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Kmira Z, Ahmed G, Wided C, Wided M, Zeineb N, Nihed A, Yosra BY, Regaieg H, Nejia B, Abderrahim K. A challenging diagnosis of plasmablastic lymphoma: importance of integrating morpholgy immunohistochemistry and flow cytometry findings (case report). Pan Afr Med J 2023; 45:158. [PMID: 37869229 PMCID: PMC10589407 DOI: 10.11604/pamj.2023.45.158.39896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 08/01/2023] [Indexed: 10/24/2023] Open
Abstract
Plasmablastic lymphoma (PBL) is a rare clinicopathological entity that still raises many diagnostic and management difficulties, particularly due to the overlap between plasmablastic lymphomas and myeloma features. We report a clinical presentation of PBL affecting bone marrow in a 43-year-old patient who was admitted for B symptoms, hepatosplenomegaly, and bicytopenia investigation. Based on these findings, acute leukemia was suspected. Bone marrow morphology immunohistochemistry and flow cytometry contributed to establishing the diagnosis of medullary PBL. The patient deteriorated and died due to septic shock. This pathology requires collaboration between clinicians, pathologists, and biologists to confirm the diagnosis early. Nevertheless, a delayed diagnosis may contribute to worsening the prognosis particularly due to advanced stage consultation. Our reported case illustrates a rare clinical presentation affecting bone marrow. In our context, a confrontation between flow cytometry and immunohistochemistry was of interest as it helped to detect the immunological features of this neoplasm.
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Affiliation(s)
- Zahra Kmira
- Department of Clinical Hematology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
| | - Gereisha Ahmed
- Department of Cytology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
| | - Cherif Wided
- Department of Clinical Hematology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
| | - Moatamri Wided
- Department of Cytology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
| | - Nfikha Zeineb
- Department of Pathology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
| | - Abdessaied Nihed
- Department of Pathology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
| | - Ben Youssef Yosra
- Department of Clinical Hematology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
| | - Haifa Regaieg
- Department of Clinical Hematology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
| | - Brahem Nejia
- Department of Cytology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
| | - Khelif Abderrahim
- Department of Clinical Hematology, Farhat Hached University Hospital, Sousse, 4081, Tunisia
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Tsutsumi Y, Kitano S, Yanagita S, Tachibana M. Epstein-Barr virus-positive mucocutaneous ulcer, plasmablastic type, associated with nodal CD4+ angioimmunoblastic T-cell lymphoma and generalised pruritus: a self-limiting lymphoproliferative disorder resembling cutaneous plasmablastic lymphoma. BMJ Case Rep 2022; 15:e247430. [PMID: 35523507 PMCID: PMC9083435 DOI: 10.1136/bcr-2021-247430] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/17/2022] [Indexed: 12/16/2022] Open
Abstract
A woman in her 80s reported of generalised pruritus, which was treated with phototherapy and steroid administration. Two months after onset, lymph node biopsy revealed CD4+ angioimmunoblastic T-cell lymphoma with systemic superficial nodal involvement. Intractable prurigo was judged as T-cell lymphoma related. After effective chemotherapy (7 months later), skin nodules appeared multifocally, including on the lip, thumb and lower leg. The biopsied infiltrative lesion on the right lower leg microscopically revealed subcutaneous growth of atypical plasmablasts with nearly 100% Ki-67 labelling and Epstein-Barr virus (EBV)-encoded small nuclear RNA positivity. Plasmablastic lymphoma (CD45/CD19/CD38/CD138/MUM1+, CD20/CD79a/PAX5-) was suspected. Immunoglobulin light-chain restriction and nuclear expression of c-myc protein were undetectable, and the ulcers were spontaneously epithelialised by the cessation of steroid administration. After 10 months, non-progressive prurigos persisted on the extremities, but without regrowth of nodal T-cell lymphoma and cutaneous lymphoproliferative lesion. Reactive nature of the EBV-induced mucocutaneous plasmablastic growth (EBV-positive mucocutaneous ulcer, plasmablastic type) is discussed.
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Affiliation(s)
- Yutaka Tsutsumi
- Division of Diagnostic Pathology, Tsutsumi Byori Shindanka Clinic, Inazawa, Aichi, Japan
- Department of Medical Technology, Yokkaichi Nursing and Medical Care University, Yokkaichi, Mie, Japan
| | - Seiya Kitano
- Department of Dermatology, Shimada General Medical Center, Shimada, Shizuoka, Japan
| | - Soshi Yanagita
- Department of Hematology, Shimada General Medical Center, Shimada, Shizuoka, Japan
| | - Mitsuhiro Tachibana
- Department of Diagnostic Pathology, Shimada General Medical Center, Shimada, Shizuoka, Japan
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Mori H, Fukatsu M, Ohkawara H, Oka Y, Kataoka Y, Taito S, Ikezoe T. Heterogeneity in the diagnosis of plasmablastic lymphoma, plasmablastic myeloma, and plasmablastic neoplasm: a scoping review. Int J Hematol 2021; 114:639-652. [PMID: 34462886 DOI: 10.1007/s12185-021-03211-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Revised: 08/20/2021] [Accepted: 08/24/2021] [Indexed: 12/19/2022]
Abstract
The diagnosis of plasmablastic lymphoma (PBL), plasmablastic myeloma (PBM), and plasmablastic neoplasm (PBN) may be arbitrary in some cases because these entities can be indistinct. We conducted this scoping review to investigate heterogeneity in diagnostic criteria used in previous studies and validate the diagnostic results of previous diagnostic algorithms and the algorithm we developed, which also includes diagnosis of PBN. Using the PRISMA Extension for Scoping Reviews, we analyzed literature published between September 2017 and April 2020. We identified a total of 163 cases (128 PBL, 32 PBM, and 3 PBN) from 77 case reports and 8 case series. We found that diagnostic criteria in the literature varied for PBL but were consistent for PBM. Our algorithm was the first attempt to include PBN in a complete structure. The results of the three diagnostic algorithms varied significantly. Hematologists and pathologists should pay more attention to the differential diagnosis of PBL, PBM, and PBN.
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Affiliation(s)
- Hirotaka Mori
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 9601295, Japan.
| | - Masahiko Fukatsu
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 9601295, Japan
| | - Hiroshi Ohkawara
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 9601295, Japan
| | - Yuka Oka
- Department of Diagnostic Pathology, Fukushima Medical University, Fukushima, Japan
| | - Yuki Kataoka
- Hospital Care Research Unit, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan.,Department of Healthcare Epidemiology, School of Public Health in the Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Department of Respiratory Medicine, Hyogo Prefectural Amagasaki General Medical Center, Amagasaki, Japan
| | - Shunsuke Taito
- Systematic Review Workshop Peer Support Group (SRWS-PSG), Osaka, Japan.,Division of Rehabilitation, Department of Clinical Practice and Support, Hiroshima University Hospital, Hiroshima, Japan
| | - Takayuki Ikezoe
- Department of Hematology, Fukushima Medical University, 1 Hikarigaoka, Fukushima, 9601295, Japan
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Light chain cast nephropathy caused by plasmablastic lymphoma of the bladder. Clin Nephrol Case Stud 2021; 9:72-80. [PMID: 34235044 PMCID: PMC8259465 DOI: 10.5414/cncs110339] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Accepted: 06/04/2021] [Indexed: 12/01/2022] Open
Abstract
Introduction: Plasmablastic lymphoma (PBL) is a rare form of B-cell lymphoma typically seen in patients with underlying immunosuppression such as HIV, autoimmune disease, and organ transplantation. PBL in HIV-positive patients usually originates from the gastrointestinal tract, with a predilection for the oral cavity. Bladder involvement by PBL is exceedingly rare, and cast nephropathy due to κ light chain-secreting PBL has not been reported previously. Case report: We report a patient who presented with acute kidney injury (AKI) in the setting of HIV, and was found to have a bladder tumor. Bladder pathology revealed a high-grade PBL with κ light chain restriction. Renal biopsy showed κ light chain cast nephropathy, presumably secondary to κ light chain-secreting PBL. Conclusion: Although the prognosis of PBL is poor, our patient recovered from AKI, achieved complete hematologic remission with chemotherapy, and underwent successful autologous stem cell transplant.
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