to our knowledge. Here, we report a case of PCFCL with extensive PD in a 77-year-old woman that was favored to represent primary cutaneous MZL on an initial punch biopsy. Excisional biopsy, however, revealed that the atypical lymphocytes expressed CD10, BCL6, and BCL2, while the plasma cell component demonstrated light-chain lambda restriction. FISH studies showed the presence of an IGH-BCL2 translocation in both the lymphocytic and plasmacytic components.
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Affiliation(s)
- Justin T Kelley
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Noah A Brown
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Alexandra C Hristov
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Scott C Bresler
- Department of Pathology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Department of Dermatology, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA
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Yu Lee-Mateus A, Garcia-Saucedo JC, Abia-Trujillo D, Khoor A, Fernandez-Bussy S. Endobronchial Extranodal Marginal Zone B-Cell Lymphoma with Plasmacytic Differentiation. Cureus 2021; 13:e13104. [PMID: 33728124 PMCID: PMC7934969 DOI: 10.7759/cureus.13104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Endobronchial tumors (ET) are unusual and mostly malignant, presenting with non-specific symptoms that often delay appropriate diagnosis and treatment. Lymphomas in the airway represent less than 1% of pulmonary malignancies and require multidisciplinary approach for their management. We present a case of a 48-year-old male former smoker with a one-year history of recurrent respiratory infections and new-onset shortness of breath. Diagnostic tests included a chest computed tomography (CT) reporting the presence of an endobronchial mass and neck and cervical lymph node biopsies with inconclusive results. Bronchoscopy was successfully performed for tumor resection, improving the patient’s respiratory symptoms. Histological analysis described an extranodal marginal zone B-cell lymphoma (ENMZL) with plasmacytic differentiation; a subtype of non-Hodgkin’s lymphoma (NHL) in mucosa-associated lymphoid tissue (MALT), rarely found as an endobronchial growth. ET should be considered in the setting of persistent and worsening respiratory symptoms. ENMZL with plasmacytic differentiation is rarely found as an ET and diagnosis requires bronchoscopic intervention and extensive immunohistochemical analysis.
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Affiliation(s)
| | | | | | - Andras Khoor
- Pathology and Laboratory Medicine, Mayo Clinic, Jacksonville, USA
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Satou A, Tabata T, Suzuki Y, Sato Y, Tahara I, Mochizuki K, Oishi N, Takahara T, Yoshino T, Tsuzuki T, Nakamura S. Nodal EBV-positive polymorphic B cell lymphoproliferative disorder with plasma cell differentiation: clinicopathological analysis of five cases. Virchows Arch 2020; 478:969-976. [PMID: 33169195 DOI: 10.1007/s00428-020-02967-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 10/07/2020] [Accepted: 11/01/2020] [Indexed: 02/08/2023]
Abstract
Plasma cell differentiation (PCD) is frequently observed in some entities of non-Hodgkin B cell lymphoma, including both low-grade and high-grade lymphomas. However, except for plasmablastic lymphoma and primary effusion lymphoma, EBV+ B cell lymphoproliferative disorder (LPD) with PCD has not been well addressed due to its rarity. We clinicopathologically examined five cases of nodal EBV+ polymorphic B cell LPD with PCD (PBLPD-PCD) initially diagnosed as polymorphic EBV+ diffuse large B cell lymphoma, not otherwise specified (DLBCL-NOS) with PCD (n = 3) and methotrexate-associated B cell LPD (MTX-associated B-LPD) (n = 2). One case had a concomitant brain lesion which was clinically diagnosed as EBV-related encephalitis. This patient received therapy with vidarabine, and both the brain lesion and the nodal EBV+ PBLPD-PCD lesions disappeared. Another case was characterized by Mott cell differentiation. This case was the first reported case of EBV+ B cell lymphoma or LPD with Mott cell differentiation. The two cases of MTX-associated B cell LPD which arose in patients with rheumatoid arthritis spontaneously regressed after MTX cessation. TCRγ and IGH PCR analysis was performed in four cases. Two cases had TCRγ rearrangements, but no IGH rearrangements. The other two cases had no rearrangements in these genes. We concluded that nodal EBV+ PBLPD-PCD is rare, with heterogeneous characteristics. PCR analysis revealed that nodal EBV+ PBLPD-PCD may have only TCR clonality and no IGH clonality. Considering the partial or complete loss of CD20 expression on the tumor cells, this result may be confusing for accurate diagnosis of EBV+ PBLPD-PCD, and pathologists need to be aware of this phenomenon to avoid misdiagnosis.
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Affiliation(s)
- Akira Satou
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, 480-1195, Japan.
| | - Tetsuya Tabata
- Department of Pathology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Yuka Suzuki
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
| | - Yasuharu Sato
- Division of Pathophysiology, Okayama University Graduate School of Health Sciences, Okayama, Japan
| | - Ippei Tahara
- Department of Pathology, Graduate School of Medicine, University of Yamanashi, Chuo, Japan
| | - Kunio Mochizuki
- Department of Pathology, Graduate School of Medicine, University of Yamanashi, Chuo, Japan
| | - Naoki Oishi
- Department of Pathology, Graduate School of Medicine, University of Yamanashi, Chuo, Japan
| | - Taishi Takahara
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, 480-1195, Japan
| | - Tadashi Yoshino
- Department of Pathology, Okayama University Graduate School of Medicine, Okayama, Japan
| | - Toyonori Tsuzuki
- Department of Surgical Pathology, Aichi Medical University Hospital, 1-1, Yazakokarimata, Nagakute, 480-1195, Japan
| | - Shigeo Nakamura
- Department of Pathology and Laboratory Medicine, Nagoya University Hospital, Nagoya, Japan
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Matsumoto Y, Masuda T, Nishimura A, Horie H, Harada K, Yoshida M, Shimura K, Kaneko H, Taniwaki M. A case of AL amyloidosis associated with follicular lymphoma with plasmacytic differentiation. Int J Hematol 2019; 111:317-323. [DOI: 10.1007/s12185-019-02734-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2019] [Revised: 09/09/2019] [Accepted: 09/12/2019] [Indexed: 12/15/2022]
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Rodrigues-Fernandes CI, de Souza LL, Santos-Costa SFD, Silva AMB, Pontes HAR, Lopes MA, de Almeida OP, Brennan PA, Fonseca FP. Clinicopathological analysis of oral plasmablastic lymphoma: A systematic review. J Oral Pathol Med 2018; 47:915-922. [PMID: 29917262 DOI: 10.1111/jop.12753] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/12/2018] [Indexed: 12/21/2022]
Abstract
BACKGROUND Plasmablastic lymphoma (PBL) is a high-grade lymphoma that often affects the oral cavity of HIV-positive patients; however, its prognostic determinants remain unknown. PURPOSE To integrate the available data on oral PBL to determine its clinicopathological features and to identify potential prognostic factors. METHODS An electronic systematic review was performed using multiple databases with a specific search strategy in February 2018. Inclusion criteria comprised cases diagnosed as PBL affecting the oral cavity and gnathic bones with sufficient data to confirm the diagnoses. RESULTS A total of 70 publications were included, representing 153 cases. Oral PBL predominantly affected HIV-positive males (76.4%). EBV was observed in 63.4% of the cases. The gingiva was the most involved site and the lesion usually presented as an asymptomatic swelling. Most cases were classified as stage I (21.6%), and chemotherapy alone was applied in 28.8% of the cases. There was a significant association between HIV and EBV infections, and cases affecting HIV-negative patients were more common in older individuals. Cumulative survival of the patients achieved 42.4% and 33.5% after 2 and 5 years, respectively. Although there were no statistically significant clinicopathological parameters in the univariate analysis, the multivariate Cox regression model demonstrated that EBV-positive status, presence of B-symptoms, and chemotherapy alone were independent prognostic determinants of a poor prognosis. CONCLUSION Oral PBL is an aggressive neoplasm with low survival rates, which is influenced by the presence of EBV, presence of B-symptoms, and with the use of chemotherapy only.
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Affiliation(s)
| | - Lucas Lacerda de Souza
- Service of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Sara Ferreira Dos Santos-Costa
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - André Myller Barbosa Silva
- Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Hélder Antônio Rebelo Pontes
- Service of Oral Pathology, João de Barros Barreto University Hospital, Federal University of Pará, Belém, Brazil
| | - Márcio Ajudarte Lopes
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Oslei Paes de Almeida
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil
| | - Peter A Brennan
- Department of Oral and Maxillofacial Surgery, Queen Alexandra Hospital, Portsmouth, UK
| | - Felipe Paiva Fonseca
- Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, Brazil.,Department of Oral Surgery and Pathology, School of Dentistry, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
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Krebs S, Ganly I, Ghossein R, Yang J, Yahalom J, Schöder H. Solitary Extramedullary Plasmacytoma of the Cricoid Cartilage-Case Report. Front Oncol 2017; 7:284. [PMID: 29230383 PMCID: PMC5711767 DOI: 10.3389/fonc.2017.00284] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Accepted: 11/10/2017] [Indexed: 01/07/2023] Open
Abstract
Solitary plasmacytoma (SP) is an extremely rare form of hematologic malignancy that can be classified as solitary bone plasmacytoma or solitary extramedullary plasmacytoma. Here, we report a patient who presented with progressive shortness of breath and foreign body sensation in his throat. Fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG-PET/CT) demonstrated an abnormal FDG-avid soft tissue mass arising from the larynx involving the cricoid cartilage without additional suspicious lesions. Histology revealed an abundance of plasma cells; immunohistochemistry was positive for CD138 expression and lambda chains, and negative for CD20. Comprehensive imaging studies and panendoscopy of the ENT tract confirmed solitary disease involvement. Following additional systemic work-up, a diagnosis of extramedullary plasmacytoma was rendered. The patient underwent definitive radiotherapy using intensity-modulated radiation therapy (total dose of 46 Gy, divided in 23 fractions of 200 cGy). Serial PET/CT showed the stepwise resolution of abnormal FDG uptake and resolution of the cricoid cartilage lesion. With 22 months of follow-up, the patient remains free of disease. We describe the rare case of SP presenting as a FDG-avid hypermetabolic soft tissue mass in the cricoid cartilage, which should be considered in the differential diagnosis of laryngeal tumors. Of note, SP is radiosensitive; favorable outcome can be expected once treated with doses of 40–50 Gy. FDG PET/CT is helpful in diagnosis and response assessment for this disease.
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Affiliation(s)
- Simone Krebs
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Ian Ganly
- Department of Surgery, Head and Neck Service, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Ronald Ghossein
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Joanna Yang
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Joachim Yahalom
- Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, New York, United States
| | - Heiko Schöder
- Department of Radiology, Molecular Imaging and Therapy Service, Memorial Sloan Kettering Cancer Center, New York, United States
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