1
|
Homsi HA, Knapp C, Agrawal S, Bhavsar S, Ko JS, Billings SD, Ronen S. Cutaneous crystal storing histiocytosis: A case series with review of literature. J Cutan Pathol 2024; 51:506-512. [PMID: 38606952 DOI: 10.1111/cup.14625] [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: 10/10/2023] [Revised: 02/09/2024] [Accepted: 04/03/2024] [Indexed: 04/13/2024]
Abstract
Crystal-storing histiocytosis (CSH) is a rare condition in which crystals accumulate in the cytoplasm of histiocytes and is usually associated with a lymphoplasmacytic neoplasm. Cutaneous CSH is extraordinarily rare and limited to case reports in the literature. We report two cases of this disease with cutaneous involvement. Case 1 was a 65-year-old male with a 4-month history of a pruritic eruption that started as a solitary pink to skin-colored indurated plaque on the anterior neck before progressing to involve the whole neck, chest wall, and face. Case 2 was a 54-year-old woman with a history of unspecified "lymphoma" who presented with a soft nodule on the forearm. Biopsies from both cases had similar findings and showed a proliferation of epithelioid cells with pink cytoplasm and intracellular crystalline structures infiltrating the dermis and subcutaneous fat. In the first case, the cells were positive for CD43, CD45, CD68, and IgG kappa, and in the second case, the crystals were positive for IgG lambda. Based on these findings, the patients were diagnosed with cutaneous CSH. We highlight this rare diagnosis and the importance of investigating an underlying lymphoplasmacytic neoplasm.
Collapse
Affiliation(s)
- Haya A Homsi
- Department of Pathology, Cleveland Clinic, Ohio, USA
| | - Calvin Knapp
- Department of Pathology, Cleveland Clinic, Ohio, USA
| | | | | | - Jennifer S Ko
- Department of Pathology, Cleveland Clinic, Ohio, USA
| | | | - Shira Ronen
- Department of Pathology, Cleveland Clinic, Ohio, USA
| |
Collapse
|
2
|
Magara K, Takasawa A, Kikuchi K, Sugawara T, Murakami T, Kyuno D, Ono Y, Takasawa K, Numata Y, Sasaki S, Nakase H, Hasegawa T, Osanai M. A novel approach to diagnosing crystal-storing histiocytosis: utility of scanning electron microscopy for formalin-fixed paraffin-embedded tissue specimens. Med Mol Morphol 2023; 56:297-302. [PMID: 37400727 DOI: 10.1007/s00795-023-00363-y] [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: 05/07/2023] [Accepted: 06/19/2023] [Indexed: 07/05/2023]
Abstract
Crystal-storing histiocytosis (CSH) is a rare disorder that shows infiltration of histiocytes with an aberrant cytoplasmic accumulation of crystalline structures and is often accompanied by lymphoproliferative-plasma cell disorders (LP-PCD) as background diseases. The diagnosis of CSH requires identification of crystalline structures that accumulate in the infiltrating histiocytes, which may be challenging by optical microscopy alone. In this case report, we describe an atypical course of systemic CSH with multifocal fibrosclerosis of an unknown background disease that was diagnosed by ultrastructural observation, including transmission electron microscopy (TEM) and scanning electron microscopy (SEM), in pathological autopsy. In addition, crystalline structures were successfully identified by scanning electron microscopic observations using formalin-fixed and paraffin-embedded (FFPE) tissue from biopsy specimens taken before death. Since CSH was identified by SEM in a tiny biopsy specimen, observation of histiocytic infiltrative lesions by SEM using FFPE tissue may lead to early detection of and initiation of treatment for CSH.
Collapse
Affiliation(s)
- Kazufumi Magara
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-Ku, Sapporo, 060-8556, Japan
| | - Akira Takasawa
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-Ku, Sapporo, 060-8556, Japan.
| | - Keisuke Kikuchi
- Department of Pathology, Obihiro Kosei General Hospital, Obihiro, Japan
| | - Taro Sugawara
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Taro Murakami
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-Ku, Sapporo, 060-8556, Japan
| | - Daisuke Kyuno
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-Ku, Sapporo, 060-8556, Japan
| | - Yusuke Ono
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-Ku, Sapporo, 060-8556, Japan
| | - Kumi Takasawa
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-Ku, Sapporo, 060-8556, Japan
| | - Yasunao Numata
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Shigeru Sasaki
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Tadashi Hasegawa
- Department of Surgical Pathology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Makoto Osanai
- Department of Pathology, Sapporo Medical University School of Medicine, S1 W17, Chuo-Ku, Sapporo, 060-8556, Japan
| |
Collapse
|
3
|
Sudul P, Piatkowska-Jakubas B, Pawlinski L, Galazka K, Sacha T, Kiec-Wilk B. The Complexities of Diagnosis with Co-Existing Gaucher Disease and Hemato-Oncology-A Case Report and Review of the Literature. J Clin Med 2023; 12:5518. [PMID: 37685585 PMCID: PMC10488105 DOI: 10.3390/jcm12175518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/05/2023] [Accepted: 08/16/2023] [Indexed: 09/10/2023] Open
Abstract
Hematological abnormalities are the most common early symptoms of Gaucher disease (GD), with an increased risk of hematopoietic system malignancies reported in patients with GD. GD may be associated with monoclonal and polyclonal gammopathies; however, the mechanism of association of GD with multiple myeloma (MM) remains uncertain. Enzyme replacement therapy (ERT) has been shown to improve patients' cytopenia and it seems to facilitate anti-myeloma therapy in patients with co-occurring GD and MM. Although it is necessary to demonstrate the deficiency of enzymatic activity, as well as using genetic tests to finally diagnose GD, due to changes in the blood count image, bone marrow biopsy is still a frequent element of the GD diagnosis procedure. The diagnosis of GD is often delayed, mainly due to the heterogeneity of the histopathological picture of bone marrow biopsy or overlapping hematological abnormalities. Unrecognized and untreated GD worsens the response of a patient with an oncological disease to targeted treatment. We present a literature review, inspired by the case of a Caucasian patient initially diagnosed with MM and later confirmed with comorbid GD type 1 (GD1). We would like to point out the problem of underdiagnosis and delay in patients with GD.
Collapse
Affiliation(s)
- Paulina Sudul
- University Hospital, 30-688 Krakow, Poland
- Unit of Rare Metabolic Diseases, Department of Metabolic Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland
| | - Beata Piatkowska-Jakubas
- University Hospital, 30-688 Krakow, Poland
- Department of Hematology, Jagiellonian University Medical College, 30-501 Krakow, Poland
| | - Lukasz Pawlinski
- University Hospital, 30-688 Krakow, Poland
- European Reference Network for Rare Metabolic Disease MetabERN, 30-688 Krakow, Poland
| | - Krystyna Galazka
- Department of Pathomorphology, Jagiellonian University Medical College, 31-531 Krakow, Poland
| | - Tomasz Sacha
- University Hospital, 30-688 Krakow, Poland
- Department of Hematology, Jagiellonian University Medical College, 30-501 Krakow, Poland
| | - Beata Kiec-Wilk
- University Hospital, 30-688 Krakow, Poland
- Unit of Rare Metabolic Diseases, Department of Metabolic Diseases, Jagiellonian University Medical College, 30-688 Krakow, Poland
- European Reference Network for Rare Metabolic Disease MetabERN, 30-688 Krakow, Poland
| |
Collapse
|
4
|
Karam S, Haidous M, Dalle IA, Dendooven A, Moukalled N, Van Craenenbroeck A, Bazarbachi A, Sprangers B. Monoclonal gammopathy of renal significance: Multidisciplinary approach to diagnosis and treatment. Crit Rev Oncol Hematol 2023; 183:103926. [PMID: 36736510 DOI: 10.1016/j.critrevonc.2023.103926] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/13/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
Monoclonal gammopathy of renal significance (MGRS) is a hemato-nephrological term referring to a heterogeneous group of kidney disorders characterized by direct or indirect kidney injury caused by a monoclonal immunoglobulin (MIg) produced by a B cell or plasma cell clone that does not meet current hematologic criteria for therapy. MGRS-associated kidney diseases are diverse and can result in the development of end stage kidney disease (ESKD). The diagnosis is typically made by nephrologists through a kidney biopsy. Many distinct pathologies have been identified and they are classified based on the site or composition of the deposited Mig, or according to histological and ultrastructural findings. Therapy is directed towards the identified underlying clonal population and treatment decisions should be coordinated between hematologists and nephrologists in a multidisciplinary fashion, depend on the type of MGRS, the degree of kidney function impairment and the risk of progression to ESKD.
Collapse
Affiliation(s)
- Sabine Karam
- Division of Nephrology and Hypertension, University of Minnesota, Minneapolis, MN, United States
| | - Mohammad Haidous
- Department of Medicine, Saint Vincent Charity Medical Center, Cleveland, OH, United States
| | - Iman Abou Dalle
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amélie Dendooven
- Department of Pathology, University Hospital Ghent, Ghent, Belgium
| | - Nour Moukalled
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Amaryllis Van Craenenbroeck
- Department of Microbiology, Immunology and Transplantation, Laboratory of Nephrology, KU Leuven, Leuven, Belgium; Division of Nephrology, University Hospitals Leuven, Leuven, Belgium
| | - Ali Bazarbachi
- Bone Marrow Transplantation Program, Department of Internal Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Department of Anatomy, Cell Biology and Physiological Sciences, American University of Beirut Medical Center, Beirut, Lebanon
| | - Ben Sprangers
- Biomedical Research Institute, Department of Immunology and Infection, University Hasselt, Diepenbeek, Belgium; Department of Nephrology, Ziekenhuis Oost-Limburg, Genk, Belgium.
| |
Collapse
|
5
|
Mobarki M, Papoudou-Bai A, Dumollard JM, Alhazmi AH, Musawi S, Madkhali MA, Muqri KY, Péoc’h M, Karpathiou G. Crystal-Storing Histiocytosis: The Iceberg of More Serious Conditions. Diagnostics (Basel) 2023; 13:diagnostics13020271. [PMID: 36673081 PMCID: PMC9858286 DOI: 10.3390/diagnostics13020271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 01/04/2023] [Accepted: 01/10/2023] [Indexed: 01/13/2023] Open
Abstract
Crystal-storing histiocytosis is a rare condition that is histologically characterized by intracellular cytoplasmic crystalline inclusions. It usually presents monoclonal immunoglobulins that deposit within histiocytes, which accumulate and affect different organs of the human body and are commonly associated with lymphoproliferative conditions, especially those with plasmacytic differentiation. The prognosis of this condition is variable and related to the underlying clinical disease. In this review article, we aim to describe and discuss the clinical and pathological characteristics of crystal-storing histiocytosis based on the available literature and to provide a thorough differential diagnosis.
Collapse
Affiliation(s)
- Mousa Mobarki
- Pathology Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
- Correspondence: ; Tel.: +966-540926111
| | - Alexandra Papoudou-Bai
- Pathology Department, Faculty of Medicine, University of Ioannina, 47100 Ioannina, Greece
| | - Jean Marc Dumollard
- Pathology Department, University Hospital of Saint-Etienne, 42023 Saint-Etienne, France
| | - Abdulaziz H. Alhazmi
- Microbiology and Parasitology Department, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Shaqraa Musawi
- Department of Medical Laboratories Technology, College of Applied Medical Sciences, Jazan University, Jazan 45142, Saudi Arabia
| | - Mohammed Ali Madkhali
- Division of Hematology and Oncology, Department of Internal Medicine, Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Khalid Y. Muqri
- Faculty of Medicine, Jazan University, Jazan 45142, Saudi Arabia
| | - Michel Péoc’h
- Pathology Department, University Hospital of Saint-Etienne, 42023 Saint-Etienne, France
| | - Georgia Karpathiou
- Pathology Department, University Hospital of Saint-Etienne, 42023 Saint-Etienne, France
| |
Collapse
|
6
|
Fend F, Dogan A, Cook JR. Plasma cell neoplasms and related entities-evolution in diagnosis and classification. Virchows Arch 2023; 482:163-177. [PMID: 36414803 PMCID: PMC9852202 DOI: 10.1007/s00428-022-03431-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Revised: 10/11/2022] [Accepted: 10/15/2022] [Indexed: 11/23/2022]
Abstract
Plasma cell neoplasms including multiple myeloma (MM) and related terminally differentiated B-cell neoplasms are characterized by secretion of monoclonal immunoglobulin and stepwise development from a preneoplastic clonal B and/or plasma cell proliferation called monoclonal gammopathy of undetermined significance (MGUS). Diagnosis of these disorders requires integration of clinical, laboratory, and morphological features. While their classification mostly remains unchanged compared to the revised 2016 WHO classification and the 2014 International Myeloma Working Group consensus, some changes in criteria and terminology were proposed in the 2022 International Consensus Classification (ICC) of mature lymphoid neoplasms. MGUS of IgM type is now divided into IgM MGUS of plasma cell type, precursor to the rare IgM MM and characterized by MM-type cytogenetics, lack of clonal B-cells and absence of MYD88 mutation, and IgM MGUS, NOS including the remaining cases. Primary cold agglutinin disease is recognized as a new entity. MM is now formally subdivided into cytogenetic groups, recognizing the importance of genetics for clinical features and prognosis. MM with recurrent genetic abnormalities includes MM with CCND family translocations, MM with MAF family translocations, MM with NSD2 translocation, and MM with hyperdiploidy, with the remaining cases classified as MM, NOS. For diagnosis of localized plasma cell tumors, solitary plasmacytoma of bone, and primary extraosseous plasmacytoma, the importance of excluding minimal bone marrow infiltration by flow cytometry is emphasized. Primary systemic amyloidosis is renamed immunoglobulin light chain amyloidosis (AL), and a localized AL amyloidosis is recognized as a distinct entity. This review summarizes the updates on plasma cell neoplasms and related entities proposed in the 2022 ICC. KEY POINTS: • Lymphoplasmacytic lymphoma can be diagnosed with lymphoplasmacytic aggregates in trephine biopsies < 10% of cellularity and evidence of clonal B-cells and plasma cells. • IgM MGUS is subdivided into a plasma cell type and a not otherwise specified (NOS) type. • Primary cold agglutinin disease is recognized as a new entity. • The term "multiple myeloma" replaces the term "plasma cell myeloma" used in the 2016 WHO classification. • Multiple myeloma is subdivided into 4 mutually exclusive cytogenetic groups and MM NOS. • Minimal bone marrow infiltration detected by flow cytometry is of major prognostic importance for solitary plasmacytoma of bone and to a lesser extent for primary extraosseous plasmacytoma. • Localized IG light chain amyloidosis is recognized as a separate entity, distinct from systemic immunoglobulin light chain (AL) amyloidosis.
Collapse
Affiliation(s)
- Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, Tübingen University Hospital, Tübingen, Germany
| | - Ahmet Dogan
- Memorial Sloan Kettering Cancer Center, New York, NY 10065 USA
| | - James R. Cook
- Department of Clinical Pathology, Cleveland Clinic, Cleveland, OH 44195 USA
| |
Collapse
|
7
|
Kong L, Xue L, Zhong Y, Wang S, Zheng D, Wang L, Jiao Y, Zhang X, Xue H, Liu X. Crystal-storing histiocytosis in the stomach: A case report and review of the literature. Front Oncol 2022; 12:1024971. [PMID: 36591494 PMCID: PMC9798227 DOI: 10.3389/fonc.2022.1024971] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2022] [Accepted: 12/02/2022] [Indexed: 12/23/2022] Open
Abstract
Crystal-storing histiocytosis (CSH) is a rare disorder characterized by the accumulation of non-neoplastic histiocytes that contain intracytoplasmic crystallized immunoglobulins. Although CSH can occur in various organs, gastric CSH is very rare. Therefore, diagnosing gastric CSH remains a challenge. Here, we present the case of a 69-year-old man with localized gastric CSH who presented with positive fecal occult blood for 2 days. Gastroscopy showed that there was a piece of irregular whitish focus in the big bend of the gastric antrum, which was soft and elastic. Histologically, the biopsied gastric mucosa showed chronic inflammation, mild activity with erosion, and numerous eosinophilic mononuclear cells containing fibrillary crystalloid inclusions in the lamina propria. Immunohistochemically, these crystal-containing cells were positive for CD68/PGM1 and Igk, which revealed that the cells were histiocytes harboring kappa light chain-restricted immunoglobulin crystals. Electron microscopic examination showed numerous high-electron-density particles in the cytoplasm of cells, with crystal structures of different sizes and shapes. This case highlights how immunohistochemistry can help with differential diagnosis and classification.
Collapse
Affiliation(s)
- Linghong Kong
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Liyan Xue
- Department of Pathology, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Yanfeng Zhong
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Shenglan Wang
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Danfeng Zheng
- Department of Pathology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
| | - Lining Wang
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Yang Jiao
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Xinpeng Zhang
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Huizhong Xue
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China
| | - Xiaogang Liu
- Department of Pathology, Beijing Chuiyangliu hospital, Beijing, China,*Correspondence: Xiaogang Liu,
| |
Collapse
|
8
|
Lesesve J, Thomas B. Crystal-storing histiocytosis associated with monoclonal kappa light chain gammopathy. Int J Lab Hematol 2022; 44:978-979. [PMID: 35451182 PMCID: PMC9790287 DOI: 10.1111/ijlh.13848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2021] [Revised: 03/07/2022] [Accepted: 03/21/2022] [Indexed: 12/30/2022]
Affiliation(s)
| | - Benoit Thomas
- Service d'Hématologie BiologiqueHopitaux Privés UNEOSMetzFrance
| |
Collapse
|
9
|
Firwana M, Clarke-Brodber AL, King RL, Dalland JC, Hartley CP, Boire NA, Sturgis CD. Cyto-histologic correlation of crystal-storing histiocytosis: Rare presentation in breast, predating diagnosis of B-cell lymphoma by two years. Ann Diagn Pathol 2022; 59:151979. [DOI: 10.1016/j.anndiagpath.2022.151979] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 05/12/2022] [Indexed: 11/01/2022]
|
10
|
Scaramellini N, Croci G, De Magistris C, Panzieri DL, Cassinerio E, Marcon A, Nascimbeni F, Quarta A, Cappellini MD, Motta I. Splenomegaly: Dare to think rare. Am J Hematol 2022; 97:1259-1265. [PMID: 35384034 DOI: 10.1002/ajh.26559] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 03/28/2022] [Accepted: 03/31/2022] [Indexed: 11/12/2022]
Affiliation(s)
- Natalia Scaramellini
- Rare Diseases Center, General Medicine Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Università degli Studi di Milano Milan Italy
| | - Giorgio Croci
- Division of Pathology Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Pathophysiology and Transplantation Università degli Studi di Milano Milan Italy
| | - Claudio De Magistris
- Rare Diseases Center, General Medicine Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Università degli Studi di Milano Milan Italy
| | - Daniele Lello Panzieri
- Rare Diseases Center, General Medicine Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Università degli Studi di Milano Milan Italy
| | - Elena Cassinerio
- Rare Diseases Center, General Medicine Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Alessia Marcon
- Rare Diseases Center, General Medicine Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| | - Fabio Nascimbeni
- Regional Referral Centre for Lysosomal Storage Diseases, Division of Internal Medicine and Metabolism University Hospital of Baggiovara, AOU of Modena Modena Italy
| | - Antonella Quarta
- Microcythemia Center Hematology with Transplant Unit, “A. Perrino” Hospital Brindisi Italy
| | - Maria Domenica Cappellini
- Rare Diseases Center, General Medicine Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
| | - Irene Motta
- Rare Diseases Center, General Medicine Unit Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico Milan Italy
- Department of Clinical Sciences and Community Health Università degli Studi di Milano Milan Italy
| |
Collapse
|
11
|
Jamshidi P, Levi J, Suarez MJ, Rivera R, Mahoney N, Eberhart CG, Rosenberg A, Rodriguez FJ. Clinicopathologic and Proteomic Analysis of Amyloidomas Involving the Ocular Surface and Adnexa. Am J Clin Pathol 2022; 157:620-627. [PMID: 34698334 PMCID: PMC8973273 DOI: 10.1093/ajcp/aqab161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Accepted: 08/22/2021] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES Ocular amyloidoma is a rare disorder characterized by deposition of insoluble proteinaceous fibrils in the extracellular space of the ocular adnexa. This study details the clinicopathologic features and proteomic characteristics of periocular amyloid deposition. METHODS Specimens (1991-2020) were retrieved and reviewed. All available H&E slides and special stains were reviewed. Proteomic analysis was performed using immunohistochemistry (IHC) for IgG, IgG4, IgA, IgD, IgM, CD20, CD3, CD138, and κ/λ, as well as chromatography-electrospray tandem mass spectrometry on formalin-fixed, paraffin-embedded tissue. RESULTS There were 14 patients (7 men, 7 women). The depositions involved eyelid (n = 3), conjunctiva (n = 8), and orbit (n = 3). All patients were adults with a median age at diagnosis of 56 (range, 39-88) years. The deposits were predominantly λ light chain restricted (n = 6) and mixed light chains (n = 2), and one case was κ predominant. Two of the cases with a mixture of κ and λ light chains had an excess of transthyretin by mass spectrometry. Four of the cases did not have adequate material for proteomic subtyping. CONCLUSIONS Amyloidomas involving ocular adnexa contain a variety of amyloid-related and immunoglobulin-associated peptides. The λ light chain predominates as in other body sites, but mixed patterns and rarely κ light chain restriction may be encountered.
Collapse
Affiliation(s)
- Pouya Jamshidi
- Department of Pathology and Laboratory Medicine, Northshore University Health System, Evanston, IL, USA
| | | | - Maria Jose Suarez
- Department of Infectious Diseases, Maimonides Medical Center, Brooklyn, NY, USA
| | - Roxana Rivera
- Cincinnati Eye Institute, Cincinnati and Department of Ophthalmology, University of Cincinnati, Cincinnati, OH, USA
| | - Nicholas Mahoney
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Charles G Eberhart
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Avi Rosenberg
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| | - Fausto J Rodriguez
- Department of Ophthalmology, Wilmer Eye Institute, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
- Department of Pathology, Johns Hopkins University, School of Medicine, Baltimore, MD, USA
| |
Collapse
|
12
|
Lee CM, Asilnejad B, Cohen LM, Roelofs KA, Rootman DB, Khanlou N, Pullarkat ST. Solitary Extramedullary Plasmacytoma of the Lacrimal Sac With Associated Crystal-Storing Histiocytosis. Ophthalmic Plast Reconstr Surg 2022; 38:102-107. [PMID: 34406151 DOI: 10.1097/iop.0000000000002028] [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: 11/25/2022]
Abstract
PURPOSE To report a rare case of crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma of the lacrimal sac and to review literature on the 2 entities to summarize important diagnostic, management, and prognostic considerations. METHODS A case report of the ophthalmologic presentation, pathology workup, and oncologic management is presented. Literature search with focus on lesions occurring in ophthalmic sites and management guidelines from expert panels and working groups. RESULTS Crystal-storing histiocytosis associated with solitary extramedullary plasmacytoma arose within the lacrimal sac of a previously healthy middle-aged woman and presented as a painless nodule with epiphora. The biopsy tissue showed sheets of crystal-filled histiocytes, interspersed with monoclonal plasma cells and rarely demonstrated plasma cell phagocytosis. Imaging and laboratory studies confirmed the localized nature. CONCLUSIONS Crystal-storing histiocytosis is an uncommon entity in which crystals, most commonly arising from altered immunoglobulins, aggregate within histiocytes and form symptomatic mass lesions. It has been reported in ophthalmic regions in patients with a concurrent lymphoproliferative or plasma cell disorder and can rarely predate a malignancy. The current case is notable because crystal-storing histiocytosis occurs with a localized process, solitary extramedullary plasmacytoma, and presents in an unusual site, the lacrimal sac. Tissue biopsy with multimodal pathological evaluation is necessary to make the diagnosis. Ophthalmologists should recognize that crystal-storing histiocytosis is commonly associated with a hematologic malignancy and, when appropriate, refer the patient for oncologic management. Surveillance may be indicated in cases with no established etiology. Solitary extramedullary plasmacytoma should also be monitored, as a proportion of cases progress to multiple myeloma.
Collapse
Affiliation(s)
- Christine M Lee
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Brenda Asilnejad
- Georgetown University School of Medicine, Washington, District of Columbia
| | - Liza M Cohen
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Kelsey A Roelofs
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Daniel B Rootman
- Division of Orbital and Ophthalmic Plastic Surgery, Doheny and Stein Eye Institutes, University of California, Los Angeles, Los Angeles, California
| | - Negar Khanlou
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| | - Sheeja T Pullarkat
- Department of Pathology and Laboratory Medicine, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, California
| |
Collapse
|
13
|
Kimura S, Oyama Y, Ziyao W, Waseda R, Nishino N, Sakata T, Takeshita M. A Rare Case of Tracheal Crystal-Storing Histiocytosis Associated with Marginal Zone Lymphoma of Mucosa-Associated Lymphoid Tissue. Int J Surg Pathol 2022; 30:543-550. [DOI: 10.1177/10668969221074615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Crystal-storing histiocytosis (CSH) is a rare non-neoplastic histiocytic lesion with abnormal accumulation of immunoglobulin (Ig) light chain. CSH is associated with Ig overproduction by B-lymphoproliferative disorders (B-LPDs) or by persistent inflammatory diseases. Eighteen cases of pulmonary CSH have been reported. However, no case reports of tracheal CSH have been published. In this patient, we found a solitary tracheal tumor in an asymptomatic 60-year-old man on chest computed tomography scan. Histologically, the tumor comprised two different lesions. One lesion showed diffuse proliferation of spindle-shaped histiocytes with abundant eosinophilic granular cytoplasm. With immunohistochemistry, the histiocytic cells were positive for CD68, CD163 and Ig kappa light chain, and the cytoplasm was weakly positive for anaplastic lymphoma kinase (ALK) protein. Fluorescence in situ hybridization indicated no split signals for the ALK gene. Electron microscopy demonstrated many elongated or rhomboid-shaped dense crystals in the cytoplasm of histiocytes. The second lesion showed proliferation of CD20-positive small atypical lymphocytes mixed with Ig kappa chain-positive plasma cells. A diagnosis of CSH and concomitant mucosa-associated lymphoid tissue lymphoma was made. In this patient, unexpected ALK protein was detected in infiltrating histiocytes. Therefore, careful assessment of the ALK protein and gene was necessary to differentiate from other histiocytic disorders.
Collapse
Affiliation(s)
- Shoichi Kimura
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Jonan-ku, Fukuoka, Japan
- Department of Otorhinolaryngology, Fukuoka University Hospital and School of Medicine, Jonan-ku, Fukuoka, Japan
| | - Yuzo Oyama
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Jonan-ku, Fukuoka, Japan
| | - Wang Ziyao
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Jonan-ku, Fukuoka, Japan
| | - Ryuichi Waseda
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Jonan-ku, Fukuoka, Japan
| | - Nanako Nishino
- Department of General Thoracic, Breast, and Pediatric Surgery, Fukuoka University, Jonan-ku, Fukuoka, Japan
| | - Toshifumi Sakata
- Department of Otorhinolaryngology, Fukuoka University Hospital and School of Medicine, Jonan-ku, Fukuoka, Japan
| | - Morishige Takeshita
- Department of Pathology, Fukuoka University Hospital and School of Medicine, Jonan-ku, Fukuoka, Japan
- Pathology Laboratory, Saiseikai Yahata General Hospital, Kitakyushu, Fukuoka, Japan
| |
Collapse
|
14
|
Lequain H, Gerfaud‐Valentin M, Fontaine J, Ferrant E, Grumet P, Jamilloux Y, Traverse‐Glehen A, Sève P. Crystal-storing histiocytosis and Bing-Neel-like syndrome revealing a small B-cell lymphoma with plasmacytic differentiation, presumed to be a marginal zone lymphoma. Clin Case Rep 2021; 9:e05202. [PMID: 34934503 PMCID: PMC8650757 DOI: 10.1002/ccr3.5202] [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: 01/06/2021] [Revised: 09/20/2021] [Accepted: 11/05/2021] [Indexed: 11/09/2022] Open
Abstract
Crystal-storing histiocytosis and Bing-Neel syndrome are two diseases induced by paraproteins. Herein, we report a rare case of crystal-storing histiocytosis associated with Bing-Neel-like neurological manifestations in the context of a small B-cell lymphoma with plasmacytic differentiation, presumed to be a marginal zone lymphoma.
Collapse
Affiliation(s)
- Hippolyte Lequain
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
| | - Mathieu Gerfaud‐Valentin
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
| | - Juliette Fontaine
- Department of PathologyCentre Hospitalier Lyon SudHospices Civils de LyonLyonFrance
| | | | - Pierre Grumet
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
| | - Yvan Jamilloux
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
| | | | - Pascal Sève
- Department of Internal MedicineHôpital de la Croix‐RousseHospices Civils de LyonUniversité Claude Bernard‐Lyon1LyonFrance
- Pôle IMERLyonFrance
- HESPER EALyonFrance
| |
Collapse
|
15
|
Ungari M, Ghiringhelli P, Marchi G, Fisogni S, Lavazza A, Molteni A, Malberti F, Bertoni R, Trombatore M, Ferrero G, Gusolfino MD, Varotti E, Tanzi G, Manotti L. Combined renal proximal tubulopathy and crystal storing histiocytosis in a patient with κ light chain multiple myeloma. Pathologica 2021; 113:285-293. [PMID: 34463673 DOI: 10.32074/1591-951x-154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Accepted: 07/13/2020] [Indexed: 11/30/2022] Open
Abstract
Multiple myeloma accounts for 10-15% of all hematologic malignancies, and 20% of deaths related to cancers of the blood and bone marrow. Diagnosis is defined by the presence of a serum monoclonal spike (M-spike) of more than 3 g/dL or more than 10% clonal plasma cells in the bone marrow and at least one myeloma-defining event, such as hypercalcemia, anemia, bone lesions, or renal impairment. The kidney is a major target organ, and renal impairment is frequently the first manifestation of the disease. Renal damage occurs in up to 40% of patients and 10-20% will require dialysis. Monoclonal immunoglobulin light chains are the major causes of renal complications in multiple myeloma. Glomerular disease, with the deposition of monoclonal immunoglobulins or their components, includes monoclonal immunoglobulin deposition disease, AL or AH amyloidosis, type I cryoglobulinemia, proliferative glomerulonephritis with monoclonal IgG deposits, immunotactoid glomerulopathy, and fibrillary glomerulonephritis. In addition, tubulointerstitial diseases with the deposition of monoclonal immunoglobulins or their components, are constituted by light chain cast nephropathy, light chain proximal tubulopathy, and crystal-storing histiocytosis. We report the case of a 66-year-old woman who presented with albumin-predominant moderate proteinuria and renal failure. Serum and urine immunofixation electrophoresis showed monoclonal κ light chain in both. Renal biopsy confirmed κ-restricted crystal-storing renal disease involving proximal tubular epithelial cells and crystal storing histiocytosis. Multiple myeloma with crystal storing histiocytosis was discovered in bone marrow biopsy. Thus, we present an unusual case of a myeloma patient presenting light chain proximal tubulopathy and crystal-storing histiocytosis both in the kidney and in the bone marrow.
Collapse
Affiliation(s)
| | | | | | | | - Antonio Lavazza
- Virology Unit of IZSLER, Istituto Zooprofilattico Sperimentale della Lombardia e dell'Emilia- Romagna, Brescia, Italy
| | | | | | | | | | | | | | | | | | | |
Collapse
|
16
|
Hamadeh F, Smith MR, Hsi ED. Crystal-storing histiocytes in ascites leading to a diagnosis of plasma cell myeloma. Diagn Cytopathol 2021; 49:E336-E339. [PMID: 33945666 DOI: 10.1002/dc.24755] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2020] [Revised: 03/23/2021] [Accepted: 04/13/2021] [Indexed: 11/10/2022]
Abstract
Histiocytes containing multiple needle-shaped eosinophilic crystals visualized in a peritoneal fluid sample during evaluation of a patient for liver transplantation led to the diagnosis of unsuspected IgA kappa myeloma. Crystal-storing histiocytosis is a rare phenomenon typically associated with multiple myeloma and B-cell lymphoproliferative disorders. It can involve almost any anatomic site and can occasionally be seen in body fluid samples.
Collapse
Affiliation(s)
- Fatima Hamadeh
- Department of Pathology and Laboratory Medicine, Cleveland Clinic, Cleveland, Ohio, USA
| | - Mitchell R Smith
- Hematology and Medical Oncology, George Washington University Katzen Cancer Research Center, Washington, District of Columbia, USA
| | - Eric D Hsi
- Department of Pathology, Wake Forest Baptist Health, Winston-Salem, North Carolina, USA
| |
Collapse
|
17
|
Wiese-Hansen H, Leh F, Lodvir Hemsing A, Reikvam H. Immunoglobulin-Storing Histiocytosis: A Case Based Systemic Review. J Clin Med 2021; 10:jcm10091834. [PMID: 33922555 PMCID: PMC8122927 DOI: 10.3390/jcm10091834] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2021] [Revised: 04/16/2021] [Accepted: 04/19/2021] [Indexed: 11/29/2022] Open
Abstract
Crystal-storing histiocytosis (CSH) is a rare event in disorders associated with monoclonal gammopathy and is mostly associated with the accumulation of immunoglobulins (Igs) in the cytoplasm of histiocytes. In this article, we present a case of a 75-year-old female with IgG kappa monoclonal gammopathy of undetermined significance (MGUS) and signs of a non-crystallized version of immunoglobulin-storing histiocytosis (IgSH) in a vertebra corpus. Furthermore, we performed a literature review based on all cases of storing histiocytosis identified by literature search between 1987 and 2020 and identified 140 cases in total. The median age at diagnosis was 60 years (range 18–91), with an equal sex distribution (51% men). The majority of the patients had an underlying neoplastic B-cell disorder, most often multiple myeloma (MM), MGUS, or lymphoplasmacytic lymphoma (LPL). The main affected organ systems or tissue sites were bone (n = 52), followed by head and neck (n = 31), kidney (n = 23), lung (n = 20), and gastrointestinal (GI)-tract (n = 18). IgG was the main immunoglobulin class involved, and most cases were associated with kappa light chain expression. We conclude that IgSH is a rare disease entity but should be considered with unusual findings in several organ systems associated with monoclonal gammopathy, especially with kappa light chain expression.
Collapse
Affiliation(s)
- Hanne Wiese-Hansen
- Institute of Clinical Science, Faculty of Medicine University of Bergen, N-5021 Bergen, Norway; (H.W.-H.); (A.L.H.)
| | - Friedemann Leh
- Department of Pathology, Haukeland University Hospital, N-5021 Bergen, Norway;
| | - Anette Lodvir Hemsing
- Institute of Clinical Science, Faculty of Medicine University of Bergen, N-5021 Bergen, Norway; (H.W.-H.); (A.L.H.)
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
| | - Håkon Reikvam
- Institute of Clinical Science, Faculty of Medicine University of Bergen, N-5021 Bergen, Norway; (H.W.-H.); (A.L.H.)
- Department of Medicine, Haukeland University Hospital, N-5021 Bergen, Norway
- Correspondence:
| |
Collapse
|
18
|
Braunstein MJ, Petrova-Drus K, Rosenbaum CA, Jayabalan DS, Rossi AC, Salvatore S, Rech K, Pearse RN, Hassane DC, Postley J, Jhanwar YS, Geyer JT, Niesvizky R. Plasma Cell Myeloma Presenting With Amyloid-Laden Crystal-Negative Histiocytosis. Am J Clin Pathol 2020; 154:767-775. [PMID: 32705137 DOI: 10.1093/ajcp/aqaa095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Crystal-storing histiocytosis (CSH) is rare in plasma cell dyscrasias, with only 3 cases reported in the setting of amyloid. No cases of crystal-negative histiocytosis coincident with multiple myeloma and amyloidosis have been reported previously. METHODS A 58-year-old woman presented with pain due to destructive bone lesions and was found to have plasma cell myeloma (PCM) and marrow amyloid deposition associated with crystal-negative histiocytosis. Differential diagnoses included Langerhans cell histiocytosis, Erdheim-Chester disease, and Rosai Dorfman disease. BRAF mutations were negative, and there was no evidence of paraprotein crystals, arguing against typical CSH. RESULTS The patient was treated with bortezomib, cyclophosphamide, and dexamethasone, and she subsequently underwent autologous stem cell transplant and ixazomib maintenance. She achieved complete remission with improvement of her symptoms and preserved remission after following up at 60 months. CONCLUSIONS We describe a case of crystal-negative histiocytosis associated with PCM. CSH is a rare disorder associated with paraprotein-producing conditions in which immunoglobulins aggregate as intracellular crystals in the lysosomes of organ-specific phagocytic macrophages. Light chain tropism in PCM can also lead to the development of amyloid deposition in organs and, in rare cases, is associated with light chain aggregation as intracellular crystals in macrophages.
Collapse
Affiliation(s)
- Marc J Braunstein
- Department of Medicine, Division of Oncology-Hematology, NYU Long Island School of Medicine, NYU Winthrop Hospital, Mineola, NY
| | | | - Cara A Rosenbaum
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - David S Jayabalan
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Adriana C Rossi
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Steven Salvatore
- Department of Medicine, Division of Nephrology, Weill Cornell Medicine, New York, NY
| | - Karen Rech
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN
| | - Roger N Pearse
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - Duane C Hassane
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| | - John Postley
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Yuliya S Jhanwar
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Julia T Geyer
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY
| | - Ruben Niesvizky
- Department of Medicine, Division of Hematology and Medical Oncology, Weill Cornell Medicine, New York, NY
| |
Collapse
|
19
|
Gibier JB, Colombat M, Grardel N, de Charette M, Ouennoure O, Akkad R, Copin MC. An 80-Year-Old Woman With a Solitary Pulmonary Nodule. Chest 2020; 157:e85-e89. [PMID: 32145822 DOI: 10.1016/j.chest.2019.10.056] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Revised: 09/13/2019] [Accepted: 10/06/2019] [Indexed: 11/19/2022] Open
Abstract
CASE PRESENTATION An 80-year-old-woman was referred for evaluation of chest pain that appeared after providing care at home for her sick husband, which included helping him to get up and move about. The pain was initially triggered by lifting heavy objects but then became constant, without exacerbating or relieving factors. The pain was located in the left hemithorax and was not associated with shortness of breath or cough. Because the patient did not feel any better after a month, her general practitioner ordered a radiograph, which revealed a suspicious pulmonary nodule in the left upper lobe. She was a lifelong nonsmoker and denied any drug abuse. She had not been professionally exposed to lung carcinogens. She had a medical history of type 2 diabetes, ischemic cardiomyopathy, and renal artery stenosis. Her father died of lung cancer. She resided in Lille, France, and did not report any recent travel.
Collapse
MESH Headings
- Aged, 80 and over
- Chest Pain
- Female
- Histiocytosis/complications
- Histiocytosis/diagnosis
- Histiocytosis/pathology
- Humans
- Immunoglobulin kappa-Chains/genetics
- Immunoglobulin kappa-Chains/immunology
- Inclusion Bodies/immunology
- Inclusion Bodies/ultrastructure
- Lung Neoplasms/complications
- Lung Neoplasms/diagnosis
- Lung Neoplasms/pathology
- Lung Neoplasms/surgery
- Lymphoma, B-Cell, Marginal Zone/complications
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/pathology
- Lymphoma, B-Cell, Marginal Zone/surgery
- Lysosomes/ultrastructure
- Microscopy, Electron
- Positron-Emission Tomography
- Solitary Pulmonary Nodule/diagnosis
- Solitary Pulmonary Nodule/pathology
- Solitary Pulmonary Nodule/surgery
- Thoracic Surgery, Video-Assisted
- Tomography, X-Ray Computed
Collapse
Affiliation(s)
- Jean-Baptiste Gibier
- Pathology Department, Centre de Biologie Pathologie, University of Lille, CHU Lille, Lille, France.
| | - Magali Colombat
- Pathology Department, Institut Universitaire du Cancer, Toulouse, France
| | - Nathalie Grardel
- Laboratory Hematology, Centre de Biologie Pathologie, University of Lille, CHU Lille, Lille, France
| | - Marie de Charette
- Hematology Department, Hôpital Claude Huriez, University of Lille, CHU Lille, Lille, France
| | - Ophélie Ouennoure
- Pneumology Department, Groupe Hospitalier Seclin Carvin, Seclin, France
| | - Rias Akkad
- Thoracic Surgery, Hôpital Claude Huriez, University of Lille, CHU Lille, Lille, France
| | - Marie-Christine Copin
- Pathology Department, Centre de Biologie Pathologie, University of Lille, CHU Lille, Lille, France
| |
Collapse
|
20
|
Pathophysiology and management of monoclonal gammopathy of renal significance. Blood Adv 2020; 3:2409-2423. [PMID: 31409583 DOI: 10.1182/bloodadvances.2019031914] [Citation(s) in RCA: 37] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 05/09/2019] [Indexed: 12/17/2022] Open
Abstract
Recent years have witnessed a rapid growth in our understanding of the pathogenic property of monoclonal proteins. It is evident that some of these small monoclonal proteins are capable of inducing end-organ damage as a result of their intrinsic physicochemical properties. Hence, an umbrella term, monoclonal gammopathy of clinical significance (MGCS), has been coined to include myriad conditions attributed to these pathogenic proteins. Because kidneys are the most commonly affected organ (but skin, peripheral nerves, and heart can also be involved), we discuss MGRS exclusively in this review. Mechanisms of renal damage may involve direct or indirect effects. Renal biopsy is mandatory and demonstration of monoclonal immunoglobulin in kidney, along with the corresponding immunoglobulin in serum or urine, is key to establish the diagnosis. Pitfalls exist at each diagnostic step, and a high degree of clinical suspicion is required to diagnose MGRS. Recognition of MGRS by hematologists and nephrologists is important, because timely clone-directed therapy improves renal outcomes. Autologous stem cell transplant may benefit selected patients.
Collapse
|
21
|
Contejean A, Larousserie F, Bouscary D, Dohan A, Deau-Fischer B, Szwebel TA, Dhooge M, Terris B, Vignon M. A colonic mass revealing a disseminated crystal storing histiocytosis secondary to indolent multiple myeloma: a case report with literature review. BMC Gastroenterol 2020; 20:239. [PMID: 32736600 PMCID: PMC7395414 DOI: 10.1186/s12876-020-01364-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/02/2020] [Indexed: 02/01/2023] Open
Abstract
Background Crystal storing histiocytosis is a rare disorder associated with monoclonal gammopathy. In this disease, monoclonal heavy and light chains accumulate in the lysosome of macrophages, leading to histiocytic reaction in different organs. It is secondary to the presence of a small B-cell clone, responsible for monoclonal immunoglobulin production. Histological diagnosis is a challenge and differential diagnoses include fibroblastic and histiocytic neoplasm. Clinical manifestations depend on the involved organs, rarely including peritoneum or digestive tract. Case presentation We present a case of a 75-year-old with a medical history of colonic carcinoma. She presented with abdominal pain and inflammatory syndrome revealing a colonic mass. Hemicolectomy was performed. Initial diagnosis was fibroblastic tumour. The patient worsened, and diagnosis of a diffuse crystal storing histiocytosis was finally done. Haematological exploration found an indolent IgG-kappa multiple myeloma. The initial treatment with conventional chemotherapy did not permit an improvement of the patient condition. Immunotherapy with anti-CD38 monoclonal antibody (daratumumab) was proposed with a clinical and biological response. Conclusion This case report emphasizes the histopathological challenge of histiocytic tumours which may involve digestive track. It focuses on the concept of monoclonal gammopathy of clinical significance, which can have a large spectrum of manifestations.
Collapse
Affiliation(s)
- Adrien Contejean
- Haematology Department, AP-HP, Cochin University Hospital, 27 rue du Faubourg Saint Jacques, Paris, France.,Paris University, Paris, France
| | - Frédérique Larousserie
- Paris University, Paris, France.,Pathology Department, AP-HP, Cochin University Hospital, Paris, France
| | - Didier Bouscary
- Haematology Department, AP-HP, Cochin University Hospital, 27 rue du Faubourg Saint Jacques, Paris, France.,Paris University, Paris, France
| | - Anthony Dohan
- Paris University, Paris, France.,Radiology A Department, AP-HP, Cochin University Hospital, Paris, France
| | - Bénédicte Deau-Fischer
- Haematology Department, AP-HP, Cochin University Hospital, 27 rue du Faubourg Saint Jacques, Paris, France
| | - Tali-Anne Szwebel
- Internal medicine Department, AP-HP, Cochin University Hospital, Paris, France
| | - Marion Dhooge
- Gastroenterology Department, AP-HP, Cochin University Hospital, Paris, France
| | - Benoit Terris
- Paris University, Paris, France.,Pathology Department, AP-HP, Cochin University Hospital, Paris, France
| | - Marguerite Vignon
- Haematology Department, AP-HP, Cochin University Hospital, 27 rue du Faubourg Saint Jacques, Paris, France. .,Paris University, Paris, France.
| |
Collapse
|
22
|
Zuo C, Zhu Y, Xu G. An update to the pathogenesis for monoclonal gammopathy of renal significance. Crit Rev Oncol Hematol 2020; 149:102926. [PMID: 32199132 DOI: 10.1016/j.critrevonc.2020.102926] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2019] [Revised: 12/20/2019] [Accepted: 03/02/2020] [Indexed: 11/24/2022] Open
Abstract
Monoclonal gammopathy of renal significance (MGRS) is characterized by the nephrotoxic monoclonal immunoglobulin (MIg) secreted by an otherwise asymptomatic or indolent B-cell or plasma cell clone, without hematologic criteria for treatment. The spectrum of MGRS-associated disorders is wide, including non-organized deposits or inclusions such as C3 glomerulopathy with monoclonal glomerulopathy (MIg-C3G), monoclonal immunoglobulin deposition disease, proliferative glomerulonephritis with monoclonal immunoglobulin deposits and organized deposits like immunoglobulin related amyloidosis, type I and type II cryoglobulinaemic glomerulonephritis, light chain proximal tubulopathy, and so on. Kidney biopsy should be conducted to identify the exact disease associated with MGRS. These MGRS-associated diseases can involve one or more renal compartments, including glomeruli, tubules and vessels. Hydrophobic residues replacement, N-glycosylated, increase in isoelectric point in MIg causes it to transform from soluble form to tissue deposition, causing glomerular damage. Complement deposition is found in MIg-C3G, which is caused by an abnormality of the alternative pathway and may involve multiple factors including complement component 3 nephritic factor, anti-complement factor auto-antibodies or MIg which directly cleaves C3. The effect of transforming growth factor beta and platelet-derived growth factor-β on mesangial extracellular matrix is associated with glomerular and tubular basement membrane thickening, nodular glomerulosclerosis, and interstitial fibrosis. Furthermore, inflammatory factors, growth factors and virus infection may play an important role in the development of the diseases. In this review, for the first time, we discussed current highlights in the mechanism of MGRS-related lesions.
Collapse
Affiliation(s)
- Chao Zuo
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang, China; Grade 2016, the Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Yuge Zhu
- Grade 2016, the First Clinical Medical College of Nanchang University, Nanchang, China
| | - Gaosi Xu
- Department of Nephrology, the Second Affiliated Hospital of Nanchang University, Nanchang, China.
| |
Collapse
|
23
|
An update to the pathogenesis for monoclonal gammopathy of renal significance. Ann Hematol 2020; 99:703-714. [PMID: 32103323 DOI: 10.1007/s00277-020-03971-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2019] [Accepted: 02/18/2020] [Indexed: 01/16/2023]
Abstract
Monoclonal gammopathy of renal significance (MGRS) is characterized by the nephrotoxic monoclonal immunoglobulin secreted by an otherwise asymptomatic or indolent B cell or plasma cell clone, without hematologic criteria for treatment. These MGRS-associated diseases can involve one or more renal compartments, including glomeruli, tubules, and vessels. Hydrophobic residue replacement, N-glycosylated, increase in isoelectric point in monoclonal immunoglobulin (MIg) causes it to transform from soluble form to tissue deposition, and consequently resulting in glomerular damage. In addition to MIg deposition, complement deposition is also found in C3 glomerulopathy with monoclonal glomerulopathy, which is caused by an abnormality of the alternative pathway and may involve multiple factors including complement component 3 nephritic factor, anti-complement factor auto-antibodies, or MIg which directly cleaves C3. Furthermore, inflammatory factors, growth factors, and virus infection may also participate in the development of the diseases. In this review, for the first time, we discussed current highlights in the mechanism of MGRS-related lesions.
Collapse
|
24
|
Riefolo M, Malvi D, Bertuzzi C, Sabattini E, Valente S, Pasquinelli G, D'Errico A, Vasuri F. Intrahepatocellular crystal storing mimicking a clinical liver disease during monoclonal gammopathy: report of a case and review of the literature. Ultrastruct Pathol 2020; 44:153-157. [PMID: 32041459 DOI: 10.1080/01913123.2020.1725697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
We present an unusual case of liver involvement in monoclonal gammopathy with generalized crystal-storing histiocytosis (G-CSH).A bone marrow storage disease was diagnosed in a 79-year-old man with monoclonal gammopathy of uncertain significance (MGUS). The patient presented with pleural effusion, an osteolytic lesion of the humerus, and an increase of aspartate transaminase and cholestatic markers that raised the clinical suspect of liver disease. A second bone marrow biopsy confirmed the diagnosis of MGUS with a histiocytic component suggestive for G-CSH.Liver biopsy showed an unremarkable histology, no significant inflammatory infiltrates, and intrasinusoidal foamy histiocytes. PAS and Masson's trichrome stains, showed, in the cytoplasm of both histiocytes and hepatocytes, rod-shaped eosinophilic crystals, which were immunoreactive for kappa light chains. Transmission electron microscopy performed on reprocessed histological sections confirmed the presence of crystals in the hepatocyte cytoplasms. Immunogold labeling intensely stained crystals for kappa light chains.To the best of our knowledge, this is the second case in which an intrahepatocellular crystal storage is described during liver involvement in G-CSH. The present case also suggests that an increase in liver serum enzymes may support the clinical diagnosis of liver CSH in a patient with MGUS.
Collapse
Affiliation(s)
- Mattia Riefolo
- Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Deborah Malvi
- Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Clara Bertuzzi
- Hematopathology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Elena Sabattini
- Hematopathology Unit, Department of Hematology and Oncology, S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Sabrina Valente
- Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Gianandrea Pasquinelli
- Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Antonia D'Errico
- Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| | - Francesco Vasuri
- Pathology Unit, Department of Experimental, Diagnostic and Specialty Medicine (DIMES), S. Orsola-Malpighi Hospital, Bologna University, Bologna, Italy
| |
Collapse
|
25
|
Reeders J, Arnold C, Chen J, Kirwan P, Lynnhtun K. Crystal-storing histiocytosis leading to the identification of IgG-kappa secreting lymphoplasmacytic lymphoma with crystalline nephropathy. Pathology 2019; 52:283-286. [PMID: 31883675 DOI: 10.1016/j.pathol.2019.11.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 11/10/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jocelyn Reeders
- Department of Anatomical Pathology, John Hunter Hospital, NSW, Australia
| | - Colin Arnold
- Department of Anatomical Pathology, Tweed Heads Hospital, NSW, Australia
| | - Jason Chen
- Department of Anatomical Pathology, Royal North Shore Hospital, NSW, Australia
| | - Paul Kirwan
- Electron Microscopy Unit, Department of Anatomical Pathology, Concord Hospital, NSW, Australia
| | - Kyaw Lynnhtun
- Department of Anatomical Pathology, John Hunter Hospital, NSW, Australia.
| |
Collapse
|
26
|
Wang Y, Camelo-Piragua S, Abdullah A, Ibrahim M, Parmar HA. Neuroimaging features of CNS histiocytosis syndromes. Clin Imaging 2019; 60:131-140. [PMID: 31874337 DOI: 10.1016/j.clinimag.2019.10.001] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 10/01/2019] [Accepted: 10/07/2019] [Indexed: 01/24/2023]
Abstract
Histiocytosis syndromes (HS) are group of heterogeneous disorders characterized by abnormal accumulation and infiltration of histiocytes, cells derived from hematopoietic cells of monocyte/macrophage lineage. Overall these disorders are rare. When they do occur they involve many organ systems including the central nervous system (CNS). While imaging findings can provide important clues, diagnosis of this disorder is challenging and definitive diagnosis often necessitates pathologic examination. In this review, we describe imaging features of HS involving the CNS, with the aim to increase our understanding of these disorders. The entities discussed in this review will include: Langerhans cell histiocytosis (LCH), Rosai-Dorfman Disease (RDD), Erdheim Chester Disease (ECD), hemophagocytic lymphohistiocytosis (HLH), and crystal-storing histiocytosis (CSH).
Collapse
Affiliation(s)
- Yuting Wang
- Department of Radiology, Sichuan Academy of Medical Sciences and Sichuan Provincial People's Hospital, Chengdu, China; Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Sandra Camelo-Piragua
- Department of Pathology, University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Asif Abdullah
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Mohannad Ibrahim
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States of America
| | - Hemant A Parmar
- Department of Radiology, University of Michigan Health System, Ann Arbor, MI, United States of America.
| |
Collapse
|
27
|
Gupta RK, Rosenberg AZ, Bagnasco SM, Arend LJ. Renal crystal-storing histiocytosis involving glomeruli - A comprehensive clinicopathologic analysis. Ann Diagn Pathol 2019; 43:151403. [PMID: 31494491 DOI: 10.1016/j.anndiagpath.2019.151403] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 08/28/2019] [Indexed: 11/28/2022]
Abstract
Crystal-storing histiocytosis (CSH) is a rare manifestation of monoclonal gammopathy in which histiocytes containing monoclonal proteins in their cytoplasm are found in various organs of the body including the kidney. Within the kidney, these monoclonal crystal-laden histiocytes have been described to occur in the interstitium (most commonly) or in the glomerular mesangium. CSH within glomerular capillary loops has rarely been reported. We describe three cases of CSH primarily affecting the glomerular capillaries and review the literature of CSH in general. Twenty cases of CSH involving the kidney are present in the literature; three describe CSH in glomeruli, only one of which showed histiocytes predominantly in glomerular capillary loops, while 15 had predominantly or solely interstitial CSH. Most cases involve IgG kappa crystals with only one case involving lambda light chain. Patients with CSH predominantly involving the glomerular capillaries showed a trend toward lower serum creatinine and proteinuria at presentation, and several patients with CSH lacked a definitive diagnosis of a monoclonal gammopathy at the time of diagnosis, emphasizing the role that kidney biopsy and particularly electron microscopy play in diagnosis of this entity.
Collapse
Affiliation(s)
- Rajib K Gupta
- Renal Pathology, Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Avi Z Rosenberg
- Renal Pathology, Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Serena M Bagnasco
- Renal Pathology, Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, MD 21287, USA
| | - Lois J Arend
- Renal Pathology, Department of Pathology, Johns Hopkins University and Johns Hopkins Hospital, Baltimore, MD 21287, USA.
| |
Collapse
|
28
|
Tao Q, Zhang W, Chen Z, Gao L, Yan J, Wang M, Xiang C, Liu W. Generalized crystal-storing histiocytosis with diffuse large B-cell lymphoma and monoclonal gammopathy in a Chinese elderly woman: a case report. BMC Cancer 2019; 19:514. [PMID: 31142285 PMCID: PMC6542005 DOI: 10.1186/s12885-019-5734-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Accepted: 05/20/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Crystal-storing histiocytosis (CSH) is a rare lesion characterized by sheets of crystal-laden non-neoplastic histiocytes. CSH shows a prominent association with lymphoproliferative disorders that express monoclonal immunoglobulins, mainly multiple myeloma (MM), lymphoplasmacytic lymphoma (LPL) and monoclonal gammopathy of undetermined significance (MGUS). However, no aggressive B cell lymphoma has been reported to be associated with CSH. CASE PRESENTATION A 74-year-old Chinese woman presented with multiple subcutaneous masses, abdominal pain, and fever. An IgM kappa type of monoclonal gammopathy (MG) was noted by immunofixation performed on the patient's serum. Computed tomographic (CT) scan revealed subcutaneous masses on the left upper arm and at the waist and multiple low-density lesions in the spleen. Microscopically, sections of subcutaneous masses revealed sheets of large polygonal and spindle cells with abundant eosinophilic cytoplasm, round to ovoid eccentric nuclei, reticulate chromatin, and median nucleoli. Massive needle-shaped crystals were confined to the cytoplasm. Immunohistochemically, these crystal-containing cells were positive for CD68/PGM1, CD163, IgM, and Igκ. Meanwhile, the splenic tumour was diagnosed as diffuse large B-cell lymphoma (DLBCL), non-germinal-centre B (non-GCB) subtype (Hans algorithm). Immunohistochemistry for IgM was positive in the cytoplasm of some neoplastic cells. Immunoglobulin heavy chain (IgH) gene rearrangement was detected by PCR analysis of the subcutaneous mass and the splenic tumour. CONCLUSION To the best of our knowledge, this is the first case of generalized CSH with DLBCL and MG. Although the rarity of CSH and separate locations of CSH and lymphoma led to a diagnostic dilemma, the presence of MG was a clue to appreciate the relation between CSH and DLBCL. This case stressed a full investigation into the underlying lymphoproliferative disorder for integrated diagnosis and correct treatments.
Collapse
Affiliation(s)
- Qing Tao
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Wenyan Zhang
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Zihang Chen
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Limin Gao
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Jiaqi Yan
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Mi Wang
- Department of Dermatology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Chunxiang Xiang
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China
| | - Weiping Liu
- Department of Pathology, West China Hospital, Sichuan University, No. 37 Guoxue Alley, Chengdu, 610041, Sichuan, China.
| |
Collapse
|
29
|
Two Cases of Crystal-storing Histiocytosis Diagnosed by Morphology, Immunohistochemistry, and Ultrastructural Examination. Appl Immunohistochem Mol Morphol 2019; 29:e1-e4. [PMID: 31135447 DOI: 10.1097/pai.0000000000000765] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Crystal-storing histiocytosis (CSH) is a non-neoplastic histiocytic proliferation containing crystalline material, usually associated with an underlying lymphoproliferative or plasmacytic disorder. The crystalline structures are typically derived from kappa light chain immunoglobulins. The lesions of CSH are comprised of sheets of histiocytes with abundant eosinophilic cytoplasm containing variably prominent, elongated crystals. This rare phenomenon is important to recognize, as it is known to morphologically obscure an underlying neoplasm. Histologically, the cells of CSH may closely mimic Gaucher cells, as well as the "pseudo-Gaucher" cells sometimes encountered in chronic myeloid leukemia. The distinction between the cells of CSH and that of histologic mimics may be made more definitively through the use of electron microscopy, as the crystalline inclusions seen in CSH display characteristic size, shape, and localization within the cells. Here, we report 2 rare cases of CSH diagnosed by morphology, immunohistochemistry, and ultrastructural examination. The first case presented was diagnosed concurrently with plasma cell myeloma, and the second case discussed was diagnosed in association with marginal zone lymphoma.
Collapse
|
30
|
Crystalglobulin-Induced Nephropathy: Unusual Presentation in a Patient With Seronegative Rheumatoid Arthritis and Leukocytoclastic Vasculitis. Kidney Int Rep 2019; 4:1190-1193. [PMID: 31440711 PMCID: PMC6698289 DOI: 10.1016/j.ekir.2019.04.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 04/26/2019] [Accepted: 04/29/2019] [Indexed: 11/24/2022] Open
|
31
|
Galeano-Valle F, Díaz-Crespo FJ, Melero-Martín R, Apaza-Chávez JE, Del-Toro-Cervera J, Demelo-Rodríguez P. Massive generalized crystal-storing histiocytosis associated with extracellular crystalline nephropathy: clinical, immunohistochemical, and ultrastructural studies of a unique disorder and review of the literature. CEN Case Rep 2019; 8:166-172. [PMID: 30712253 DOI: 10.1007/s13730-019-00385-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Accepted: 01/29/2019] [Indexed: 11/26/2022] Open
Abstract
Crystal-storing histiocytosis (CSH) is a rare disorder characterized by the accumulation of nonneoplastic histiocytes containing intracytoplasmic crystallized immunoglobulins. In most cases, there is an associated underlying lymphoplasmacytic neoplasm expressing Ig kappa light chain. About 131 cases of CSH have been identified. There is a localized and a generalized form of CSH and it can involve several sites including bone marrow, lungs, lymph nodes, liver, spleen, gastrointestinal tract, and kidney. Generalized CSH is less frequent and involves multiple organs and tends to have a worst prognosis than localized CSH. Around 20 cases of renal involvement in CSH have been reported so far. Paraprotein-induced crystalline nephropathy can be divided into two categories based on whether the crystals in the kidney are intracellular (including light chain proximal tubulopathy with crystals and CSH) or extracellular (including the crystalline variant of myeloma cast nephropathy and crystalglobulin-induced nephropathy). The former tends to present with slowly worsening kidney dysfunction and generally has a good prognosis, whereas the latter usually presents with rapidly progressive renal failure and is associated with poor renal outcome. We present a case of generalized CSH associated with extracellular crystalline nephropathy with a fulminant and fatal clinical course. Kappa light-chain crystals were found exclusively extracellularly within the tubular lumen, not within the tubular epithelial cells nor the histiocytes, and the massive presence of those precipitates led to the acute renal failure. Consequently, we review the renal involvement in CSH in the literature and discuss the unique mechanism of renal injury in this case.
Collapse
Affiliation(s)
- Fransico Galeano-Valle
- Deparment of Internal Medicine, Hospital General Universitario Gregorio Marañón, C/. Doctor Esquerdo, 46, 28007, Madrid, Spain.
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain.
| | - F J Díaz-Crespo
- Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - R Melero-Martín
- Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J E Apaza-Chávez
- Department of Pathology, Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - J Del-Toro-Cervera
- Deparment of Internal Medicine, Hospital General Universitario Gregorio Marañón, C/. Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| | - P Demelo-Rodríguez
- Deparment of Internal Medicine, Hospital General Universitario Gregorio Marañón, C/. Doctor Esquerdo, 46, 28007, Madrid, Spain
- Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Madrid, Spain
| |
Collapse
|
32
|
Ito K, Hara S, Yamada K, Zoshima T, Mizushima I, Fujii H, Miyazaki R, Kawai Y, Yachie A, Nagata M, Izui S, Yamagishi M, Kawano M. A case report of crystalline light chain inclusion-associated kidney disease affecting podocytes but without Fanconi syndrome: A clonal analysis of pathological monoclonal light chain. Medicine (Baltimore) 2019; 98:e13915. [PMID: 30702553 PMCID: PMC6380839 DOI: 10.1097/md.0000000000013915] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
RATIONALE Crystalline light chain inclusion-associated kidney disease affects mainly tubular epithelial cells and is often clinically manifested as Fanconi syndrome. However, only very few case reports about the crystalline deposits within the podocytes are available, and the nature of the pathogenic monoclonal light chain implicated in these cases is still unknown. We report a case of crystalline inclusion-associated kidney disease manifested as crystalline podocytopathy in which we identified the complete structure of the pathogenic monoclonal light chain as belonging to the germ-line gene of Vκ1-39. PATIENT CONCERNS We describe a 65-year-old woman with crystalline light chain inclusion-associated kidney disease showing mild proteinuria and renal insufficiency with monoclonal gammopathy of undetermined significance without Fanconi syndrome. She had crystalline inclusions mainly within podocytes, tubular epithelial cells and histiocytes in the kidney. Light microscopy showed vacuolation of podocytes and tubular epithelial cells, while eosin negative pale needle-like crystals were present within these cells. Electron microscopy showed accumulation of club-like crystals with high electron density in podocytes, proximal tubular epithelial cells and interstitial histiocytes. Clonal analysis revealed that a pathogenic monoclonal light chain was derived from germline gene, Vκ1-39. DIAGNOSES The diagnosis of crystalline light chain inclusion-associated kidney disease was made. INTERVENTIONS AND OUTCOMES Bortezomib and dexamethasone were started and her renal function improved to eGFR 36 mL/min/1.73 m after 9 courses of therapy. LESSONS Patients with light chain crystalline podocytopathy may have a similar pathogenic monoclonal light chain derived from the same germline gene, Vκ1-39, to that of patients with light chain proximal tubulopathy.
Collapse
Affiliation(s)
- Kiyoaki Ito
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa
| | - Satoshi Hara
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa
| | - Kazunori Yamada
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa
| | - Takeshi Zoshima
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa
| | - Ichiro Mizushima
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa
| | - Hiroshi Fujii
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa
| | | | - Yasukazu Kawai
- Department of Hematology and Oncology, Fukui Prefectural Hospital, Fukui
| | - Akihiro Yachie
- Department of Pediatrics, Kanazawa University Graduate School of Medicine, Kanazawa
| | - Michio Nagata
- Department of Kidney and Vascular Pathology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan
| | - Shozo Izui
- Department of Pathology and Immunology, University Medical Center, University of Geneva, Switzerland
| | - Masakazu Yamagishi
- Division of Cardiology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Mitsuhiro Kawano
- Division of Rheumatology, Department of Internal Medicine, Kanazawa University Graduate School of Medicine, Kanazawa
| |
Collapse
|
33
|
Michon A, Cohen Aubart F, Haroche J, Charlotte F, Maksud P, Amoura Z. Long-bones involvement in generalized crystal-storing histiocytosis. Joint Bone Spine 2019; 86:652-653. [PMID: 30685538 DOI: 10.1016/j.jbspin.2019.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2018] [Revised: 10/21/2018] [Accepted: 01/10/2019] [Indexed: 12/31/2022]
Affiliation(s)
- Arthur Michon
- Sorbonne université, assistance publique Hôpitaux de Paris, service de médecine interne 2, institut e3m, hôpital de la Pitié-Salpêtrière, centre national de référence maladies rares histiocytoses, Paris 75013, France
| | - Fleur Cohen Aubart
- Sorbonne université, assistance publique Hôpitaux de Paris, service de médecine interne 2, institut e3m, hôpital de la Pitié-Salpêtrière, centre national de référence maladies rares histiocytoses, Paris 75013, France.
| | - Julien Haroche
- Sorbonne université, assistance publique Hôpitaux de Paris, service de médecine interne 2, institut e3m, hôpital de la Pitié-Salpêtrière, centre national de référence maladies rares histiocytoses, Paris 75013, France
| | - Frédéric Charlotte
- Assistance publique Hôpitaux de Paris, service d'anatomopathologie, hôpital de la Pitié-Salpêtrière, 75013 Paris, France
| | - Philippe Maksud
- Assistance publique Hôpitaux de Paris, département de médecine nucléaire, hôpital de la Pitié-Salpêtrière, Paris 75013, France
| | - Zahir Amoura
- Sorbonne université, assistance publique Hôpitaux de Paris, service de médecine interne 2, institut e3m, hôpital de la Pitié-Salpêtrière, centre national de référence maladies rares histiocytoses, Paris 75013, France
| |
Collapse
|
34
|
Tomsula J, Meis JM, Koy RD, Monheit J, Zieske A, Ro J, Ayala A. Crystal storing histiocytosis: Unusual clinical presentations in two patients. Ann Diagn Pathol 2019; 40:13-17. [PMID: 30825790 DOI: 10.1016/j.anndiagpath.2019.01.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2019] [Accepted: 01/15/2019] [Indexed: 11/26/2022]
Affiliation(s)
- Jessica Tomsula
- Houston Methodist Hospital, 6565 Fannin St, M227, Houston, TX 77030, United States of America.
| | - Jeanne M Meis
- MD Anderson, Houston, TX 77030, United States of America
| | - Robert D Koy
- Memorial Hermann Hospital, Katy, TX 77494, United States of America
| | - Jacqueline Monheit
- Catholic Health Initiative St. Luke's Patient Medical Center, Houston, TX 77030, United States of America
| | - Arthur Zieske
- Houston Methodist Hospital, 6565 Fannin St, M227, Houston, TX 77030, United States of America
| | - Jae Ro
- Houston Methodist Hospital, 6565 Fannin St, M227, Houston, TX 77030, United States of America; Weill Medical College of Cornell University, New York, NY 10065, United States of America
| | - Alberto Ayala
- Houston Methodist Hospital, 6565 Fannin St, M227, Houston, TX 77030, United States of America; Weill Medical College of Cornell University, New York, NY 10065, United States of America
| |
Collapse
|
35
|
Boudhabhay I, Titah C, Talbot A, Harel S, Verine J, Touchard G, Kaaki S, Gabison E, Vasseur V, Mauget-Faÿsse M, Sené T. Multiple myeloma with crystal-storing histiocytosis, crystalline podocytopathy, and light chain proximal tubulopathy, revealed by retinal abnormalities: A case report. Medicine (Baltimore) 2018; 97:e13638. [PMID: 30593133 PMCID: PMC6314660 DOI: 10.1097/md.0000000000013638] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RATIONALE Crystal sorting histiocytosis (CSH) is a rare disorder that is morphologically characterized by the accumulation of monoclonal immunoglobulin crystals, predominantly of a kappa light chain type, within lysosomes of macrophages. CSH may result in a variety of clinical manifestations depending on the involved organs. In this case report, we aim to describe a patient with ophthalmic manifestations which lead to the diagnosis of multiple myeloma with crystal-storing histiocytosis, crystalline podocytopathy, and light chain proximal tubulopathy. PATIENT CONCERNS A 60-year-old male patient presented with progressive bilateral decreased vision for 2 years. DIAGNOSIS Ophthalmic explorations showed bilateral macular and papillary edema, and multiple crystalline deposits in the anterior stromal cornea and in the retina. Laboratory tests showed nephrotic syndrome and renal dysfunction. Further work-up revealed IgG kappa multiple myeloma, with biopsy-proven combined crystalline podocytopathy and tubulopathy. INTERVENTIONS The patient received chemotherapy (bortezomib, cyclophosphamide, and dexamethasone for 3 cycles, then bortezomib, lenalidomide, and dexamethasone). OUTCOMES Despite partial hematologic response and improvement of the papilledema and macular edema, the patient developed dialysis-dependent end-stage renal failure. LESSONS This report, highlighting the protean presentation of paraprotein-mediated injuries, provides additional information on the ocular anomalies not previously described that may be associated with crystal-storing histiocytosis.
Collapse
Affiliation(s)
| | - Chérif Titah
- Department of Ophthalmology, Fondation Ophtalmologique Adolphe de Rothschild
| | - Alexis Talbot
- Department of Immuno-Hematology, Hôpital Saint-Louis
| | | | | | - Guy Touchard
- Department of Pathology, Centre Hospitalier Universitaire de Poitiers, Poitiers
| | - Sihem Kaaki
- Department of Pathology, Centre Hospitalier Universitaire de Poitiers, Poitiers
| | - Eric Gabison
- Department of Ophthalmology, Fondation Ophtalmologique Adolphe de Rothschild
| | - Vivien Vasseur
- Department of Clinical Research, Fondation Ophtalmologique Adolphe de Rothschild
| | | | - Thomas Sené
- Department of Internal Medicine, Fondation Ophtalmologique Adolphe de Rothschild, Paris, France
| |
Collapse
|
36
|
Gastric crystal-storing histiocytosis without any underlying disorders: Report of a case. HUMAN PATHOLOGY: CASE REPORTS 2018. [DOI: 10.1016/j.ehpc.2018.09.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
|
37
|
Flanagan ME, Keene CD, Louis DN, Juric-Sekhar G. Localized crystal-storing histiocytosis of the posterior fossa. Neuropathology 2018; 38:529-534. [PMID: 30066398 DOI: 10.1111/neup.12486] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2018] [Revised: 06/01/2018] [Accepted: 06/01/2018] [Indexed: 11/30/2022]
Abstract
Crystal-storing histiocytosis (CSH) is an uncommon histiocytic proliferation reported to involve diverse organs and tissues, but involvement of the central nervous system (CNS) is rare. In most cases CSH is identified in association with underlying lymphoproliferative, plasma cell diseases or rarely with various inflammatory or infectious conditions. CSH is characterized by the cytoplasmic accumulation of crystalline material in histiocytes, most commonly of kappa immunoglobulin light chain. We report a unique case of localized CSH involving the left cerebellum and caudal brain stem in a young man with a history of gout but without known lymphoproliferative or plasma cell disorders. Awareness of this entity is important diagnostically, but also to ensure appropriate management and follow-up, particularly in the absence of apparent underlying malignancy.
Collapse
Affiliation(s)
| | | | - David N Louis
- Department of Pathology, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts, USA
| | | |
Collapse
|
38
|
Zioni F, Giovanardi P, Bozzoli M, Artusi T, Bonacorsi G, Sighinolfi P. Massive Bone Marrow Crystal-Storing Histiocytosis in a Patient with Iga-Lambda Multiple Myeloma and Extensive Extramedullary Disease. A Case Report. TUMORI JOURNAL 2018; 90:348-51. [PMID: 15315320 DOI: 10.1177/030089160409000318] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
We report a case of multiple myeloma (MM) displaying an unusual course, with metastatic spread in uncommon sites (gastroduodenal and upper respiratory tract, breast, skin and liver) and with a fatal outcome. In our patient this plasma cell neoplasm was associated with a rare condition named crystal-storing histiocytosis (CSH), resulting from the storage in reactive histiocytes of crystalline immunoglobulin inclusions. These crystal-forming paraprotein components are secreted by the neoplastic plasma cells and give rise to the crystalline material of the histiocytes only after their ingestion and degradation by the same histiocytes. In this disorder crystal-storing cells may be present in various tissues (in our case mainly in bone marrow), often with functional alterations of the involved organs. In our opinion the association of this “atypical” MM with CSH is to be considered an uncommon event.
Collapse
Affiliation(s)
- Franco Zioni
- Department of Internal Medicine, Hospital of Vignola, Modena, Italy.
| | | | | | | | | | | |
Collapse
|
39
|
Abstract
Benign and malignant proliferations of histiocytes and dendritic cells may be encountered in lymph nodes. Reactive histiocytic and dendritic cell infiltrates occur in response to diverse stimuli and in addition to causing lymphadenopathy, may be present unexpectedly in lymph nodes excised for other indications. This review summarizes the pathogenesis and histopathological features of the various non-neoplastic histiocytic and dendritic cell infiltrates that can occur in lymph nodes.
Collapse
Affiliation(s)
- Caoimhe Egan
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, United States
| | - Elaine S Jaffe
- Hematopathology Section, Laboratory of Pathology, National Cancer Institute, Bethesda, MD, United States.
| |
Collapse
|
40
|
Alegría-Landa V, Cerroni L, Kutzner H, Requena L. Paraprotein deposits in the skin. J Am Acad Dermatol 2017; 77:1145-1158. [PMID: 28985955 DOI: 10.1016/j.jaad.2017.07.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/19/2017] [Accepted: 07/23/2017] [Indexed: 02/04/2023]
Abstract
Cutaneous manifestations secondary to paraprotein deposits in the skin include a group of different disorders that although rare, may be the first clinical manifestation of the underlying hematologic dyscrasia. In this article we review the clinical manifestations and histopathologic findings of the processes that result from specific deposition of the paraprotein in different structures of the skin. Paraneoplastic processes frequently associated with hematologic malignancies will not be covered in this review. Some of the disorders included here result from deposition of the intact paraprotein in the skin, whereas in other cases the lesions are due to deposition of modified paraproteins in the form of amyloid substance, cryoglobulins, or crystalglobulins. Cutaneous amyloidoma refers to nodular dermal deposits of amyloid derived from immunoglobulin light chains produced by local plasma cells in the absence of systemic amyloidosis. Dermatologists and dermatopathologists should be aware of the clinical and histopathologic features of these rare disorders because sometimes the cutaneous lesions are the first sign of an underlying silent hematologic malignancy with paraproteinemia.
Collapse
Affiliation(s)
| | - Lorenzo Cerroni
- Dermatopathology Research Unit, Medical University of Graz, Graz, Austria
| | - Heinz Kutzner
- Dermatopathologie Friedrichschafen, Friedrichschafen, Germany
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain.
| |
Collapse
|
41
|
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
|
42
|
Kokuho N, Terasaki Y, Kunugi S, Onda N, Urushiyama H, Terasaki M, Hino M, Gemma A, Hatori T, Shimizu A. Localized pulmonary crystal-storing histiocytosis complicating pulmonary mucosa-associated lymphoid tissue lymphoma presenting with multiple mass lesions. Hum Pathol 2017; 65:180-186. [DOI: 10.1016/j.humpath.2016.10.028] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 10/04/2016] [Accepted: 10/14/2016] [Indexed: 10/20/2022]
|
43
|
Uthamalingam P, Mehta S. Crystal-Storing Histiocytosis: Report of a Rare Case Presenting With Pathological Fracture of Femur. Is There More to the Entity? Int J Surg Pathol 2017; 25:458-461. [PMID: 28381142 DOI: 10.1177/1066896917696746] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Crystal-storing histiocytosis (CSH) is a rare histiocytic lesion, most often described in association with lymphoid malignancies, especially plasma cell myeloma or lymphomas associated with monoclonal gammopathy. A few cases have also been described in patients without an underlying lymphoid/plasmacytic neoplasm. The histiocytes are characterized by intralysosomal accumulation of crystals composed of whole or part of the immunoglobulin molecule. The pathobiology is largely unclear. It is a rare phenomenon and the available literature is restricted to case reports and a few case series. We present a case of a 70-year-old gentleman who presented with pathological fracture of left neck of femur secondary to CSH, a presentation so far unreported in the literature. Because of associated clinical features, a plasma cell dyscrasia was suspected and the workup, including bone marrow biopsy, yielded a diagnosis of plasma cell myeloma. Histological examination of the excised femoral head showed near complete replacement of the marrow spaces with sheets of histocytes rich in intracytoplasmic crystals and only occasional plasma cells. The peculiar presentation with pathological fracture of femur in the index case and predominant tumefactive lesions in the cases in the literature might suggest a possible neoplastic origin of this lesion.
Collapse
Affiliation(s)
| | - Sangita Mehta
- 1 Kovai Medical Center and Hospital, Coimbatore, Tamil Nadu, India
| |
Collapse
|
44
|
Balakrishna J, Chen A, Urken M. Crystal storing histiocytosis clinically mimicking metastatic carcinoma: Report of a case and reviews of literature. Head Neck 2015; 38:E95-8. [DOI: 10.1002/hed.24321] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2015] [Revised: 06/22/2015] [Accepted: 09/20/2015] [Indexed: 11/06/2022] Open
Affiliation(s)
- Jayalakshmi Balakrishna
- Department of Pathology; Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai; New York New York
| | - Angela Chen
- Jonathan Edward College; Yale University; New Haven Connecticut
| | - Mark Urken
- Department of Otolaryngology; Head Neck Institute, Mount Sinai Beth Israel, Icahn School of Medicine at Mount Sinai; New York New York
| |
Collapse
|
45
|
Jeon YL, Lee WI, Choi Y, Kang SY, Kim MH, Lim SJ, Lee SH. Crystalloid podocytopathy with focal segmental glomerulosclerosis in PCM: a case report. Diagn Pathol 2015; 10:213. [PMID: 26670310 PMCID: PMC4681144 DOI: 10.1186/s13000-015-0448-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2015] [Accepted: 11/28/2015] [Indexed: 12/16/2022] Open
Abstract
Background Crystalloid podocytopathy with focal segmental glomerulosclerosis in plasma cell myeloma (PCM) is rare. Case Presentation We present a case of crystalline deposition in the bone marrow (BM) and various renal cells with only proteinuria as a symptom. As workup for proteinuria, a renal biopsy sample was obtained. EM showed multiple crystalline depositions in renal tubular cells and podocytes. Focal segmental glomerulosclerosis with crystalloid podocytopathy was diagnosed. Because monoclonal gammopathy was detected in the serum and urine, a BM study was also performed. Plasma cells with needle-shaped inclusion bodies were observed. The crystalline deposits in the plasma cells and podocytes were positive for Masson’s trichrome and kappa light-chain staining. These findings indicated that the crystalline deposits originated from paraprotein. The case showed a rare process of focal segmental glomerulosclerosis via crystalline deposition in podocytes in plasma cell myeloma. Conclusions Crystalloid podocytopathy is a likely cause of renal damage such as FSGS in PCM, although it is an uncommon mechanism for myeloma kidney.
Collapse
Affiliation(s)
- You La Jeon
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea.
| | - Woo In Lee
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea.
| | - Yujin Choi
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea.
| | - So Young Kang
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea.
| | - Myeong Hee Kim
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, 892, Dongnam-ro, Gangdong-gu, Seoul, 134-727, Republic of Korea.
| | - Sung-Jig Lim
- Department of Pathology, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
| | - Sang Ho Lee
- Division of Nephrology, Department of Internal Medicine, School of Medicine, Kyung Hee University and Kyung Hee University Hospital at Gangdong, Seoul, Republic of Korea.
| |
Collapse
|
46
|
Kanagal-Shamanna R, Xu-Monette ZY, Miranda RN, Dogan A, Zou D, Luthra R, Weber DM, O'Malley DP, Jorgensen JL, Khoury JD, Bueso-Ramos CE, Orlowski RZ, Medeiros LJ, Young KH. Crystal-storing histiocytosis: a clinicopathological study of 13 cases. Histopathology 2015; 68:482-91. [PMID: 26118455 DOI: 10.1111/his.12768] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2015] [Accepted: 06/25/2015] [Indexed: 11/29/2022]
Abstract
AIMS Crystal-storing histiocytosis (CSH) is a rare lesion composed of histiocytes with abnormal intralysosomal accumulation of immunoglobulin (Ig) as crystals, reported in patients with plasmacytic/lymphoplasmacytic neoplasms. The aims of this study were to report the clinicopathological features of 13 patients with CSH, and to describe the proteomic composition of the crystals in three cases analysed by mass spectrometry (MS). METHODS AND RESULTS There were seven men and six women, with a median age of 60 years (range, 33-79 years). CSH was generalized in one patient (8%) and localized in 12 (92%) patients, involving various sites. CSH was associated with a low-grade B-cell lymphoma with plasmacytoid differentiation or a plasma cell neoplasm in all cases. In 10 (77%) cases, CSH represented >50% of the neoplastic infiltrate. According to immunohistochemical studies, histiocytes were positive for monotypic kappa in 5 (50%) cases, and for monotypic lambda in 4 (40%) cases; in 1 (10%) case, the results were equivocal. MS analysis of the histiocyte contents in all three tested cases showed a predominance of variable-region fragments of Ig light and/or heavy chains. CONCLUSIONS CSH is frequently associated with an underlying lymphoplasmacytic neoplasm. MS findings suggest that Ig alterations and/or possibly defects in the ability of histiocytes to process Ig play a role in pathogenesis.
Collapse
Affiliation(s)
- Rashmi Kanagal-Shamanna
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Zijun Y Xu-Monette
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Roberto N Miranda
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ahmet Dogan
- Department of Pathology, Memorial Sloan-Kettering Cancer Center, New York, NY, USA
| | - Dehui Zou
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Rajyalakshmi Luthra
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Donna M Weber
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | | | - Jeffrey L Jorgensen
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Joseph D Khoury
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Carlos E Bueso-Ramos
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Robert Z Orlowski
- Department of Lymphoma and Myeloma, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - L Jeffrey Medeiros
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| | - Ken H Young
- Department of Hematopathology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA
| |
Collapse
|
47
|
|
48
|
Aline-Fardin A, Bender S, Fabiani B, Buob D, Brahimi S, Verpont MC, Mothy M, Ronco P, Boffa JJ, Aucouturier P, Garderet L. Pseudo-Peritoneal Carcinomatosis Presentation of a Crystal-Storing Histiocytosis With an Unmutated Monoclonal κ Light Chain. Medicine (Baltimore) 2015; 94:e1247. [PMID: 26266355 PMCID: PMC4616688 DOI: 10.1097/md.0000000000001247] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
Crystal-storing histiocytosis (CSH) is a rare complication of monoclonal gammopathies caused by accumulation of crystalline material inside macrophages, and it may result in a variety of clinical manifestations depending on the involved organs. Although immunoglobulin κ light chains (LCs) seem to be the most frequent pathogenic component, very few molecular data are currently available.A 69-year-old man presented with a very poor performance status. Remarkable features were mesenteric lymph node enlargement and proteinuria, including a monoclonal κ LC. Light and electron microscopy studies revealed the presence of crystals within macrophages in the lymph nodes, bone marrow, and kidney, leading to the diagnosis of CSH. The pathogenic κ LC variable domain sequence was identical to the germline Vk3-2001/Jk201 gene segments, without any somatic mutation, suggesting an extra-follicular B cell proliferation.The patient was successfully treated with 4 cycles of bortezomib and dexamethasone. After a 12-month follow-up, he remains in hematological and renal remission.CSH may present as pseudo-peritoneal carcinomatosis and relate to a monoclonal κ LC encoded by an unmutated gene. Bortezomib-based therapy proved efficacious in this case.
Collapse
Affiliation(s)
- Aude Aline-Fardin
- From the AP-HP (AA-F, BF), Hôpital Saint Antoine, Department of Pathology, Paris; CNRS UMR 7276 Université de Limoges (SB, MCV), Hôpital Universitaire Dupuytren; AP-HP (DB), Hôpital Tenon, Department of Pathology, Paris; Université Pierre et Marie Curie-Paris 6 (DB), Paris; Centre hospitalier de Troyes (SB), Service D'Hématologie; AP-HP (MM), Hôpital Saint-Antoine, Service d'Hématologie Clinique et Thérapie Cellulaire, Paris; Université Pierre & Marie Curie (MM), Paris; INSERM (MM), UMRs, U938, Paris; AP-HP (PR, JJB), Hôpital Tenon, Department of Nephrology and Dialysis, Paris; Sorbonne Universités (PR, JJB), UPMC Univ Paris 06, UMR_S 1155; INSERM (PR, JJB), UMR_S 1155, Paris; INSERM (PA), UMRS 938, Hôpital Saint-Antoine, Paris; Université Pierre et Marie Curie-Paris6 (PA), Hôpital Saint-Antoine, Paris; INSERM (LG), UMR_S 938, Paris; AP-HP (LG), Hôpital Saint Antoine, Département d'hématologie et de thérapie cellulaire, Paris; and Université Pierre et Marie Curie-Paris6 (LG), Paris, France
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
49
|
Baird SM, Kenealy MK, Hoy R. Complete remission of Waldenström's associated generalized crystal-storing histiocytosis of IgM lambda subtype with bortezomib-based combination chemotherapy. Leuk Lymphoma 2015; 56:3233-5. [PMID: 25837422 DOI: 10.3109/10428194.2015.1036261] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Samantha M Baird
- a Faculty of Medicine, Nursing & Health Sciences, Monash University , Melbourne , Australia
| | - Melita K Kenealy
- b Department of Haematology , Cabrini Health , Melbourne , Australia
| | - Ryan Hoy
- c Department of Allergy , Immunology and Respiratory Medicine, Alfred Hospital , Australia
| |
Collapse
|
50
|
Plasma cell morphology in multiple myeloma and related disorders. Morphologie 2015; 99:38-62. [PMID: 25899140 DOI: 10.1016/j.morpho.2015.02.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2014] [Accepted: 02/23/2015] [Indexed: 12/28/2022]
Abstract
Normal and reactive plasma cells (PC) are easy to ascertain on human bone marrow films, due to their small mature-appearing nucleus and large cytoplasm, the latter usually deep blue after Giemsa staining. Cytoplasm is filled with long strands of rough endoplasmic reticulum and one large Golgi apparatus (paranuclear hof), demonstrating that PC are dedicated mainly to protein synthesis and excretion (immunoglobulin). Deregulation of the genome may induce clonal expansion of one PC that will lead to immunoglobulin overproduction and eventually to one among the so-called PC neoplasms. In multiple myeloma (MM), the number of PC is over 10% in most patients studied. Changes in the morphology of myeloma PC may be inconspicuous as compared to normal PC (30-50% patients). In other instances PC show one or several morphological changes. One is related to low amount of cytoplasm, defining lymphoplasmacytoid myeloma (10-15% patients). In other cases (40-50% patients), named immature myeloma cases, nuclear-cytoplasmic asynchrony is observed: presence of one nucleolus, finely dispersed chromatin and/or irregular nuclear contour contrast with a still large and blue (mature) cytoplasm. A peculiar morphological change, corresponding to the presence of very immature PC named plasmablasts, is observed in 10-15% cases. Several prognostic morphological classifications have been published, as mature myeloma is related to favorable outcome and immature myeloma, peculiarly plasmablastic myeloma, is related to dismal prognosis. However, such classifications are no longer included in current prognostic schemes. Changes related to the nucleus are very rare in monoclonal gammopathy of unknown significance (MGUS). In contrast, anomalies related to the cytoplasm of PC, including color (flaming cells), round inclusions (Mott cells, Russell bodies), Auer rod-like or crystalline inclusions, are reported in myeloma cases as well as in MGUS and at times in reactive disorders. They do not correspond to malignant changes of PC but are related to abnormal synthesis, trafficking, or excretion of the immunoglobulin that is stored in excess within the cytoplasm. Occurrence of crystalline inclusions within PC may be the first anomaly leading to the diagnosis of adult Fanconi syndrome. After a historical perspective, the authors report on the various morphological aspects of PC that may occur in multiple myeloma and related disorders, and discuss about their clinical and pathophysiological significance. Today, morphological identification and accurate determination of % PC within bone marrow remain ancillary criteria for the diagnosis of MM and help for the diagnosis of rare renal disorders.
Collapse
|