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Attygalle AD, Chan JKC, Coupland SE, Du MQ, Ferry JA, Jong DD, Gratzinger D, Lim MS, Naresh KN, Nicolae A, Ott G, Rosenwald A, Schuh A, Siebert R. The 5th edition of the World Health Organization Classification of mature lymphoid and stromal tumors - an overview and update. Leuk Lymphoma 2024; 65:413-429. [PMID: 38189838 DOI: 10.1080/10428194.2023.2297939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2023] [Accepted: 08/15/2023] [Indexed: 01/09/2024]
Abstract
The purpose of this review is to give an overview on the conceptual framework and major developments of the upcoming 5th edition of the World Health Organization (WHO) Classification of Haematolymphoid tumours (WHO-HAEM5) and to highlight the most significant changes made in WHO-HAEM5 compared with the revised 4th edition (WHO-HAEM4R) of lymphoid and stromal neoplasms. The changes from the revised 4th edition include the reorganization of entities by means of a hierarchical system that is realized throughout the 5th edition of the WHO classification of tumors of all organ systems, a modification of nomenclature for some entities, the refinement of diagnostic criteria or subtypes, deletion of certain entities, and introduction of new entities. For the first time, tumor-like lesions, mesenchymal lesions specific to lymph node and spleen, and germline predisposition syndromes associated with the lymphoid neoplasms are included in the classification.
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Affiliation(s)
- Ayoma D Attygalle
- Department of Histopathology, The Royal Marsden Hospital, London, UK
| | - John K C Chan
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong, SAR China
| | - Sarah E Coupland
- Department of Molecular and Clinical Cancer Medicine, ISMIB, University of Liverpool, Liverpool, UK
- Liverpool Clinical Laboratories, Liverpool University Hospitals Foundation Trust, Liverpool, UK
| | - Ming-Qing Du
- Department of Pathology, University of Cambridge, Cambridge, UK
| | - Judith A Ferry
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, MA, USA
| | - Daphne de Jong
- The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Dita Gratzinger
- Department of Pathology, Stanford University School of Medicine, Stanford, USA
| | - Megan S Lim
- Memorial Sloan Kettering Cancer Center, New York City, NY, USA
| | - Kikkeri N Naresh
- Fred Hutchinson Cancer Center, University of Washington, Seattle, USA
| | - Alina Nicolae
- Department of Pathology, University Hospital of Strasbourg, Strasbourg, France
| | - German Ott
- Department of Clinical Pathology, Robert-Bosch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute of Clinical Pharmacology, Stuttgart, Germany
| | - Andreas Rosenwald
- Institute of Pathology, Julius-Maximilians-UniversitätWürzburg, and Cancer Center Mainfranken, Würzburg, Germany
| | - Anna Schuh
- Department of Oncology, University of Oxford, Oxford, UK
| | - Reiner Siebert
- Institute of Human Genetics, Ulm University and Ulm University Medical Center, Ulm, Germany
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2
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Charles DD, Pavlisko EN, Neff JL, Kang Y, Carney JM. Coinciding kappa AL amyloidosis and kappa light chain deposition disease in the lung. Virchows Arch 2023; 483:705-707. [PMID: 37535125 DOI: 10.1007/s00428-023-03610-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Revised: 06/30/2023] [Accepted: 07/23/2023] [Indexed: 08/04/2023]
Affiliation(s)
- Derald D Charles
- Department of Pathology, Duke University Health System, Durham, NC, USA
| | | | - Jadee L Neff
- Department of Pathology, Duke University Health System, Durham, NC, USA
| | - Yubin Kang
- Duke Cancer Institute, Duke University Health System, Durham, NC, USA
| | - John M Carney
- Department of Pathology, Duke University Health System, Durham, NC, USA.
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, USA.
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3
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Riehani A, Soubani AO. The spectrum of pulmonary amyloidosis. Respir Med 2023; 218:107407. [PMID: 37696313 DOI: 10.1016/j.rmed.2023.107407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/07/2023] [Revised: 08/21/2023] [Accepted: 09/08/2023] [Indexed: 09/13/2023]
Abstract
Amyloidosis is a disease caused by misfolded proteins that deposit in the extracellular matrix as fibrils, resulting in the dysfunction of the involved organ. The lung is a common target of Amyloidosis, but pulmonary amyloidosis is uncommonly diagnosed since it is rarely symptomatic. Diagnosis of pulmonary amyloidosis is usually made in the setting of systemic amyloidosis, however in cases of localized pulmonary disease, surgical or transbronchial tissue biopsy might be indicated. Pulmonary amyloidosis can be present in a variety of discrete entities. Diffuse Alveolar septal amyloidosis is the most common type and is usually associated with systemic AL amyloidosis. Depending on the degree of the interstitial involvement, it may affect alveolar gas exchange and cause respiratory symptoms. Localized pulmonary Amyloidosis can present as Nodular, Cystic or Tracheobronchial Amyloidosis which may cause symptoms of airway obstruction and large airway stenosis. Pleural effusions, mediastinal lymphadenopathy and pulmonary hypertension has also been reported. Treatment of all types of pulmonary amyloidosis depends on the type of precursor protein, organ involvement and distribution of the disease. Most of the cases are asymptomatic and require only close monitoring. Diffuse alveolar septal amyloidosis treatment follows the treatment of underlying systemic amyloidosis. Tracheobronchial amyloidosis is usually treated with bronchoscopic interventions including debulking and stenting or with external beam radiation. Long-term prognosis of pulmonary amyloidosis usually depends on the type of lung involvement and other organ function.
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Affiliation(s)
- Anas Riehani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA
| | - Ayman O Soubani
- Division of Pulmonary, Critical Care and Sleep Medicine, Wayne State University School of Medicine, Detroit, MI, USA.
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4
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Mihalova TZ, Ivanova SS, Mekov EV, Yamakova YТ, Petkov RE. Ultrasound-controlled transthoracic true-cut needle biopsy in pulmonary nodular amyloidosis. Respirol Case Rep 2023; 11:e01142. [PMID: 37200954 PMCID: PMC10186149 DOI: 10.1002/rcr2.1142] [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] [Received: 12/04/2022] [Accepted: 03/30/2023] [Indexed: 05/20/2023] Open
Abstract
The current case report presents a 59-year-old man with imaging studies of the thorax showing nodular lesions in the lungs bilaterally. Based on radiographic and CT images, preliminary diagnoses for possible granulomatosis (tuberculosis) or pulmonary metastatic dissemination of a neoplastic process were made. An ultrasound-controlled transthoracic true-cut needle biopsy of a subpleural lesion was performed. Special staining with Congo red and examination with a polarizing light microscope for detection of amyloid confirmed the diagnosis of 'pulmonary nodular amyloidosis' by visualizing green birefringence.
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Affiliation(s)
- Teodora Z. Mihalova
- Clinic for Treatment of Nonspecific Lung Diseases and TuberculosisUMHAT “St. Ivan Rilski”, Medical University—SofiaSofiaBulgaria
| | - Silviya S. Ivanova
- Department of PathomorphologyUMHAT "St. Ivan Rilski", Medical University—SofiaSofiaBulgaria
| | - Evgeni V. Mekov
- Department of Professional DiseasesUMHAT “St. Ivan Rilski”, Medical University—SofiaSofiaBulgaria
| | - Yordanka Т. Yamakova
- Department of Intensive Care, Clinic for CardiologyUMHAT “Alexandrovska”, Medical University—SofiaSofiaBulgaria
| | - Rosen E. Petkov
- Clinic for Treatment of Nonspecific Lung Diseases and TuberculosisUMHAT “St. Ivan Rilski”, Medical University—SofiaSofiaBulgaria
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5
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Pornchai A, Moua T. Dyspnea and cough in a 68-year-old female with light chain deposition disease. Respir Med Case Rep 2023; 43:101839. [PMID: 37021143 PMCID: PMC10068249 DOI: 10.1016/j.rmcr.2023.101839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 01/31/2023] [Accepted: 03/17/2023] [Indexed: 03/28/2023] Open
Abstract
Light chain deposition disease (LCDD) is a rare hematologic disorder characterized by non-amyloid monoclonal immunoglobulin light chain deposition in multiple organs. Pulmonary LCDD (PLCDD) is an uncommon manifestation of LCDD usually seen in middle-aged patients presenting with radiologic cystic and nodular findings. We report the case of a 68-year-old female who presented with shortness of breath and atypical chest pain. Chest computerized tomography (CT) scan revealed numerous diffuse but basilar predominant pulmonary cysts and mild bronchiectasis without nodular disease. Given concomitant abnormal renal function and hepatic laboratory indices, she underwent biopsy of both organs confirming the presence of LCDD. Directed chemotherapy was initiated and stabilized renal and hepatic progression, but on follow-up imaging, pulmonary disease appeared worse. While therapeutic options targeting other organ involvement are available, their directed efficacy for progressive lung disease is not well known.
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Affiliation(s)
| | - Teng Moua
- Corresponding author. Division of Pulmonary and Critical Care Medicine, Mayo Clinic, 200 First St SW, Rochester, MN, 55905, USA.
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6
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Kronen R, Ziehr DR, Kane AE, VanderLaan PA, Kholdani CA, Hallowell RW. Pulmonary amyloidosis as the presenting finding in a patient with multiple myeloma. Respir Med Case Rep 2022; 37:101626. [PMID: 35342704 PMCID: PMC8943293 DOI: 10.1016/j.rmcr.2022.101626] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 02/19/2022] [Accepted: 03/07/2022] [Indexed: 12/15/2022] Open
Affiliation(s)
- Ryan Kronen
- Department of Medicine, University of Washington, Seattle, WA, USA
- Corresponding author. Department of Medicine University of Washington, 1959 NE Pacific Street Seattle, WA, 98195, USA.
| | - David R. Ziehr
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
| | - Ashley E.D. Kane
- Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Paul A. VanderLaan
- Department of Pathology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Cyrus A. Kholdani
- Division of Pulmonary, Critical Care, and Sleep Medicine, Department of Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Robert W. Hallowell
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA
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7
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Abstract
The association between malignancy and rheumatic diseases has been demonstrated in a multitude of studies. Little is understood regarding the pathogenesis of rheumatic and musculoskeletal diseases in association with malignancy. There is strong evidence regarding the association between Sjögren syndrome and lymphoma as well as risk factors for development of lymphoma in these patients. This article discusses the accumulating data on various malignancies described in primary Sjögren syndrome, highlighting non-Hodgkin lymphoma and thyroid, multiple myeloma, and skin cancers. These reported associations may have clinical implications in daily practice and contribute to understanding of both autoimmunity and cancer.
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Affiliation(s)
- Ann Igoe
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Department of Medicine, University of Oklahoma Health Sciences Center, MS 38, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA; Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, MS 38, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA
| | - Sali Merjanah
- The Metrohealth System, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA
| | - R Hal Scofield
- Arthritis and Clinical Immunology Program, Oklahoma Medical Research Foundation, Departments of Medicine and Pathology, University of Oklahoma Health Sciences Center, MS 38, 825 Northeast 13th Street, Oklahoma City, OK 73104, USA; US Department of Veterans Affairs, Oklahoma City, OK, USA.
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8
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Sugi MD, Kawashima A, Salomao MA, Bhalla S, Venkatesh SK, Pickhardt PJ. Amyloidosis: Multisystem Spectrum of Disease with Pathologic Correlation. Radiographics 2021; 41:1454-1474. [PMID: 34357805 DOI: 10.1148/rg.2021210006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Amyloidosis is a group of conditions defined by extracellular deposition of insoluble proteins that can lead to multiorgan dysfunction and failure. The systemic form of the disease is often associated with a plasma cell dyscrasia but may also occur in the setting of chronic inflammation, long-term dialysis, malignancy, or multiple hereditary conditions. Localized forms of the disease most often involve the skin, tracheobronchial tree, and urinary tract and typically require tissue sampling for diagnosis, as they may mimic many conditions including malignancy at imaging alone. Advancements in MRI and nuclear medicine have provided greater specificity for the diagnosis of amyloidosis involving the central nervous system and heart, potentially obviating the need for biopsy of the affected organ in certain circumstances. Specifically, a combination of characteristic findings at noninvasive cardiac MRI and skeletal scintigraphy in patients without an underlying plasma cell dyscrasia is diagnostic for cardiac transthyretin amyloidosis. Histologically, the presence of amyloid is denoted by staining with Congo red and a characteristic apple green birefringence under polarized light microscopy. The imaging features of amyloid vary across each organ system but share some common patterns, such as soft-tissue infiltration and calcification, that may suggest the diagnosis in the appropriate clinical context. The availability of novel therapeutics that target amyloid protein fibrils such as transthyretin highlights the importance of early diagnosis. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Mark D Sugi
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Akira Kawashima
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Marcela A Salomao
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Sanjeev Bhalla
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Sudhakar K Venkatesh
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
| | - Perry J Pickhardt
- From the Department of Radiology and Biomedical Imaging, University of California, 505 Parnassus Ave, 3rd Floor, M391, Box 0628, San Francisco, CA 94143 (M.D.S.); Departments of Radiology (A.K.) and Laboratory Medicine and Pathology (M.A.S.), Mayo Clinic Arizona, Scottsdale, Ariz; Mallinckrodt Institute of Radiology, Washington University School of Medicine, St Louis, Mo (S.B.); Department of Radiology, Mayo Clinic College of Medicine, Mayo Clinic, Rochester, Minn (S.K.V.); and Department of Radiology, University of Wisconsin School of Medicine and Public Health, Madison, Wis (P.J.P.)
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9
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Hudak M, Sardana R, Parwani AV, Mathewson RC, Gibson CG, Cohen PA, Lazarus JJ, Bruce JT, Son JH, Tynski Z. Light chain deposition disease presenting as an atrial mass: a case report and review of literature. Cardiovasc Pathol 2021; 55:107368. [PMID: 34324992 DOI: 10.1016/j.carpath.2021.107368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 06/30/2021] [Accepted: 07/02/2021] [Indexed: 10/20/2022] Open
Abstract
Light chain deposition disease (LCDD) also known as nonamyloidotic immunoglobulin deposition disease is a rare systemic disorder due to the abnormal deposition of immunoglobulin in multiple organs caused by the clonal proliferation of B lymphocytes and plasma cells. Renal involvement is the most common with cardiac manifestations being the most common extra renal presentation of the disease. Renal involvement is not always associated with LCDD. Isolated cardiac involvement can manifest in a wide variety of ways: heart failure, cardiomyopathy, arrhythmias, angina, myocardial infarction, etc. We hereby present an unusual case of 59-year-old female who presented to clinic for routine follow up. A murmur on physical exam was evaluated with echocardiogram which led to the discovery of an incidental right atrial mass. Cardiac magnetic resonance imaging was completed 6 months later for follow up which showed increasing size of the mass. The mass was excised and found to be consistent with LCDD. To the best of our knowledge, this is the first reported case of LCDD manifesting as an atrial mass. Through this case report and review of literature we would like to generate awareness among our fellow pathologists and clinicians to maintain a high level of suspicion for LCDD as it can manifest in many unusual ways, with or without kidney involvement.
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Affiliation(s)
- Madeline Hudak
- Department of Internal Medicine, Fairfield Medical Center, Lancaster, Ohio
| | - Ruhani Sardana
- Department of Pathology, The Ohio State University Medical Center and Comprehensive Cancer Center, Columbus, Ohio
| | - Anil V Parwani
- Department of Pathology, The Ohio State University Medical Center and Comprehensive Cancer Center, Columbus, Ohio
| | | | | | - P Aryeh Cohen
- Department of Cardiothoracic Surgery, Fairfield Medical Center, Lancaster, Ohio
| | - John J Lazarus
- Department of Cardiology, Fairfield Medical Center, Lancaster, Ohio
| | - Jarrod T Bruce
- Department of Pulmonary Medicine, Fairfield Medical Center, Lancaster, Ohio
| | - Jae H Son
- Department of Internal Medicine, Fairfield Medical Center, Lancaster, Ohio
| | - Zofia Tynski
- Department of Pathology, Fairfield Medical Center, Lancaster, Ohio.
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10
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Rendo M, Franks TJ, Galvin JR, Berglund A, Volk C, Peterson M. Autologous Stem Cell Transplantation in the Treatment of Pulmonary Light Chain Deposition Disease. Chest 2021; 160:e13-e17. [PMID: 34246382 DOI: 10.1016/j.chest.2021.02.041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Revised: 02/12/2021] [Accepted: 02/16/2021] [Indexed: 10/20/2022] Open
Abstract
Light chain deposition disease is a rare condition that results in the deposition of light chains in organs and their subsequent dysfunction. It is often the consequence of unchecked light chain production by a plasma cell clone. Rarely does it manifest with solely pulmonary involvement, especially in the young otherwise healthy patient. This article highlights the presentation and diagnosis of pulmonary light chain deposition disease in an active duty solider, the discovery of a plasma cell clone responsible for his symptoms, and the therapy targeted at the plasma cell clone-inducing pulmonary disease. This therapy included a novel successful treatment with an autologous stem cell transplantation. To date, it is among the first such documented successful bone marrow transplantations in treatment of isolated pulmonary light chain deposition disease.
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Affiliation(s)
- Matthew Rendo
- Department of Hematology and Oncology, Brooke Army Medical Center, Fort Sam Houston, TX.
| | - Teri J Franks
- The Joint Pathology Center, Defense Health Agency National Capital Region Medical Directorate, Silver Springs, MD
| | - Jeffrey R Galvin
- Department of Defense and Diagnostic Radiology and Nuclear Medicine and Pulmonary/Critical Care Medicine, University of Maryland School of Medicine, Baltimore, MD
| | - Andrew Berglund
- Department of Pulmonary/Critical Care, Brooke Army Medical Center, Fort Sam Houston, TX
| | - Charles Volk
- Pulmonary/Critical Care, Naval Medical Center San Diego, San Diego, CA
| | - Matthew Peterson
- Department of Hematology and Oncology, Brooke Army Medical Center, Fort Sam Houston, TX
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11
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The Clone Wars: Diagnosing and Treating Dysproteinemic Kidney Disease in the Modern Era. J Clin Med 2021; 10:jcm10081633. [PMID: 33921394 PMCID: PMC8069250 DOI: 10.3390/jcm10081633] [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] [Received: 03/04/2021] [Revised: 03/23/2021] [Accepted: 03/25/2021] [Indexed: 11/17/2022] Open
Abstract
Dysproteinemic kidney diseases are disorders that occur as the result of lymphoproliferative (B cell or plasma cell) disorders that cause kidney damage via production of nephrotoxic monoclonal immunoglobulins or their components. These monoclonal immunoglobulins have individual physiochemical characteristics that confer specific nephrotoxic properties. There has been increased recognition and revised characterization of these disorders in the last decade, and in some cases, there have been substantial advances in disease understanding and treatments, which has translated to improved patient outcomes. These disorders still present challenges to nephrologists and patients, since they are rare, and the field of hematology is rapidly changing with the introduction of novel testing and treatment strategies. In this review, we will discuss the clinical presentation, kidney biopsy features, hematologic characteristics and treatment of dysproteinemic kidney diseases.
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12
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Masson Trichrome and Sulfated Alcian Blue Stains Distinguish Light Chain Deposition Disease From Amyloidosis in the Lung. Am J Surg Pathol 2021; 45:405-413. [PMID: 33002919 DOI: 10.1097/pas.0000000000001593] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Light chain deposition disease, characterized by nonamyloidogenic deposits of immunoglobulin light chains, is rare in the lung and possibly underdiagnosed due to low clinical suspicion and lack of readily accessible tests. We encountered a case of pulmonary light chain deposition disease (PLCDD) in which light chain deposits appeared crimson red with a Masson trichrome (MT) stain and salmon pink with a sulfated Alcian blue (SAB) stain. This prompted us to characterize a series of PLCDD cases and assess the utility of MT and SAB stains to distinguish them from amyloidosis. From the pathology archives of 2 institutions spanning 10 years, we identified 11 cases of PLCDD, including 7 diagnosed as such and 4 determined retrospectively. The deposits in all cases of PLCDD stained crimson red with MT and salmon pink with SAB, while the cases of pulmonary amyloid (n=10) stained blue-gray and blue-green, respectively. The immunoglobulin light chain nature of the deposits was confirmed in 10 of 11 cases by either immunofluorescence microscopy (n=5) or mass spectrometry (n=5). Transmission electron microscopy revealed osmiophilic, electron-dense deposits in all cases analyzed (n=3). An extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue type was diagnosed in 10 cases and 1 represented a plasma cell neoplasm. Our study highlights the importance of considering PLCDD in the differential diagnosis of amyloid-like deposits in the lung and the value of performing MT and SAB stains to distinguish between PLCDD and amyloidosis.
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13
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Atypical Nodular Pulmonary Kappa Light-Chain Deposition. Case Rep Pathol 2021; 2021:5578885. [PMID: 33777471 PMCID: PMC7979308 DOI: 10.1155/2021/5578885] [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: 01/05/2021] [Revised: 02/23/2021] [Accepted: 02/25/2021] [Indexed: 11/18/2022] Open
Abstract
We report a case of an incidental positron emission tomography avid right middle lobe lesion which was increasing in size. Due to concerns regarding malignancy, the patient underwent right middle lobectomy. Microscopic examination showed a 12 × 10 × 10 mm poorly circumscribed lesion composed of eosinophilic material. The material labelled strongly for kappa light chains; however, Congo red stain was only weakly positive and without "apple-green" positive birefringence under polarised light. Electron microscopy revealed fibrillar amyloid-like material. The features were those of kappa light-chain deposition.
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14
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Green DB, Restrepo CS, Legasto AC, Bang TJ, Oh AS, Vargas D. Imaging of the rare cystic lung diseases. Curr Probl Diagn Radiol 2021; 51:648-658. [PMID: 33618900 DOI: 10.1067/j.cpradiol.2021.02.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2020] [Accepted: 02/01/2021] [Indexed: 12/20/2022]
Abstract
When discussing cystic lung diseases, a certain group of diseases tends to receive the majority of attention. Other less frequently discussed cystic lung diseases are also important causes of morbidity in patients. Etiologies include genetic syndromes, lymphoproliferative diseases, infections, exogenous exposures, and a developmental abnormality. This review article focuses on the clinical and imaging features of these other cystic lung diseases.
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Affiliation(s)
- Daniel B Green
- Department of Radiology, Weill Cornell Medicine, New York, NY.
| | - Carlos S Restrepo
- Department of Radiology, University of Texas Health Science Center at San Antonio, San Antonio, TX
| | - Alan C Legasto
- Department of Radiology, Weill Cornell Medicine, New York, NY
| | - Tami J Bang
- Department of Radiology, University of Colorado, Aurora, CO
| | - Andrea S Oh
- Department of Radiology, National Jewish Health, Denver, CO
| | - Daniel Vargas
- Department of Radiology, University of Colorado, Aurora, CO
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15
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Mezzanotte JN, Gibbons-Fideler IS, Shilo K, Lustberg M, Devarakonda S. Nodular pulmonary deposition disease in a patient with the acquired immunodeficiency syndrome: a case report. J Med Case Rep 2020; 14:64. [PMID: 32498712 PMCID: PMC7273682 DOI: 10.1186/s13256-020-02394-w] [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] [Received: 02/05/2020] [Accepted: 04/28/2020] [Indexed: 11/27/2022] Open
Abstract
Background Pulmonary nodules are a common cause for concern in patients with human immunodeficiency virus and acquired immunodeficiency syndrome. Most commonly, they are the result of an infection, given the patients’ immunocompromised state; however, in some cases, pulmonary nodules in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome can result from cellular or protein deposits. We report a rare case of nodular pulmonary light chain deposition disease in a patient with acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance. Case presentation A 53-year-old African American woman with acquired immunodeficiency syndrome had pulmonary nodules detected incidentally by imaging of her lungs. Pulmonary tuberculosis was high on the differential diagnosis, but she had a negative test result for pulmonary tuberculosis. Imaging also revealed multiple lucent bone lesions, and earlier in the year, serum protein electrophoresis had shown an immunoglobulin G-kappa monoclonal protein (M spike). She was mildly anemic, so there was concern for progression to myeloma; however, the result of her bone marrow biopsy was unremarkable. Lung biopsy revealed finely granular eosinophilic material with negative Congo red staining, consistent with light chain deposition disease. Conclusions The extent of this patient’s light chain deposition disease was thought to be caused by a combination of acquired immunodeficiency syndrome and monoclonal gammopathy of undetermined significance, and the interval decrease in lung nodule size after restarting antiretroviral therapy confirms this hypothesis and also highlights a potentially unique contribution of the hypergammaglobulinemia to this disease process in patients with human immunodeficiency virus and patients with acquired immunodeficiency syndrome .
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Affiliation(s)
- Jessica N Mezzanotte
- Department of Internal Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, USA.
| | | | - Konstantin Shilo
- Department of Pathology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Mark Lustberg
- Department of Infectious Disease, The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Srinivas Devarakonda
- Department of Hematology, The Ohio State University Wexner Medical Center, Columbus, OH, USA
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Baqir M, Moua T, White D, Yi ES, Ryu JH. Pulmonary nodular and cystic light chain deposition disease: A retrospective review of 10 cases. Respir Med 2020; 164:105896. [PMID: 32217287 DOI: 10.1016/j.rmed.2020.105896] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2019] [Revised: 02/03/2020] [Accepted: 02/05/2020] [Indexed: 12/22/2022]
Abstract
INTRODUCTION Light chain deposition disease (LCDD) rarely involves the lungs. We report clinical and radiologic findings of pulmonary LCDD. METHODS We retrospectively identified patients with biopsy-proven pulmonary LCDD seen at Mayo Clinic (Rochester, Minnesota) from January 1997 through December 2018. Demographic, clinical, and imaging features were analyzed. RESULTS We identified 10 patients with pulmonary LCDD (median age at diagnosis, 55 years; range, 39-77 years). Eight patients were women and 7 were never-smokers. Dyspnea (n = 3) and chest pain (n = 3) were the most common respiratory symptoms. Associated conditions included Sjögren syndrome (n = 6), sarcoidosis (n = 1), and limited scleroderma (n = 1). Eight patients had mucosa-associated lymphoid tissue (MALT) lymphoma. Among the 9 patients with chest computed tomography (CT) images, 8 (89%) had cysts. Cysts were predominantly distributed in the lower lung and were round or oval. All patients had multiple cysts (5 patients had 1-5 cysts, 3 had >20 cysts). The median diameter of the largest cyst was 18 mm (range, 5-68 mm). All 9 patients had solid nodules (3 had >10 nodules). Five patients had subsolid nodules. The median diameter of the largest solid nodules was 13 mm (range, 6-26 mm). Positron emission tomography-CT images were available for 8 patients. The median maximum standardized uptake value of the most avid pulmonary nodule was 2.2 (range, 1.9-6.0). Two patients died during a median follow-up of 2.3 years (range, 0.5-9.9 years). CONCLUSIONS Pulmonary LCDD is characterized by cysts and nodules. The disease is associated with MALT lymphoma, especially in the setting of Sjögren syndrome.
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Affiliation(s)
- Misbah Baqir
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA.
| | - Teng Moua
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
| | - Darin White
- Department of Radiology, Mayo Clinic, Rochester, MN, USA
| | - Eunhee S Yi
- Division of Anatomic Pathology, Mayo Clinic, Rochester, MN, USA
| | - Jay H Ryu
- Division of Pulmonary and Critical Care Medicine, Mayo Clinic, Rochester, MN, USA
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Kato T, Muto H, Hishima T, Kawashima M, Nagai H, Matsui H, Shimada M, Hebisawa A, Doki N, Miyawaki S, Ohashi K. A 56-Year-Old Woman With Multiple Pulmonary Cysts and Severe Chest Pain. Chest 2019; 153:e105-e112. [PMID: 29731050 DOI: 10.1016/j.chest.2017.12.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2017] [Revised: 11/17/2017] [Accepted: 12/07/2017] [Indexed: 12/17/2022] Open
Abstract
A 56-year-old woman presented to our hospital with a 4-month history of worsening chest pain. She denied having any respiratory symptoms, such as dyspnea, sputum, cough, or hemoptysis, or any history of smoking or exposure to dusts. One year previously she had a vertebral fracture. There was no specific family history, including pulmonary or autoimmune diseases. Chest CT performed 3 years earlier showed multiple thin-walled pulmonary cysts, although no further investigations were performed.
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Affiliation(s)
- Takafumi Kato
- Hematology Division, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan; Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hideharu Muto
- Hematology Division, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan; Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan.
| | - Tsunekazu Hishima
- Pathology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Masahiro Kawashima
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hideaki Nagai
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Hirotoshi Matsui
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Masahiro Shimada
- Center for Pulmonary Diseases, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Akira Hebisawa
- Division of Pathology, National Hospital Organization Tokyo National Hospital, Tokyo, Japan
| | - Noriko Doki
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
| | - Shuichi Miyawaki
- Hematology Division, Tokyo Metropolitan Ohtsuka Hospital, Tokyo, Japan
| | - Kazuteru Ohashi
- Hematology Division, Tokyo Metropolitan Cancer and Infectious Diseases Center, Komagome Hospital, Tokyo, Japan
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Cutaneous Light Chain Deposition Disease: A Report of 2 Cases and Review of the Literature. Am J Dermatopathol 2018; 40:337-341. [DOI: 10.1097/dad.0000000000000991] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Uzunhan Y, Jeny F, Kambouchner M, Didier M, Bouvry D, Nunes H, Bernaudin JF, Valeyre D. The Lung in Dysregulated States of Humoral Immunity. Respiration 2017; 94:389-404. [PMID: 28910817 DOI: 10.1159/000480297] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
In common variable immunodeficiency, lung manifestations are related to different mechanisms: recurrent pneumonias due to encapsulated bacteria responsible for diffuse bronchiectasis, diffuse infiltrative pneumonia with various patterns, and lymphomas, mostly B cell extranodal non-Hodgkin type. The diagnosis relies on significant serum Ig deficiency and the exclusion of any primary or secondary cause. Histopathology may be needed. Immunoglobulin (IgG) replacement is crucial to prevent infections and bronchiectasis. IgG4-related respiratory disease, often associated with extrapulmonary localizations, presents with solitary nodules or masses, diffuse interstitial lung diseases, bronchiolitis, lymphadenopathy, and pleural or pericardial involvement. Diagnosis relies on international criteria including serum IgG4 dosage and significantly increased IgG4/IgG plasma cells ratio in pathologically suggestive biopsy. Respiratory amyloidosis presents with tracheobronchial, nodular, and cystic or diffuse interstitial lung infiltration. Usually of AL (amyloid light chain) subtype, it may be localized or systemic, primary or secondary to a lymphoproliferative process. Very rare other diseases due to nonamyloid IgG deposits are described. Among the various lung manifestations of dysregulated states of humoral immunity, this article covers only those associated with the common variable immunodeficiency, IgG4-related disease, amyloidosis, and pulmonary light-chain deposition disease. Autoimmune connective-vascular tissue diseases or lymphoproliferative disorders are addressed in other chapters of this issue.
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Milani P, Basset M, Russo F, Foli A, Palladini G, Merlini G. The lung in amyloidosis. Eur Respir Rev 2017; 26:26/145/170046. [DOI: 10.1183/16000617.0046-2017] [Citation(s) in RCA: 79] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2017] [Accepted: 05/31/2017] [Indexed: 01/10/2023] Open
Abstract
Amyloidosis is a disorder caused by misfolding of autologous protein and its extracellular deposition as fibrils, resulting in vital organ dysfunction and eventually death. Pulmonary amyloidosis may be localised or part of systemic amyloidosis.Pulmonary interstitial amyloidosis is symptomatic only if the amyloid deposits severely affect gas exchange alveolar structure, thus resulting in serious respiratory impairment. Localised parenchymal involvement may be present as nodular amyloidosis or as amyloid deposits associated with localised lymphomas. Finally, tracheobronchial amyloidosis, which is usually not associated with evident clonal proliferation, may result in airway stenosis.Because the treatment options for amyloidosis are dependent on the fibril protein type, the workup of all new cases should include accurate determination of the amyloid protein. Most cases are asymptomatic and need only a careful follow-up. Diffuse alveolar-septal amyloidosis is treated according to the underlying systemic amyloidosis. Nodular pulmonary amyloidosis is usually localised, conservative excision is usually curative and the long-term prognosis is excellent. Tracheobronchial amyloidosis is usually treated with bronchoscopic interventions or external beam radiation therapy.
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21
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Gorospe Sarasúa L, Pacios-Blanco RE, Arrieta P, Chinea-Rodríguez A. Hemorragia intraquística en paciente con afectación pulmonar quística secundaria a enfermedad por depósito de cadenas ligeras. Arch Bronconeumol 2017; 53:285-287. [DOI: 10.1016/j.arbres.2016.08.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2016] [Accepted: 08/06/2016] [Indexed: 10/20/2022]
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Abstract
CONTEXT -Amyloidosis is a heterogeneous group of diseases characterized by the deposition of congophilic amyloid fibrils in the extracellular matrix of tissues and organs. To date, 31 fibril proteins have been identified in humans, and it is now recommended that amyloidoses be named after these fibril proteins. Based on this classification scheme, the most common forms of amyloidosis include systemic AL (formerly primary), systemic AA (formerly secondary), systemic wild-type ATTR (formerly age-related or senile systemic), and systemic hereditary ATTR amyloidosis (formerly familial amyloid polyneuropathy). Three different clinicopathologic forms of amyloidosis can be seen in the lungs: diffuse alveolar-septal amyloidosis, nodular pulmonary amyloidosis, and tracheobronchial amyloidosis. OBJECTIVE -To clarify the relationship between the fibril protein-based amyloidosis classification system and the clinicopathologic forms of pulmonary amyloidosis and to provide a useful guide for diagnosing these entities for the practicing pathologist. DATA SOURCES -This is a narrative review based on PubMed searches and the authors' own experiences. CONCLUSIONS -Diffuse alveolar-septal amyloidosis is usually caused by systemic AL amyloidosis, whereas nodular pulmonary amyloidosis and tracheobronchial amyloidosis usually represent localized AL amyloidosis. However, these generalized scenarios cannot always be applied to individual cases. Because the treatment options for amyloidosis are dependent on the fibril protein-based classifications and whether the process is systemic or localized, the workup of new clinically relevant cases should include amyloid subtyping (preferably with mass spectrometry-based proteomic analysis) and further clinical investigation.
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Nodular pulmonary light chain deposition disease. Pathology 2016; 48:515-8. [DOI: 10.1016/j.pathol.2016.04.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Accepted: 04/15/2016] [Indexed: 12/24/2022]
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Muñoz-Largacha JA, O’Hara CJ, Sloan JM, Fernando HC, Litle VR. Surgical Management of Pulmonary Mucosa-Associated Lymphoid Tissue Lymphoma Associated With Light-Chain Deposition Disease. Ann Thorac Surg 2016; 101:e207-10. [DOI: 10.1016/j.athoracsur.2015.10.089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/24/2015] [Revised: 09/14/2015] [Accepted: 10/26/2015] [Indexed: 11/25/2022]
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Hampson JA, Stockley RA, Turner AM. Free light chains: potential biomarker and predictor of mortality in alpha-1-antitrypsin deficiency and usual COPD. Respir Res 2016; 17:34. [PMID: 27036487 PMCID: PMC4815123 DOI: 10.1186/s12931-016-0348-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 03/18/2016] [Indexed: 12/15/2022] Open
Abstract
Background Circulating free light chains (FLCs) can alter neutrophil migration, apoptosis and activation and may be a biomarker of autoimmune disease and adaptive immune system activation. These pathogenic roles could be relevant to lung disease in alpha 1 antitrypsin deficiency (A1ATD) and chronic obstructive pulmonary disease (COPD). Methods Total combined (c)FLCs were measured using the FreeLite® assay in 547 patients with A1ATD and 327 patients with usual COPD in the stable state, and assessed for association with clinical phenotype, disease severity, airway bacterial colonisation and mortality. Univariate and multivariate analyses were undertaken. Results Circulating cFLCs were static in the stable state when measured on 4 occasions in A1ATD and twice in usual COPD. Levels were inversely related to renal function (A1ATD and COPD p = <0.01), and higher in patients with chronic bronchitis (p = 0.019) and airway bacterial colonisation (p = 0.008). After adjusting for renal function and age the relationship between cFLCs and lung function was weak. Kaplan Meier curves showed that cFLC > normal (43.3 mg/L) significantly associated with mortality in both cohorts (A1ATD p = 0.001, COPD p = 0.013). Conclusions cFLCs may be a promising biomarker for risk stratification in A1ATD and COPD. Electronic supplementary material The online version of this article (doi:10.1186/s12931-016-0348-1) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Judith A Hampson
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, B15 2WB, UK.,ADAPT Project, University Hospital Birmingham, Birmingham, B15 2WB, UK
| | - Robert A Stockley
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, B15 2WB, UK.,ADAPT Project, University Hospital Birmingham, Birmingham, B15 2WB, UK
| | - Alice M Turner
- Centre for Translational Inflammation Research, University of Birmingham, Birmingham, B15 2WB, UK. .,ADAPT Project, University Hospital Birmingham, Birmingham, B15 2WB, UK. .,Heart of England NHS Foundation Trust, Birmingham, B9 5SS, UK.
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Ferreira Francisco FA, Soares Souza A, Zanetti G, Marchiori E. Multiple cystic lung disease. Eur Respir Rev 2015; 24:552-64. [DOI: 10.1183/16000617.0046-2015] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Multiple cystic lung disease represents a diverse group of uncommon disorders that can present a diagnostic challenge due to the increasing number of diseases associated with this presentation. High-resolution computed tomography of the chest helps to define the morphological aspects and distribution of lung cysts, as well as associated findings. The combination of appearance upon imaging and clinical features, together with extrapulmonary manifestations, when present, permits confident and accurate diagnosis of the majority of these diseases without recourse to open-lung biopsy. The main diseases in this group that are discussed in this review are lymphangioleiomyomatosis, pulmonary Langerhans cell histiocytosis and folliculin gene-associated syndrome (Birt–Hogg–Dubé); other rare causes of cystic lung disease, including cystic metastasis of sarcoma, are also discussed. Disease progression is unpredictable, and understanding of the complications of cystic lung disease and their appearance during evolution of the disease are essential for management. Correlation of disease evolution and clinical context with chest imaging findings provides important clues for defining the underlying nature of cystic lung disease, and guides diagnostic evaluation and management.
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27
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Arrossi AV, Merzianu M, Farver C, Yuan C, Wang SH, Nakashima MO, Cotta CV. Nodular pulmonary light chain deposition disease: an entity associated with Sjögren syndrome or marginal zone lymphoma. J Clin Pathol 2015; 69:490-6. [DOI: 10.1136/jclinpath-2015-203342] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2015] [Accepted: 10/03/2015] [Indexed: 11/04/2022]
Abstract
BackgroundLight chain deposition disease (LCDD) is usually a systemic disorder characterised by non-amyloid monoclonal immunoglobulin light chain deposition in tissues. Localised nodular pulmonary (NP) LCDD is a rare and poorly characterised entity and, owing to the difficulties in diagnosis, limited data are available.MethodsWe investigated the clinical, radiological and pathological characteristics of a series of six confidently diagnosed cases of NPLCDD.ResultsThere were three men and three women with ages ranging from 33 to 74 years. In all cases there were single or multiple pulmonary nodules, in one case associated with cysts. Two patients had no previous history of a lymphoproliferative or autoimmune disorder, two had Sjögren syndrome (SS) and two had extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). Lung biopsies led to diagnoses of MALT lymphoma in four patients, including both of those with a previous history of lymphoma and one with SS. In five cases the diagnosis was confirmed by liquid chromatography–tandem mass spectrometry (LC–MS/MS) and in one by electron microscopy. There was no evidence of systemic LCDD in any of the cases. Five patients had an indolent course in spite of limited therapeutic intervention while, in the patient who died, the cause of death was related to the spread of the lymphoma and was not due to the pulmonary lesions.ConclusionsNPLCDD is an indolent disease, in most cases associated with MALT lymphoma or autoimmune disease.
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28
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Sheard S, Nicholson A, Edmunds L, Wotherspoon A, Hansell D. Pulmonary light-chain deposition disease: CT and pathology findings in nine patients. Clin Radiol 2015; 70:515-22. [DOI: 10.1016/j.crad.2015.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2014] [Revised: 01/01/2015] [Accepted: 01/06/2015] [Indexed: 10/24/2022]
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Jen KY, Fix OK, Foster EN, Laszik ZG, Ferrell LD. Monoclonal light chain deposits within the stomach manifesting as immunotactoid gastropathy. Ultrastruct Pathol 2014; 39:62-8. [PMID: 25191812 DOI: 10.3109/01913123.2014.939796] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Immunotactoid deposits are defined by their ultrastructural appearance and are characterized by microtubular or cylindrical structures typically measuring greater than 30 nm in diameter. Although a rare entity, immunotactoid deposition most often manifests as immunotactoid glomerulopathy and is associated with underlying lymphoplasmacytic disorders. Corneal immunotactoid deposition known as immunotactoid keratopathy has also been reported in patients with paraproteinemia. Here, we describe the first reported case of immunotactoid deposition in the stomach. The deposits were composed solely of kappa immunoglobulin light chains without significant lambda light chain or immunoglobulin heavy chain components. The patient displayed no renal signs or symptoms, and additional thorough clinical examination failed to detect any evidence of a paraproteinemia or plasma cell dyscrasia. Thus, the gastric immunotactoid deposits in this case appear to be an isolated finding of light chain deposition, of which the significance and etiology are unclear.
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Affiliation(s)
- Kuang-Yu Jen
- Department of Pathology, University of California San Francisco , San Francisco, CA , USA
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30
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Lung Transplantation for Advanced Cystic Lung Disease Due to Nonamyloid Kappa Light Chain Deposits. Ann Am Thorac Soc 2014; 11:1025-31. [DOI: 10.1513/annalsats.201404-137oc] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
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Luraine R, Sohier L, Kerjouan M, Desrues B, Delaval P, Jouneau S. [An unusual cause of cystic lung disease: light chain deposition disease]. Rev Mal Respir 2013; 30:567-71. [PMID: 24034462 DOI: 10.1016/j.rmr.2013.02.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/21/2013] [Indexed: 11/19/2022]
Abstract
INTRODUCTION Light chain deposition disease is a rare clinical entity characterized by deposition of monoclonal immunoglobulin light chains in organs. The kidneys are almost always affected, while the lung manifestations that have been reported, including nodular or diffuse disease, especially cystic lesions, are unusual. CASE REPORT We report the case of a 60-year-old man with a diffuse infiltrative lung disease characterized by numerous apical cysts. The diagnosis of light chain deposition cystic lung disease was obtained by surgical lung biopsy. Light chain deposits in the salivary glands were the only extrapulmonary manifestation. Despite 12 chemotherapy cycles, the patient's lung function and radiological appearances worsened. CONCLUSION This is the fourth case describing a cystic lung disease due to light chain deposition in the literature. It highlights the need for comprehensive investigations so as not to miss this rare cause of cystic lung disease, which appears to be related to a primary pulmonary lymphoproliferative disorder. The only treatment that appears to be effective is lung transplantation.
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Affiliation(s)
- R Luraine
- Service de pneumologie, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France
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32
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Ryu JH, Tian X, Baqir M, Xu K. Diffuse cystic lung diseases. Front Med 2013; 7:316-27. [PMID: 23666611 DOI: 10.1007/s11684-013-0269-z] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2013] [Accepted: 03/28/2013] [Indexed: 12/16/2022]
Abstract
Diffuse cystic lung diseases are uncommon but can present a diagnostic challenge because increasing number of diseases have been associated with this presentation. Cyst in the lung is defined as a round parenchymal lucency with a well-defined thin wall (< 2 mm thickness). Focal or multifocal cystic lesions include blebs, bullae, pneumatoceles, congenital cystic lesions, traumatic lesions, and several infectious processes such as coccidioidomycosis, Pneumocystis jiroveci pneumonia, and hydatid disease. "Diffuse" distribution in the lung implies involvement of all lobes. Diffuse lung involvement with cystic lesions can be seen in pulmonary lymphangioleiomyomatosis, pulmonary Langerhans' cell histiocytosis, lymphoid interstitial pneumonia, Birt-Hogg-Dubé syndrome, amyloidosis, light chain deposition disease, honeycomb lung associated with advanced fibrosis, and several other rare causes including metastatic disease. High-resolution computed tomography of the chest helps define morphologic features of the lung lesions as well as their distribution and associated features such as intrathoracic lymphadenopathy. Correlating the tempo of the disease process and clinical context with chest imaging findings serve as important clues to defining the underlying nature of the cystic lung disease and guide diagnostic evaluation as well as management.
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Affiliation(s)
- Jay H Ryu
- Mayo Clinic, Division of Pulmonary and Critical Care Medicine, Rochester, MN 55905, USA.
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William J, Variakojis D, Yeldandi A, Raparia K. Lymphoproliferative neoplasms of the lung: a review. Arch Pathol Lab Med 2013; 137:382-91. [PMID: 23451749 DOI: 10.5858/arpa.2012-0202-ra] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
CONTEXT Diagnosis and classification of lymphomas are based on the morphologic, immunologic, and genetic features that the lesional cells share with their normal B and T lymphocyte counterparts. Primary pulmonary lymphomas account for 0.3% of primary lung neoplasms and less than 0.5% of all lymphomas. OBJECTIVE To describe and summarize the clinical and histopathologic features of the primary pulmonary lymphoma and secondary involvement of the lung by lymphoma. DATA SOURCES Peer-reviewed published literature and personal experience. CONCLUSIONS Diagnosis of clonal lymphoid proliferations in the lung has evolved owing to the greater utility of molecular and flow cytometric analysis of tissue. Further studies are needed to best define the clinical and prognostic features, as well as search for targeted therapy for these patients with rare neoplasms.
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Affiliation(s)
- Josette William
- Department of Pathology, Northwestern University, Feinberg School of Medicine, Chicago, IL 60611, USA
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Pimenta SP, Baldi BG, Nascimento ECTD, Mauad T, Kairalla RA, Carvalho CRR. Birt-Hogg-Dubé syndrome: metalloproteinase activity and response to doxycycline. Clinics (Sao Paulo) 2012; 67:1501-4. [PMID: 23295609 PMCID: PMC3521818 DOI: 10.6061/clinics/2012(12)25] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Suzana Pinheiro Pimenta
- Faculdade de Medicina da Universidade de São Paulo, Heart Institute, Pulmonary Division, São Paulo/SP, Brazil.
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Sasaki K, Chang A, Najafian B. Indolent systemic mastocytosis associated with light chain deposition disease. Clin Kidney J 2012; 5:424-7. [PMID: 26019820 PMCID: PMC4432416 DOI: 10.1093/ckj/sfs104] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 07/17/2012] [Indexed: 11/18/2022] Open
Abstract
Systemic mastocytosis (SM) is characterized by infiltration of neoplastic mast cells in one or more organ systems. SM in association with plasma cell dyscrasia is very rare. We report a first case of indolent SM (ISM) associated with light chain deposition disease (LCDD) in a kidney biopsy from a 59-year-old female presenting with skin rash, elevated serum creatinine, hematuria and mild proteinuria. Subsequent workup demonstrated IgG kappa monoclonal protein in serum and urine. A bone marrow biopsy revealed neoplastic mast cells involving bone marrow without evidence of clonal myeloid or lymphoid proliferation. Kidney biopsy demonstrated modest mesangial expansion detected by light microscopy and unequivocal evidence of monoclonal kappa light chain deposition within glomerular capillaries, tubular basement membranes and vascular walls detected by immunofluorescence and/or electron microscopy, along with equivocal evidence of light chain cast nephropathy. Despite treatment with bortezomib and dexamethasone, her renal function was progressively declined over the next 6 months. This case is a reminder that SM can coincide with LCDD, which requires clinical suspicion and multimodality workup on a kidney biopsy including immunofluorescence and electron microscopy to reach the correct diagnosis.
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Affiliation(s)
- Kotaro Sasaki
- Department of Pathology , University of Washington Medical Center , Seattle, WA 98195 , USA
| | - Alice Chang
- Nephrology , Group Health Cooperative , Seattle, WA 98112 , USA
| | - Behzad Najafian
- Department of Pathology , University of Washington Medical Center , Seattle, WA 98195 , USA
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Intimal IgM lambda paraprotein deposition in myocardial arteries resulting in acute myocardial infarction and sudden death. Pathology 2011; 43:732-4. [DOI: 10.1097/pat.0b013e32834c7ed1] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Pulmonary light and heavy chain deposition disease: a pitfall for lung cancer evaluation with F-18 FDG PET/CT. Clin Nucl Med 2010; 35:640-3. [PMID: 20631525 DOI: 10.1097/rlu.0b013e3181e4dd44] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rho L, Qiu L, Strauchen JA, Gordon RE, Teirstein AS. Pulmonary manifestations of light chain deposition disease. Respirology 2010; 14:767-70. [PMID: 19659654 DOI: 10.1111/j.1440-1843.2009.01560.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Light chain deposition disease (LCDD) is a rare condition characterized by extracellular light chain deposition in tissues. Patients commonly have an underlying plasma cell dyscrasia, and produce excess levels of monoclonal light chains. Renal involvement is the most common clinical manifestation. Rarely, light chains are deposited in the lung. We present the pathologic and radiographic findings of three patients with biopsy-proven pulmonary light chain disease and a review of the literature.
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Affiliation(s)
- Lisa Rho
- Division of Pulmonary, Critical Care and Sleep Medicine, New York, USA.
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Zidar N, Zver S, Jurcić V. Extraosseus plasmacytoma of the pharynx with localized light chain deposition. Case report. Pathol Oncol Res 2009; 16:249-52. [PMID: 19967475 DOI: 10.1007/s12253-009-9218-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2009] [Accepted: 10/20/2009] [Indexed: 01/10/2023]
Abstract
Light chain deposition disease (LCDD) is a rare disorder associated with a clonal proliferation of plasma cells, which synthesize abnormal monoclonal immunoglobulin light chains. It is characterized by systemic deposition of light chains in various organs, with the kidneys being most commonly affected. There have been few reports of isolated LCDD, i.e. in the brain, lungs and cervical lymph nodes. We here report on another patient with an isolated form of LCDD, which was limited to the pharyngeal mucosa and was associated with an extraosseus plasmacytoma of the pharynx, expanding the spectrum that has been recognized for LCDD. The patient was treated by local radiotherapy, with an excellent response. A less aggressive clinical course can probably be expected than in the usual form of LCDD, but a long-term follow-up is necessary to establish the clinical significance of this variant of LCDD.
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Affiliation(s)
- Nina Zidar
- Institute of Pathology, Faculty of Medicine, University of Ljubljana, Korytkova 2, 1000, Ljubljana, Slovenia.
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Cohen G, Hörl WH. Free Immunoglobulin Light Chains as a Risk Factor in Renal and Extrarenal Complications. Semin Dial 2009; 22:369-72. [DOI: 10.1111/j.1525-139x.2009.00582.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Herrera GA. Renal lesions associated with plasma cell dyscrasias: practical approach to diagnosis, new concepts, and challenges. Arch Pathol Lab Med 2009; 133:249-67. [PMID: 19195968 DOI: 10.5858/133.2.249] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/11/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT Patients with plasma cell dyscrasias (myeloma) may exhibit a variety of renal manifestations as a result of damage from circulating light- and heavy-chain immunoglobulin components produced by the neoplastic plasma cells. The renal alterations can occur in any of the renal compartments, and in a significant number of the cases more than one compartment is affected. Research in the laboratory has helped considerably in providing a solid conceptual understanding of how renal damage occurs. OBJECTIVES To detail advances that have been made in the diagnosis of these conditions and to provide an account of research accomplishments that have solidified diagnostic criteria. The new knowledge that has been acquired serves to provide a solid platform for the future design of new therapeutic interventions aimed at ameliorating or abolishing the progressive renal damage that typically takes place. DATA SOURCES Translational efforts have substantially contributed to elucidate mechanistically the molecular events responsible for the renal damage. The spectrum of renal manifestations associated with plasma cell dyscrasias has expanded significantly in the last 10 years. Diagnostic criteria have also been refined. This information has been summarized from work done at several institutions. CONCLUSIONS A number of significant challenges remain in the diagnosis of these conditions, some of which will be discussed in this article. Dealing with these challenges will require additional translational efforts and close cooperation between basic researchers, clinicians, and pathologists in order to improve the diagnostic tools available to renal pathologists and to acquire a more complete understanding of clinical and pathologic manifestations associated with these conditions.
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Affiliation(s)
- Guillermo A Herrera
- Pathology Department, Nephrocor Laboratory, 1700 N Desert Drive, Tempe, AZ 85281, USA.
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Primary cystic lung light chain deposition disease: a clinicopathologic entity derived from unmutated B cells with a stereotyped IGHV4-34/IGKV1 receptor. Blood 2008; 112:2004-12. [PMID: 18483396 DOI: 10.1182/blood-2007-11-123596] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
We have recently described a new form of light chain deposition disease (LCDD) presenting as a severe cystic lung disorder requiring lung transplantation. There was no bone marrow plasma cell proliferation. Because of the absence of disease recurrence after bilateral lung transplantation and of serum-free light chain ratio normalization after the procedure, we hypothesized that monoclonal light chain synthesis occurred within the lung. The aim of this study was to look for the monoclonal B-cell component in 3 patients with cystic lung LCDD. Histologic examination of the explanted lungs showed diffuse nonamyloid kappa light chain deposits associated with a mild lymphoid infiltrate composed of aggregates of small CD20(+), CD5(-), CD10(-) B lymphocytes reminiscent of bronchus-associated lymphoid tissue. Using polymerase chain reaction (PCR), we identified a dominant B-cell clone in the lung in the 3 studied patients. The clonal expansion of each patient shared an unmutated antigen receptor variable region sequence characterized by the use of IGHV4-34 and IGKV1 subgroups with heavy and light chain CDR3 sequences of more than 80% amino acid identity, a feature evocative of an antigen-driven process. Combined with clinical and biologic data, our results strongly argue for a new antigen-driven primary pulmonary lymphoproliferative disorder.
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Molina-Garrido MJ, Guillén-Ponce C, Mora A, Guirado-Risueño M, Molina MA, Molina MJ, Carrato A. Deposition-associated diseases related with a monoclonal compound. Clin Transl Oncol 2007; 9:777-83. [PMID: 18158981 DOI: 10.1007/s12094-007-0139-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Up to 3% of adults over 50 years of age show a monoclonal peak values in blood or urine. Findings and prognosis will be distinct in view of the nature of this factor. In B-cell neoplasias (multiple myeloma, Waldeström macroglobulinaemia, chronic myeloid leukaemia and non-Hodgkin lymphoma) the clinical pattern is dominated by the systemic effects produced by the expansion of the malign clone; the monoclonal protein may result in hyperviscosity syndrome or renal damage. On the other hand, there are other less frequent processes called diseases associated to monoclonal components, where the main clinical manifestations and prognosis depend of the biological effects of the monoclonal protein. With reference to this last group, which is the objective of this revision, no bone lesions, anaemia or a greater tendency to infections usually occur when compared with the first group. Even so, there are some cases of interposition between both groups: for instance, type IgM immunoglobulin present in Waldeström macroglobulinaemia may have cold agglutinin activity, and in the case of multiple myeloma, the clone may secrete amyloidogenic light chains.
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Affiliation(s)
- M J Molina-Garrido
- Oncology Department, General Universitary Hospital in Elche, Elche, Alicante, Spain.
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Satani T, Yokose T, Kaburagi T, Asato Y, Itabashi M, Amemiya R. Amyloid deposition in primary pulmonary marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue. Pathol Int 2007; 57:746-50. [PMID: 17922687 DOI: 10.1111/j.1440-1827.2007.02164.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Tetsuo Satani
- Thoracic Oncology Group, Ibaraki Prefectural Central Hospital and Regional Cancer Center, Ibaraki, Japan
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