1
|
Su MY, Chen TC, Teng CLJ, Wu CH. Relapsed B-cell prolymphocytic leukemia (B-PLL) with distinctive granular inclusion bodies. Int J Lab Hematol 2024; 46:585-586. [PMID: 38284307 DOI: 10.1111/ijlh.14237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 01/17/2024] [Indexed: 01/30/2024]
Affiliation(s)
- Mei-Yu Su
- Division of Hematology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Tsung-Chih Chen
- Division of Hematology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Chieh-Lin Jerry Teng
- Division of Hematology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Post-Baccalaureate Medicine, College of Medicine, National Chung Hsing University, Taichung, Taiwan
- Department of Life Science, Tunghai University, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
| | - Cheng-Han Wu
- Division of Medical Oncology, Department of Oncology, Taichung Veterans General Hospital, Taichung, Taiwan
- Institute of Biomedical Informatics, School of Medicine, National Yang-Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
2
|
Hasegawa H, Wang S, Kast E, Chou HT, Kaur M, Janlaor T, Mostafavi M, Wang YL, Li P. Understanding the biosynthesis of human IgM SAM-6 through a combinatorial expression of mutant subunits that affect product assembly and secretion. PLoS One 2024; 19:e0291568. [PMID: 38848420 PMCID: PMC11161108 DOI: 10.1371/journal.pone.0291568] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 05/06/2024] [Indexed: 06/09/2024] Open
Abstract
Polymeric IgMs are secreted from plasma cells abundantly despite their structural complexity and intricate multimerization steps. To gain insights into IgM's assembly mechanics that underwrite such high-level secretion, we characterized the biosynthetic process of a natural human IgM, SAM-6, using a heterologous HEK293(6E) cell platform that allowed the production of IgMs both in hexameric and pentameric forms in a controlled fashion. By creating a series of mutant subunits that differentially disrupt secretion, folding, and specific inter-chain disulfide bond formation, we assessed their effects on various aspects of IgM biosynthesis in 57 different subunit chain combinations, both in hexameric and pentameric formats. The mutations caused a spectrum of changes in steady-state subcellular subunit distribution, ER-associated inclusion body formation, intracellular subunit detergent solubility, covalent assembly, secreted IgM product quality, and secretion output. Some mutations produced differential effects on product quality depending on whether the mutation was introduced to hexameric IgM or pentameric IgM. Through this systematic combinatorial approach, we consolidate diverse overlapping knowledge on IgM biosynthesis for both hexamers and pentamers, while unexpectedly revealing that the loss of certain inter-chain disulfide bonds, including the one between μHC and λLC, is tolerated in polymeric IgM assembly and secretion. The findings highlight the differential roles of underlying non-covalent protein-protein interactions in hexamers and pentamers when orchestrating the initial subunit interactions and maintaining the polymeric IgM product integrity during ER quality control steps, secretory pathway trafficking, and secretion.
Collapse
Affiliation(s)
- Haruki Hasegawa
- Discovery Protein Science, Department of Large Molecule Discovery and Research Data Science, Amgen Inc., South San Francisco, CA, United States of America
| | - Songyu Wang
- Discovery Protein Science, Department of Large Molecule Discovery and Research Data Science, Amgen Inc., South San Francisco, CA, United States of America
| | - Eddie Kast
- Molecular Analytics, Department of Biologic Therapeutic Discovery, Amgen Inc., South San Francisco, CA, United States of America
| | - Hui-Ting Chou
- Structural Biology, Department of Small Molecule Therapeutic Discovery, Amgen Inc., South San Francisco, CA, United States of America
| | - Mehma Kaur
- Discovery Protein Science, Department of Large Molecule Discovery and Research Data Science, Amgen Inc., South San Francisco, CA, United States of America
| | - Tanakorn Janlaor
- Discovery Protein Science, Department of Large Molecule Discovery and Research Data Science, Amgen Inc., South San Francisco, CA, United States of America
| | - Mina Mostafavi
- Discovery Protein Science, Department of Large Molecule Discovery and Research Data Science, Amgen Inc., South San Francisco, CA, United States of America
| | - Yi-Ling Wang
- Discovery Protein Science, Department of Large Molecule Discovery and Research Data Science, Amgen Inc., South San Francisco, CA, United States of America
| | - Peng Li
- Discovery Protein Science, Department of Large Molecule Discovery and Research Data Science, Amgen Inc., South San Francisco, CA, United States of America
| |
Collapse
|
3
|
Roldán Galiacho V, Lobo Olmedo A, Aranguren Del Castillo L, Arzuaga-Mendez J, García-Ruiz JC. Lymphocytes with auer rod-like inclusions in chronic lymphocytic leukemia. Hematol Transfus Cell Ther 2021; 44:616-617. [PMID: 34580044 PMCID: PMC9605899 DOI: 10.1016/j.htct.2021.06.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Accepted: 06/21/2021] [Indexed: 11/18/2022] Open
|
4
|
Hasegawa H, Wei KY, Thomas M, Li P, Kinderman F, Franey H, Liu L, Jacobsen F. Light chain subunit of a poorly soluble human IgG2λ crystallizes in physiological pH environment both in cellulo and in vitro. BIOCHIMICA ET BIOPHYSICA ACTA-MOLECULAR CELL RESEARCH 2021; 1868:119078. [PMID: 34118277 DOI: 10.1016/j.bbamcr.2021.119078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 05/17/2021] [Accepted: 06/07/2021] [Indexed: 11/28/2022]
Abstract
Prominent inclusion bodies can develop in the endoplasmic reticulum (ER) when overexpressed antibodies possess intrinsically high condensation propensities. These observations suggest that antibodies deemed to show notable solubility problems may reveal such characteristics preemptively in the form of ER-associated inclusion bodies during antibody overexpression. To define the relationships between solubility problems and inclusion body phenotypes, we investigated the biosynthesis of a model human IgG2λ that shows severe opalescence in an acidic formulation buffer yet retains high solubility at physiological pH. Consistent with the pH-dependent solubility characteristics, the model antibody did not induce notable inclusion body in the physiological pH environment of the ER lumen. However, when individual subunit chains of the antibody were expressed separately, the light chain (LC) spontaneously induced notable crystal-like inclusion bodies in the ER. The LC crystallization event was readily reproducible in vitro by simply concentrating the purified LC protein at physiological pH. Two independent structural determinants for the LC crystallization were identified through rational mutagenesis approach by monitoring the effect of amino acid substitutions on intracellular LC crystallogenesis. The effect of mutations on crystallization was also recapitulated in vitro using purified LC proteins. Importantly, when introduced directly into the model antibody, a mutation that prevents the LC crystallization remediated the antibody's solubility problem without compromising the secretory output or antigen binding. These results illustrate that the ER can serve as a "physiological test tube" that not only reports secretory cargo's high condensation propensity at physiological pH, but also provides an orthogonal method that guides antibody engineering strategy.
Collapse
Affiliation(s)
- Haruki Hasegawa
- Department of Therapeutic Discovery, Amgen Inc., South San Francisco, CA 94080, USA.
| | - Kathy Y Wei
- Department of Therapeutic Discovery, Amgen Inc., South San Francisco, CA 94080, USA
| | - Melissa Thomas
- Department of Therapeutic Discovery, Amgen Inc., South San Francisco, CA 94080, USA
| | - Peng Li
- Department of Therapeutic Discovery, Amgen Inc., South San Francisco, CA 94080, USA
| | - Francis Kinderman
- Department of Process Development, Amgen Inc., Thousand Oaks, CA 91320, USA
| | - Heather Franey
- Department of Process Development, Amgen Inc., Thousand Oaks, CA 91320, USA
| | - Ling Liu
- Department of Therapeutic Discovery, Amgen Inc., Thousand Oaks, CA 91320, USA
| | - Frederick Jacobsen
- Department of Therapeutic Discovery, Amgen Inc., Thousand Oaks, CA 91320, USA
| |
Collapse
|
5
|
Huang Y, Zhang L. Intracellular rod-like crystals in chronic lymphocyte leukemia. Int J Hematol 2020; 112:267. [PMID: 32666468 DOI: 10.1007/s12185-020-02933-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 02/26/2020] [Accepted: 07/02/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Yiling Huang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China
| | - Lixia Zhang
- Department of Laboratory Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, 210029, People's Republic of China.
| |
Collapse
|
6
|
Gao Z, Cui F, Liu M, Guo Y, Hu Y, Shi M. Auer rod-like inclusions in the cytoplasm of B-cell lymphoma cells with bone marrow infiltration. Exp Hematol 2019; 77:6-11. [PMID: 31442465 DOI: 10.1016/j.exphem.2019.08.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 07/10/2019] [Accepted: 08/19/2019] [Indexed: 11/28/2022]
Abstract
Auer rod-like inclusions are rarely seen in B-cell neoplasms patients. Here, we present a case of B-cell lymphoma with Auer rod-like inclusions in lymphoma cells. By light and transmission electron microscopy, these structures closely resembled Auer rods which were found in acute myeloid leukemia. The Auer rod-like inclusions were negative for cytochemical staining of MPO, α-naphthyl acetate esterase, and periodic acid-Schiff. Immunostaining and flow cytometric analysis confirmed monoclonal Kappa-positive malignant lymphocytes. Interestingly, the Auer rod-like inclusions exhibited diverse ultrastructural features, which ranged from fusiform, to needle-shape, to round, to crystalline cuboid, to long rod, to short rod and others; some were membrane structures, some membrane-free dense structures, and some lamellar structures. The patient was diagnosed with B-cell lymphoma with bone marrow infiltration.
Collapse
Affiliation(s)
- Zhanxi Gao
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Fang Cui
- Department of Electron Microscope Laboratory Centre, Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Mei Liu
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yukai Guo
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China
| | - Yuhong Hu
- Instrumental Analysis Center, Hebei Normal University, Shijiazhuang, Hebei Province, China
| | - Min Shi
- Department of Clinical Laboratory, Second Hospital of Hebei Medical University, Shijiazhuang, Hebei Province, China.
| |
Collapse
|
7
|
Ramlal B, DiGiuseppe JA. Intracytoplasmic crystalline inclusions in chronic lymphocytic leukemia. Clin Case Rep 2019; 7:1460-1461. [PMID: 31360515 PMCID: PMC6637332 DOI: 10.1002/ccr3.2250] [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: 01/31/2019] [Revised: 05/09/2019] [Accepted: 05/15/2019] [Indexed: 11/25/2022] Open
Abstract
Neoplastic B cells may have cytoplasmic inclusions that are visible in routine peripheral blood smears by light microscopy.
Collapse
|
8
|
Rodríguez CM, Stanganelli C, Bussi C, Arroyo D, Sastre D, Heller V, Iribarren P, Slavutsky I. Intracytoplasmic filamentous inclusions and IGHV rearrangements in a patient with chronic lymphocytic leukemia. Leuk Lymphoma 2017; 59:1239-1243. [PMID: 28868956 DOI: 10.1080/10428194.2017.1370549] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Cecilia M Rodríguez
- a Hospital Nacional de Clínicas, Facultad de Ciencias Médicas , Universidad Nacional de Córdoba , Córdoba , Argentina.,b Facultad de Ciencias Químicas , Centro de Investigación en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Universidad Nacional de Córdoba , Córdoba , Argentina
| | - Carmen Stanganelli
- c División Patología Molecular , Instituto de Investigaciones Hematológicas, Academia Nacional de Medicina , Buenos Aires , Argentina
| | - Claudio Bussi
- b Facultad de Ciencias Químicas , Centro de Investigación en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Universidad Nacional de Córdoba , Córdoba , Argentina
| | - Daniela Arroyo
- b Facultad de Ciencias Químicas , Centro de Investigación en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Universidad Nacional de Córdoba , Córdoba , Argentina
| | - Darío Sastre
- a Hospital Nacional de Clínicas, Facultad de Ciencias Médicas , Universidad Nacional de Córdoba , Córdoba , Argentina
| | - Viviana Heller
- a Hospital Nacional de Clínicas, Facultad de Ciencias Médicas , Universidad Nacional de Córdoba , Córdoba , Argentina
| | - Pablo Iribarren
- b Facultad de Ciencias Químicas , Centro de Investigación en Bioquímica Clínica e Inmunología (CIBICI-CONICET), Universidad Nacional de Córdoba , Córdoba , Argentina
| | - Irma Slavutsky
- d Laboratorio de Genética de Neoplasias Linfoides , Instituto de Medicina Experimental, CONICET-Academia Nacional de Medicina , Buenos Aires , Argentina
| |
Collapse
|
9
|
Zimmerman B, Yamaguchi MI, Rush LJ. Immunoglobulin Crystals in Reactive Plasma Cells in a Dog. Vet Pathol 2016; 44:389-91. [PMID: 17491084 DOI: 10.1354/vp.44-3-389] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Intracellular crystalline deposits of immunoglobulin are occasionally seen in human B-cell lymphoproliferative disorders such as multiple myeloma, chronic lymphocytic leukemia, and various forms of lymphoma. Even more uncommon is the occurrence of immunoglobulin crystals in benign plasma cells or reactive lymphocytes. Here we describe the histologic, immunohistochemical, and ultrastructural features of intracellular immunoglobulin crystals in nonneoplastic plasma cells in a chronic inflammatory lesion in a dog. Microscopically, the intracellular, nonbirefringent eosinophilic crystals were square to rectangular, 2–20 μgm long, and caused nuclear displacement to the periphery. The crystal-containing cells, as well as some of the crystals themselves, were positive for lambda light chain. Ultrastructural findings were consistent with a lattice network of protein-molecule alignment. The cause and significance of the crystals is unknown.
Collapse
Affiliation(s)
- B Zimmerman
- Department of Veterinary Biosciences, The Ohio State University, Columbus, OH 43210, USA
| | | | | |
Collapse
|
10
|
Antibodies that bind complex glycosaminoglycans accumulate in the Golgi. Proc Natl Acad Sci U S A 2013; 110:11958-63. [PMID: 23818632 DOI: 10.1073/pnas.1308620110] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Light (L) chains that edit anti-DNA heavy (H) chains rescue B-cell development by suppressing DNA binding. However, exceptional editor L chains allow B cells to reach splenic compartments even though their B-cell receptors remain autoreactive. Such incompletely edited B cells express multireactive antibodies that accumulate in the Golgi and are released as insoluble, amyloid-like immune complexes. Here, we examine examples of incomplete editing from the analysis of variable to joining (VJ) gene junction of the variable (Vλx) editor L chain. When paired with the anti-DNA heavy chain, VH56R, the Vλx variants yield antibodies with differing specificities, including glycosaminoglycan reactivity. Our results implicate these specificities in the evasion of receptor editing through intracellular sequestration of IgM and the release of insoluble IgM complexes. Our findings can be extrapolated to human L chains and have implications for understanding a latent component of the Ig repertoire that could exert pathogenic and protective functions.
Collapse
|
11
|
Ko HM, da Cunha Santos G, Boerner SL, Bailey DJ, Geddie WR. Negative images of crystalline immunoglobulin in crystal storing histiocytosis: A potential cytologic mimic of mycobacteria in smears. Diagn Cytopathol 2011; 40:916-9. [DOI: 10.1002/dc.21677] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2010] [Accepted: 02/06/2011] [Indexed: 11/12/2022]
|
12
|
Tasso D, Gulbahce HE, Berger MJ, McKenna RW, Pambuccian SE. Intracytoplasmic crystalline and globular inclusions in small lymphocytic lymphoma in transformation. Diagn Cytopathol 2010; 40:42-4. [PMID: 22180236 DOI: 10.1002/dc.21609] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2010] [Accepted: 10/21/2010] [Indexed: 11/06/2022]
Affiliation(s)
- David Tasso
- Department of Laboratory Medicine and Pathology, University of Minnesota Medical School, Minneapolis, Minnesota 55455, USA
| | | | | | | | | |
Collapse
|
13
|
Kravic-Stevovic T, Bogdanovic A, Boskovic D, Bumbasirevic V. Ribosome-lamella complexes in the peripheral blood of patients with chronic lymphocytic leukemia are associated with serological immune deficiency. Ultrastruct Pathol 2010; 34:31-4. [PMID: 20070151 DOI: 10.3109/01913120903419492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
The ribosome-lamella complex (RLC) is a cylindrical structure composed of different numbers of circular lamellae with associated particles, regarded as ribosomes, around a central core. Structures resembling RLC, but lacking the typical mature appearance of RLC, have been called pre-RLC. The authors have found RLCs and pre-RLCs in peripheral lymphocytes of 3 patients with chronic lymphocytic leukemia (CLL). The fact that CLL patients with RLCs were in early Rai clinical stages, had good clinical prognostic factors, and did not require immediate therapy indicates that RLCs occurred in the early course of some cases of CLL. Moreover, the presence of RLC was associated with hypogammaglobulinemia M.
Collapse
Affiliation(s)
- Tamara Kravic-Stevovic
- Institute of Histology and Embryology, Faculty of Medicine, University of Belgrade, Visegradska 26, Belgrade, Serbia.
| | | | | | | |
Collapse
|
14
|
Pulmonary crystal-storing histiocytoma in a patient without a lymphoproliferative disorder. Am J Med Sci 2009; 338:421-4. [PMID: 19773640 DOI: 10.1097/maj.0b013e3181ad3feb] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Pulmonary crystal-storing histiocytoma is a very rare disorder and is characterized by infiltration of histiocytes with intracytoplasmic accumulation of crystallized immunoglobulins. It is usually associated with lymphoproliferative diseases or plasma cell dyscrasia. Here, we report a case of pulmonary crystal-storing histiocytoma in a 64-year-old man, presenting as a chronic pulmonary consolidation in the lung exposed to asbestos. Video-assisted thoracoscopic surgical biopsy displayed sheets of large, epithelioid histiocytes filled with a large number of needle-like crystals, showing the accumulation of crystallized polyclonal immunoglobulins. This lesion was consistent with crystal-storing histiocytosis or crystal-storing histiocytoma. With extensive clinical work-up, the current case was not associated with lymphoproliferative diseases. Herein, we present this extremely rare entity of pulmonary pathology, a pulmonary crystal-storing histiocytoma arising in the lung exposed to asbestos, and demonstrate the clinical, radiologic, and pathologic features of the tumor.
Collapse
|
15
|
Ben-Bassat H, Polliack A, Shlomai Z, Kohn G, Hadar R, Rabinowitz R, Leizerowitz R, Matutes E, Buchier V, Brok-Simoni F, Okon E, Livni N, Schlesinger M. Farage, a Novel Early B Cell Lymphoma Cell Line with Trisomy 11. Leuk Lymphoma 2009. [DOI: 10.3109/10428199209053591] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Hannah Ben-Bassat
- Laboratory of Experimental Surgery, Hadassah University Hospital, Holon, Israel
- The Paul Ehrlich Center for the Study of Normal and Leukemic White Blood Cells, Holon, Israel
| | - Aaron Polliack
- Department of Hematology, Hadassah University Hospital, Holon, Israel
- The Paul Ehrlich Center for the Study of Normal and Leukemic White Blood Cells, Holon, Israel
| | - Ziporah Shlomai
- Laboratory of Experimental Surgery, Hadassah University Hospital, Holon, Israel
| | - Gertrude Kohn
- The Hebrew University, Jerusalem and the Institute for Medical Genetics Wolfson, Holon, Israel
| | - Rivka Hadar
- Hadassah University Hospital, Department of Experimental Medicine and Cancer Research, Holon, Israel
- The Paul Ehrlich Center for the Study of Normal and Leukemic White Blood Cells, Holon, Israel
| | - Ruth Rabinowitz
- Hadassah University Hospital, Department of Experimental Medicine and Cancer Research, Holon, Israel
- The Paul Ehrlich Center for the Study of Normal and Leukemic White Blood Cells, Holon, Israel
| | | | - Estella Matutes
- Department of Hematology and Cytogenetics, The Royal Marsden Hospital, Fulham Road, London, UK
| | - Valerie Buchier
- Department of Hematology and Cytogenetics, The Royal Marsden Hospital, Fulham Road, London, UK
| | - Frida Brok-Simoni
- Department of Hematology, The Ch. Sheba Medical Center, Tel-Hashomer, Israel
| | - Elimelech Okon
- Department of Pathology, Hadassah University Hospital, Holon, Israel
| | - Nelly Livni
- Department of Pathology, Hadassah University Hospital, Holon, Israel
| | - Michael Schlesinger
- Hadassah University Hospital, Department of Experimental Medicine and Cancer Research, Holon, Israel
- The Paul Ehrlich Center for the Study of Normal and Leukemic White Blood Cells, Holon, Israel
| |
Collapse
|
16
|
Abstract
Chronic lymphocytic leukemia (CLL)/small lymphocytic lymphoma (SLL) is a clonal lymphoproliferative disorder characterized by proliferation of morphologically and immunophenotypically mature lymphocytes. CLL/SLL may proceed through different phases: an early phase in which tumor cells are predominantly small in size, with a low proliferation rate and prolonged cell survival, and a transformation phase with the frequent occurrence of extramedullary proliferation and an increase in large, immature cells. Although some patients with CLL have an indolent disease course and die after many years of unrelated causes, others have very rapidly disease progression and die of the disease within a few years of the diagnosis. In the past few years, considerable progress has been made in our ability to diagnose and classify CLL accurately. Through cytogenetics and molecular biology, it has been shown that CLL and variants are associated with a unique genotypic profile and that these genetic lesions often have a direct bearing on the pathogenesis and prognosis of the disease. Similarly, the development of antibodies to new biologic markers has allowed the identification of a unique immunophenotypic profile for CLL and variants. Moreover, accumulating evidence suggests that CLL cells respond to selected microenvironmental signals and that this confers a growth advantage and an extended survival to CLL cells. In this article, we will review the progress in the pathobiology of CLL and give an update on prognostic markers and tools in current pathology practice for risk stratification of CLL.
Collapse
MESH Headings
- Bone Marrow/pathology
- Chromosome Aberrations
- Diagnosis, Differential
- Female
- Humans
- Immunophenotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/diagnosis
- Leukemia, Lymphocytic, Chronic, B-Cell/immunology
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymph Nodes/pathology
- Male
- Prognosis
Collapse
Affiliation(s)
- Kedar V Inamdar
- Department of Hematopathology, The University of Texas M D Anderson Cancer Center, Houston, TX 77030, USA
| | | |
Collapse
|
17
|
Stewart CJR, Spagnolo DV. Crystalline plasma cell inclusions in helicobacter-associated gastritis. J Clin Pathol 2006; 59:851-4. [PMID: 16537672 PMCID: PMC1860445 DOI: 10.1136/jcp.2005.033233] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2005] [Indexed: 11/03/2022]
Abstract
BACKGROUND Crystalline cytoplasmic inclusions are well documented in B cell lymphomas but have rarely been described in reactive plasmacytic infiltrates. AIM Three cases of Lelicobacter-associated gastritis are described in which plasma cells focally contained rhomboid and needle-shaped crystalline inclusions. METHODS Crystalline inclusions were identified in the gastric biopsy specimens from three patients undergoing routine upper gastrointestinal endoscopy. The cells were characterised immunohistochemically using the following antisera: cytokeratin, leucocyte common antigen, desmin, CD20, CD68, CD79a, CD138, immunoglobulin (Ig)G, IgA and IgM heavy chains, and kappa and lambda Ig light chains. Clinical follow-up data were obtained. RESULTS All biopsies showed a Lelicobacter-associated active chronic gastritis. Variable numbers of plasma cells with intracytoplasmic crystalline inclusions in the superficial lamina propria were seen. The crystals were not stained with any of the antisera tested, but the cells containing the crystals expressed CD79a and CD138 and, in the two assessable cases, showed IgA and lambda light chain immunoreactivity. The more numerous morphologically normal plasma cells in each patient were polytypic, and there were no histological features to suggest lymphoma. Crystals were not identified in the plasma cells in mucosal biopsy specimens from other sites in any of the patients. CONCLUSIONS Crystalline inclusions in plasma cells can occur in association with Lelicobacter gastritis. Although light chain restriction was shown in two patients, the overall histological and clinical findings indicated a reactive process. The presence of plasma cell crystals in isolation should not be considered to be diagnostic of lymphoma.
Collapse
Affiliation(s)
- C J R Stewart
- Division of Anatomical Pathology, PathWest, Sir Charles Gairdner Hospital, Perth, Western Australia
| | | |
Collapse
|
18
|
Dorion RP, Shaw JH. Intracytoplasmic filamentous inclusions in the peripheral blood of a patient with chronic lymphocytic leukemia. A bright-field, electron microscopic, immunofluorescent, and flow cytometric study. Arch Pathol Lab Med 2003; 127:618-20. [PMID: 12708910 DOI: 10.5858/2003-127-0618-ifiitp] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracellular inclusions in lymphoproliferative disorders are not common. Multiple different types of inclusions have been reported in chronic lymphocytic leukemia (CLL), including vacuoles, crystals, and pseudocrystals. Most of the reported cases were seen in the bone marrow lymphocytes, and the majority of these on electron microscopy. We report a case of long-standing CLL with no therapy that had filamentous cytoplasmic inclusions in the peripheral blood that were readily seen by light microscopy. Electron microscopy demonstrated dilated cisternae of the rough endoplasmic reticulum filled with amorphous electron-dense material. By immunofluorescence, the material proved to be immunoglobulin G-lambda deposits. The immunophenotype had the typical CLL pattern with positive staining with CD19, CD5, and CD23, and low-density CD20 staining; however, it also had unusual staining with CD25 and intermediate-intensity staining with CD22.
Collapse
MESH Headings
- Aged
- Aged, 80 and over
- Antigens, CD/analysis
- Antigens, CD/immunology
- Cytoplasm/ultrastructure
- Female
- Flow Cytometry/methods
- Humans
- Immunoglobulin G/ultrastructure
- Immunoglobulin lambda-Chains/ultrastructure
- Immunophenotyping/methods
- Inclusion Bodies/ultrastructure
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Microscopy, Electron/methods
- Receptors, IgE/analysis
- Receptors, IgE/immunology
- Receptors, Interleukin-2/analysis
- Receptors, Interleukin-2/immunology
Collapse
Affiliation(s)
- R Patrick Dorion
- Department of Pathology, Geisinger Medical Center, Danville, Pa 17822, USA.
| | | |
Collapse
|
19
|
Coupland SE, Foss HD, Hummel M, Stein H. Extranodal marginal zone B-cell lymphoma of the lacrimal gland associated with crystal-storing histiocytosis. Ophthalmology 2002; 109:105-10. [PMID: 11772588 DOI: 10.1016/s0161-6420(01)00837-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Crystal-storing histiocytosis (CSH) is a very rare immunoglobulin (Ig) deposition disorder that can be associated with B-cell neoplasms as well as some reactive Ig-secreting lymphoproliferative disorders. This article reports the clinical, histopathologic, and molecular biologic findings of CSH in association with an extranodal marginal zone lymphoma (EMZL) of the lacrimal gland. DESIGN Interventional case report with clinicopathologic correlation. INTERVENTION Treatment consisted of conjunctival and orbital biopsies, as well as low-dose radiation of the left orbit. METHODS Histopathologic findings of the conjunctival and orbital biopsies were compared. Further, extensive immunohistochemistry, polymerase chain reaction (PCR) for the detection of Ig heavy chain (IgH) gene rearrangement, Gene Scan analysis, and DNA sequencing were performed on all tissues. RESULTS The tumor manifestations in the specimens demonstrated a similar morphologic and immunophenotypic characteristics consistent with the diagnosis of EMZL. Immunoglobulin H PCR and Gene Scan analysis showed B cells derived from the same clone. In association with the orbital EMZL were large accumulations histiocytes filled with refractile crystals, consistent with the diagnosis of CSH. CONCLUSIONS The current case describes an EMZL of the lacrimal gland appearing 5 years after excision and low-dose radiation of a conjunctival lymphoma. The orbital recurrence was associated with surrounding CSH, a rare Ig storage disorder more often reported in patients with multiple myeloma or lymphoplasmacytic lymphoma or immunocytoma. Ophthalmic pathologists should be aware of the diagnosis when reviewing orbital biopsies, because difficulties may arise when the crystal-storing macrophages occupy more tissue space than the Ig-secreting cells or when they resemble cell types such as rhabdomyoblasts.
Collapse
Affiliation(s)
- Sarah E Coupland
- Department of Pathology, University Hospital Benjamin Franklin, Freie Universität, Hindenburgdamm 30, D-12200 Berlin, Germany.
| | | | | | | |
Collapse
|
20
|
Prasad ML, Charney DA, Sarlin J, Keller SM. Pulmonary immunocytoma with massive crystal storing histiocytosis: a case report with review of literature. Am J Surg Pathol 1998; 22:1148-53. [PMID: 9737249 DOI: 10.1097/00000478-199809000-00015] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An unusual immunocytoma (lymphoplasmacytoid lymphoma) composed predominantly of sheets of globoid and spindle-shaped crystal-storing histiocytes was detected incidentally in the right lung of a 72-year-old woman. Scattered lymphoplasmacytic aggregates within the tumor had monoclonality with anti-kappa immunoglobulin (Ig) M antibodies. The crystals were outlined positively by the same antibodies. They stained an intense blue with phosphotungstic acid-hematoxylin (PTAH) and were found during electron microscopy to be membrane bound and also within type I pneumocytes and the extracellular space. Excessive production of kappa IgM by neoplastic low-grade lymphoplasmacytoid cells of B-cell origin in an altered intra- or extracellular milieu may lead to crystallization and phagocytosis by reactive histiocytes. Review of the literature revealed seven more cases: four in the head and neck, and one each in the skin, the lymph node, and the lung. IgM was the most frequently crystallizing immunoglobulin (four of seven) and all had kappa light chains. The lesion needs to be differentiated from neoplastic and nonneoplastic histiocytic and lymphoplasmacytic disorders. The difference with bronchial mucosa-associated lymphoid tissue lymphoma and marginal zone lymphoma is, perhaps, semantic.
Collapse
Affiliation(s)
- M L Prasad
- Department of Pathology, The New York Hospital-Cornell Medical Center, New York 10021, USA
| | | | | | | |
Collapse
|
21
|
Suarez P, el-Naggar AK, Batsakis JG. Intracellular crystalline deposits in lymphoplasmacellular disorders. Ann Otol Rhinol Laryngol 1997; 106:170-2. [PMID: 9041825 DOI: 10.1177/000348949710600215] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Crystalline immunoglobulin intracellular inclusions may be found in a range of B-cell neoplasias, including MALT (mucosa-associated lymphoid tissue) lymphoma. The crystals are regarded as an outcome of impaired cell secretory activity leading to their accumulation. At times the deposits may be so profound as to obscure the diagnosis and may even lead to misdiagnosis. Examples of the crystals are presented along with a brief literature review.
Collapse
Affiliation(s)
- P Suarez
- Department of Pathology, University of Texas M. D. Anderson Cancer Center, Houston, USA
| | | | | |
Collapse
|
22
|
|
23
|
Wong KF, Chan JK, Kwong YL, Sin VC, Ma SK, Tang KC. B-cell small lymphocytic lymphoma with circulating granular prolymphocytes and a novel trisomy 15 anomaly. CANCER GENETICS AND CYTOGENETICS 1995; 81:28-32. [PMID: 7773956 DOI: 10.1016/0165-4608(94)00200-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
A 53-year-old man presented with cervical lymphadenopathy and massive splenomegaly. Peripheral blood examination showed many prolymphocytes with cytoplasmic azurophilic granules, giving an initial impression of large granular lymphocytosis. The lymph node biopsy and immunohistochemical study findings, however, were more compatible with a diagnosis of B-cell small lymphocytic lymphoma. The circulating prolymphocytes showed restricted kappa light chain expression similar to the lymphoid infiltrate in the lymph node. Karyotypic analysis revealed trisomy 15, a chromosomal abnormality that has rarely been described in small lymphocytic lymphoma or chronic lymphocytic leukemia.
Collapse
MESH Headings
- Bone Marrow/pathology
- Bone Marrow/ultrastructure
- Chromosomes, Human, Pair 15
- Humans
- Immunophenotyping
- Karyotyping
- Leukemia, Lymphocytic, Chronic, B-Cell/blood
- Leukemia, Lymphocytic, Chronic, B-Cell/genetics
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Lymph Nodes/pathology
- Lymphocytes/pathology
- Lymphocytes/ultrastructure
- Lymphoma, B-Cell/blood
- Lymphoma, B-Cell/genetics
- Lymphoma, B-Cell/pathology
- Male
- Middle Aged
- Trisomy/genetics
Collapse
Affiliation(s)
- K F Wong
- Department of Pathology, Queen Elizabeth Hospital, Kowloon, Hong Kong
| | | | | | | | | | | |
Collapse
|
24
|
Hoffman MA, Valderrama E, Fuchs A, Friedman M, Rai K. Leukemic meningitis in B-cell prolymphocytic leukemia. A clinical, pathologic, and ultrastructural case study and a review of the literature. Cancer 1995; 75:1100-3. [PMID: 7850707 DOI: 10.1002/1097-0142(19950301)75:5<1100::aid-cncr2820750508>3.0.co;2-q] [Citation(s) in RCA: 25] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
BACKGROUND Leukemic meningitis is rare in B-chronic lymphocytic leukemia (CLL) and B-prolymphocytic leukemia (PLL); a MEDLINE search for reports published 1960 and after disclosed only nine prior reports. A patient with stable Rai Stage II CLL/PL developed mental status changes. Lumbar puncture revealed a lymphocytic pleocytosis with prolymphocytes containing intracytoplasmic inclusions. METHODS The patient's cerebrospinal fluid lymphocyte population was analyzed by immunophenotyping and electron microscopy. RESULTS The studies revealed a clonal population of B prolymphocytes, with typical immunophenotypic and ultrastructural characteristics. The patient was treated with intrathecal chemotherapy with eventual resolution of the cerebrospinal fluid pleocytosis and return to his normal neurologic status. Prior studies also have revealed the efficacy of intrathecal chemotherapy. CONCLUSION Leukemic meningitis in CLL or PLL is responsive to treatment with intrathecal chemotherapy.
Collapse
MESH Headings
- Aged
- Humans
- Leukemia, Lymphocytic, Chronic, B-Cell/complications
- Leukemia, Lymphocytic, Chronic, B-Cell/pathology
- Leukemia, Prolymphocytic/complications
- Leukemia, Prolymphocytic/pathology
- Male
- Meningitis, Aseptic/etiology
- Meningitis, Aseptic/pathology
Collapse
Affiliation(s)
- M A Hoffman
- Department of Medicine, Albert Einstein College of Medicine, New Hyde Park, New York
| | | | | | | | | |
Collapse
|
25
|
den Ottolander GJ, Brederoo P, Schuurman RK, Teeuwsen VJ, Schuit HR, van der Meulen J, Jansen J, Hijmans W. Intracellular immunoglobulin G 'pseudocrystals' in a patient with chronic B-cell leukemia. Cancer 1986; 58:43-51. [PMID: 2423226 DOI: 10.1002/1097-0142(19860701)58:1<43::aid-cncr2820580109>3.0.co;2-c] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
A patient with chronic B-cell leukemia in whom the malignant lymphocytes showed intracellular inclusions of immunoglobulin (Ig) G kappa molecules is described. Electron microscopy revealed filamentous material in the nuclear envelopes and in the cisternae of the rough endoplasmic reticulum. These in vivo surface Ig-negative, nonexcreting cells could be stimulated in vitro to excrete immunoglobulin-free light chain molecules into the supernatant, which were not found in the cytoplasm after stimulation.
Collapse
|
26
|
Robinson DS, Melo JV, Andrews C, Schey SA, Catovsky D. Intracytoplasmic inclusions in B prolymphocytic leukaemia: ultrastructural, cytochemical, and immunological studies. J Clin Pathol 1985; 38:897-903. [PMID: 2993372 PMCID: PMC499391 DOI: 10.1136/jcp.38.8.897] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
The intracytoplasmic inclusions seen in most cells from a patient with B prolymphocytic leukaemia were analysed using both light and electron microscopy. They consisted of a dense homogeneous structure and were surrounded by a membrane, which had no continuity with the Golgi cisternae or the endoplasmic reticulum; some inclusions had a clear association with small lysosomal granules. Immunofluorescence and immunoperoxidase studies using light microscopy failed to elucidate completely the nature of the inclusions, but immunocytochemical reactions performed using electron microscopy suggested an immunoglobulin nature. All inclusions were negative for acid phosphatase and periodic acid Schiff. The nature of the inclusions described in the prolymphocytes of this patient were compared with those previously recorded in B prolymphocytic leukaemia.
Collapse
|
27
|
Dehou MF, De Waele M, De Greve J, Van Camp B, Gepts W. Unusual nonimmunoglobulin-containing inclusions in a case of follicular large cell lymphoma. Ultrastruct Pathol 1985; 8:71-82. [PMID: 3901455 DOI: 10.3109/01913128509141510] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Intracytoplasmic inclusion bodies were found in a case of follicular large cell lymphoma. They did not react with anti-immunoglobulin antisera and showed no enzyme reactivity. On electron microscopy the inclusions consisted of loosely packed fibrillar material not surrounded by a membrane or by rough endoplasmic reticulum. They were found only in the large lymphomatous cells. Immunocytochemistry showed a reactivity of these cells with anti-HLA-Dr and the OKT10 monoclonal antibodies. The nature of the inclusions remains unknown. They differ significantly from those described in the literature in cases of B-cell lymphoproliferative disorders.
Collapse
|