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Singh AP, Courville EL. Advances in Monitoring and Prognostication for Lymphoma by Flow Cytometry. Clin Lab Med 2023; 43:351-361. [PMID: 37481316 DOI: 10.1016/j.cll.2023.04.010] [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] [Indexed: 07/24/2023]
Abstract
Flow cytometry (FC) is a well-established method important in the diagnosis and subclassification of lymphoma. In this article, the role of FC in lymphoma prognostication will be explored, and the clinical role for FC minimal/measurable residual disease testing as a monitoring tool for mature lymphoma will be introduced. Potential pitfalls of monitoring for residual/recurrent disease following immunotherapy will be presented.
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Affiliation(s)
- Amrit P Singh
- Department of Pathology, University of Virginia Health, PO Box 800214, Charlottesville, VA 22908, USA
| | - Elizabeth L Courville
- Department of Pathology, University of Virginia Health, PO Box 800214, Charlottesville, VA 22908, USA.
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2
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Cook JR, Amador C, Czader M, Duffield A, Goodlad J, Ott G, Xiao W, Dave S, Thakkar D, Thacker E, Dogan A, Wasik M, Nejati R. Transformations of marginal zone lymphomas and lymphoplasmacytic lymphomas: Report from the 2021 SH/EAHP Workshop. Am J Clin Pathol 2023:7143713. [PMID: 37186259 DOI: 10.1093/ajcp/aqad034] [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: 12/05/2022] [Accepted: 03/10/2023] [Indexed: 05/17/2023] Open
Abstract
OBJECTIVES To summarize the conclusions of the 2021 Society for Hematopathology/European Association for Haematopathology workshop regarding transformations of marginal zone lymphoma (MZL) and lymphoplasmacytic lymphoma (LPL). METHODS Nineteen cases were submitted to this portion of the workshop. Additional studies were performed in cases with sufficient material. RESULTS Cases included splenic MZL (n = 4), splenic diffuse red pulp small B-cell lymphoma (n = 2), nodal MZL (n = 4), extranodal MZL (n = 1), and LPL (n = 8). The most common transformation was to diffuse large B-cell lymphoma (DLBCL), but others included classic Hodgkin lymphoma, high-grade B-cell lymphomas with MYC and BCL6 rearrangements, plasmablastic lymphoma, and plasma cell leukemia. Two splenic MZLs with transformation to DLBCL contained t(14;19)(q32;q13.3) IGH::BCL3 rearrangements in both samples. Paired sequencing studies in 5 MZLs with transformation to clonally related DLBCL identified a variety of mutations and gene fusions at the time of transformation, including CARD11, IGH::MYC, NOTCH2, P2RY8, TBLX1X1, and IGH::CD274. CONCLUSIONS Marginal zone lymphoma and LPL may undergo a variety of transformation events, most commonly to DLBCL, which is usually, although not always, directly clonally related to the underlying low-grade lymphoma. Multiparameter analysis including broad-based sequencing studies can assist in the diagnosis and classification of these uncommon cases.
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Affiliation(s)
- James R Cook
- Department of Laboratory Medicine, Robert J. Tomisch Pathology and Laboratory Medicine Institute, Cleveland Clinic, Cleveland, OH, US
| | - Catalina Amador
- Department of Pathology and Laboratory Medicine, University of Miami Miller School of Medicine, Miami, FL, US
| | - Magdalena Czader
- Department of Pathology and Laboratory Medicine, Indiana University School of Medicine, Indianapolis, IN, US
| | - Amy Duffield
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Medical Center, New York, NY, US
| | - John Goodlad
- Department of Pathology, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - German Ott
- Department of Clinical Pathology, Robert-Borsch-Krankenhaus, and Dr. Margarete Fischer-Bosch Institute for Clinical Pharmacology, Stuttgart, Germany
| | - Wenbin Xiao
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Medical Center, New York, NY, US
| | - Sandeep Dave
- Duke University School of Medicine, Durham, NC, US
| | | | | | - Ahmet Dogan
- Department of Pathology and Laboratory Medicine, Memorial Sloan Kettering Medical Center, New York, NY, US
| | - Mariusz Wasik
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, US
| | - Reza Nejati
- Department of Pathology, Fox Chase Cancer Center, Philadelphia, PA, US
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3
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Lymphoplasmacytic lymphoma with IgG or IgA paraprotein: a study of 29 cases including cases that can mimic plasma cell neoplasms. Hum Pathol 2022; 130:47-57. [PMID: 36244464 DOI: 10.1016/j.humpath.2022.10.005] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/06/2022] [Accepted: 10/10/2022] [Indexed: 11/04/2022]
Abstract
Lymphoplasmacytic lymphoma (LPL) with IgG or IgA paraprotein is rare and a subset of cases can mimic a plasma cell neoplasm (PCN). We studied 29 such cases to explore their clinicopathological features and the best diagnostic approaches with a focus on bone marrow findings. The cohort included 18 men and 11 women with a median age of 68 years. The median M protein was 3.1 g/dL, IgG in 19 patients (66%), IgA in 9 (31%), and dual IgG/IgA in 1 (3%). All patients had bone marrow involvement with CD138+ plasma cells (PCs) ranging from 1 to 35% (median, 10%). Two patients also had amyloidosis. Immunoglobulin light chain concordant monotypic PCs and monotypic B cells were identified in 96% of cases assessed by flow cytometry. Notably, the neoplastic PCs were consistently positive for CD45 (dim, 100%), CD19 (96%), CD81 (89%), CD27 (83%), rarely and only weakly or partially express CD56 (16%), whereas CD117 was consistently negative. Eleven cases analyzed by fluorescence in situ hybridization were negative for CCND1::IGH and myeloma-related aberrations. MYD88 mutation was detected in 17 of 24 cases (71%), and CXCR4 mutation was identified in 6 of 19 cases (32%), of which 4 had concurrent MYD88 mutation. In conclusion, the results highlight a potential diagnostic pitfall of LPL associated with marked plasmacytic differentiation and an IgG or IgA paraprotein that can resemble a PCN. Useful features in favor of LPL against PCN include the characteristic immunophenotypic profile of the PCs in LPL, absence of CCND1::IGH, and the presence of MYD88 and/or CXCR4 mutations.
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4
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Canali A, Corre J, Riviere B, Condom P, Rieu J. Monoclonal plasma cells with normal phenotype can lead to diagnosis of small B-cell lymphoma. EJHAEM 2022; 3:1400-1401. [PMID: 36467835 PMCID: PMC9713182 DOI: 10.1002/jha2.540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Accepted: 07/23/2022] [Indexed: 06/17/2023]
Affiliation(s)
- Alban Canali
- Haematology LaboratoryCancer University Institute of Toulouse ‐ OncopoleToulouseFrance
| | - Jill Corre
- Medical Biology Laboratory, Centre Hospitalier Intercommunal Castres ‐ MazametCastresFrance
| | - Brigitte Riviere
- Medical Biology Laboratory, Centre Hospitalier Intercommunal Castres ‐ MazametCastresFrance
| | - Pauline Condom
- Haematology LaboratoryCancer University Institute of Toulouse ‐ OncopoleToulouseFrance
- Medical Biology Laboratory, Centre Hospitalier Intercommunal Castres ‐ MazametCastresFrance
| | - Jean‐Baptiste Rieu
- Haematology LaboratoryCancer University Institute of Toulouse ‐ OncopoleToulouseFrance
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5
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Kelley JT, Fuller LD, Lai KK, Yantiss RK, Dzedzik S, Alapat D, Mashayekhi A, Alpert L, Gonzalez RS, Owens SR, Arber DA, Lamps LW. Gastrointestinal, Hepatic and Pancreatobiliary Involvement by Plasma Cell Neoplasms: Clinicopathologic Correlations in a Retrospective Cohort of 116 Cases. Histopathology 2022; 81:742-757. [PMID: 35984728 DOI: 10.1111/his.14778] [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: 04/29/2022] [Revised: 06/23/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS Plasma cell neoplasms (PCNs) may involve the gastrointestinal (GI) tract in two forms: plasmacytoma (PC), an isolated lesion which lacks marrow involvement, and extramedullary myeloma (EMM). However, previous literature on PCNs involving the GI tract, liver and pancreas is limited. We evaluated the clinicopathologic features of the largest series of GI PCNs to date. METHODS AND RESULTS Six institutional archives were searched for GI, liver and pancreas cases involved by PCNs. Medical records were reviewed for clinical and imaging features. Histopathologic features evaluated included involved organ, tumor grade and marrow involvement. Overall, 116 cases from 102 patients were identified. Tumors most presented as incidental findings (29%). The liver was most involved (47%), and masses/polyps (29%) or ulcers (21%) were most common findings. Most cases had high-grade morphology (55%). The majority (74%) of GI PCNs were classified as EMM due to the presence of marrow involvement at some point during the disease course, occurring within a year of marrow diagnosis in 46% of patients. PC was classified in 26% of patients due to the lack of marrow involvement. Most (70%) patients died from disease within 10 years (median 14.1) of diagnosis and more than half (58%) died within 6 months. CONCLUSION PC and EMM involving the GI tract, liver and pancreas have a wide range of clinicopathologic presentations. Tumors may occur virtually anywhere in the GI tract or abdomen and may precede the diagnosis of marrow involvement. Both GI PC and EMM are associated with a poor prognosis.
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Affiliation(s)
- Justin T Kelley
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Keith K Lai
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Siarhei Dzedzik
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Daisy Alapat
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Azin Mashayekhi
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lindsay Alpert
- Department of Pathology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Scott R Owens
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Laura W Lamps
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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Cao Y, Zou L, Zhou H, Fu G, Zhao X. Hemophagocytic lymphohistiocytosis as an onset of diffuse large B‑cell lymphoma: A case report. Oncol Lett 2022; 24:298. [PMID: 35949601 PMCID: PMC9353227 DOI: 10.3892/ol.2022.13418] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2022] [Accepted: 05/19/2022] [Indexed: 12/03/2022] Open
Abstract
A 53-year-old male presented with a 1-month history of hyperpyrexia. The clinical manifestations revealed hemophagocytic lymphohistiocytosis (HLH). Although a lymph node biopsy could not be obtained, a bone marrow biopsy revealed the activated B-cell subtype of diffuse large B-cell lymphoma (DLBCL). After being treated with HLH-1994 (dexamethasone and etoposide), a rituximab-containing chemotherapy and target agents involving bortezomib, the patient achieved remission. To understand the molecular profile of patient, next-generation sequencing and MYD88 L265P mutation examinations were performed, and the patient was determined to be positive for the MYD88 L265P mutation. Reports of DLBCL with plasmacytic differentiation and a MYD88 innate immune signal transduction adaptor L265P mutation concurrent with HLH are rare. Early recognition, precise diagnosis and timely therapy are pivotal in improving patient prognosis. Furthermore, molecular profiling enables researchers to develop potential therapies aimed at the activated NF-κB and endoplasmic reticulum stress signaling pathways. The present study highlights this pathogenesis and provides suggestions for further individualized therapeutics.
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Affiliation(s)
- Yueqing Cao
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Lang Zou
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Hao Zhou
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Gan Fu
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
| | - Xielan Zhao
- Department of Hematology, Xiangya Hospital, Central South University, Changsha, Hunan 410008, P.R. China
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7
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Righi S, Novero D, Godio L, Bertuzzi C, Bacci F, Agostinelli C, Sagramoso C, Rossi M, Piccioli M, Gazzola A, Mannu C, Roncador G, Sabattini E. Myeloid Nuclear Differentiation Antigen (MNDA): an aid in differentiating lymphoplasmayctic lymphoma and splenic marginal zone lymphoma in bone marrow biopsies at presentation. Hum Pathol 2022; 124:67-75. [PMID: 35339566 DOI: 10.1016/j.humpath.2022.03.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Revised: 03/16/2022] [Accepted: 03/16/2022] [Indexed: 11/04/2022]
Abstract
The differential diagnosis between lymphoplasmacytic lymphoma (LPL) and marginal zone B-cell lymphoma, particularly splenic type (SMZL) can be challenging on onset bone marrow biopsy (BMB) since morphology and phenotype are not specific and clinical features can overlap or be mildly developed at diagnosis. The LPL-specific L265P mutation in the MYD88 gene is not available in all laboratories and genetic aberrancies identified in SMZL (del7q, mutations of NOTCH2 and KLF2) are seldom searched in routine practice. The study aim is to investigate the potential role of MNDA expression in this specific differential diagnosis. We report MNDA reactivity in 559 small B-cell lymphoma (SBCL) patients including bone marrow biopsies from 90 LPL and 91 SMZL. MYD88 p.Leu265Pro mutation status was assessed and confirmed as positive in 24 of 90 LPL cases, which served as the test set. MNDA staining was negative in 23/24 LPL cases in the test set (96%). In the 157 remaining cases (66 LPL, 91 SMZL), which served as validation set, the MYD88 p.Leu265Pro mutation was unavailable and MNDA was more frequently expressed in SMZL (p<0.00001). In addition, immunohistochemical features more consistent with SMZL (i.e. presence of CD23+ follicular dendritic cell meshworks, polytypic plasma cells, DBA44 reactivity) were more often present in MNDA positive cases (statistically significant for 2 such parameters). On the widest case-series so far published focusing on LPL and SMZL immunohistochemical diagnosis at onset on BMB, we demonstrated that MNDA expression significantly support the diagnosis of SMZL. This observation may be of particular help in cases where the MYD88 p.Leu265Pro mutational status and/or SMZL-related genetic aberrations are unavailable.
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Affiliation(s)
- Simona Righi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy, Via Massarenti 11, 40138 Bologna, Italy.
| | - Domenico Novero
- Unit of Surgical Pathology - University Hospital of Turin, Città Della Salute - Ospedale Le Molinette, Turin, Italy, Corso Bramante 88, 10126, Turin, Italy.
| | - Laura Godio
- Unit of Surgical Pathology - University Hospital of Turin, Città Della Salute - Ospedale Le Molinette, Turin, Italy, Corso Bramante 88, 10126, Turin, Italy.
| | - Clara Bertuzzi
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.Via Massarenti 9 - 40138 Bologna, Italy.
| | - Francesco Bacci
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.Via Massarenti 9 - 40138 Bologna, Italy.
| | - Claudio Agostinelli
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.Via Massarenti 9 - 40138 Bologna, Italy; Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy, Via Massarenti 11, 40138 Bologna, Italy.
| | - Carlo Sagramoso
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.Via Massarenti 9 - 40138 Bologna, Italy.
| | - Maura Rossi
- Department of Experimental, Diagnostic and Specialty Medicine, University of Bologna, Bologna, Italy, Via Massarenti 11, 40138 Bologna, Italy.
| | - Milena Piccioli
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.Via Massarenti 9 - 40138 Bologna, Italy.
| | - Anna Gazzola
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.Via Massarenti 9 - 40138 Bologna, Italy.
| | - Claudia Mannu
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.Via Massarenti 9 - 40138 Bologna, Italy.
| | - Giovanna Roncador
- Biotechnology Program, Spanish National Cancer Research Centre, Madrid, Spain, C/ Melchor Fernández Almagro 3, 28029 Madrid, Spain.
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy.Via Massarenti 9 - 40138 Bologna, Italy.
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8
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Amaador K, Vos JMI, Pals ST, Kraan W, Dobber JA, Minnema MC, Koene HR, de Bruin PC, Zwinderman AH, Kersten MJ. Discriminating between Waldenström macroglobulinemia and marginal zone lymphoma using logistic LASSO regression. Leuk Lymphoma 2021; 63:1070-1079. [DOI: 10.1080/10428194.2021.2018584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Karima Amaador
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Josephine M. I. Vos
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Steven T. Pals
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Willem Kraan
- Department of Pathology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
| | - Johan A. Dobber
- Laboratory of Hematology, Amsterdam UMC, Amsterdam, The Netherlands
| | - Monique C. Minnema
- Department of Hematology, University Medical Center, University Utrecht, Utrecht, The Netherlands
| | - Harry R. Koene
- Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Peter C. de Bruin
- Department of Pathology, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Aiko H. Zwinderman
- Department of Clinical Epidemiology, Biostatistics and Bioinformatics, Amsterdam UMC, University of Amsterdam, The Netherlands
| | - Marie José Kersten
- Department of Hematology, Amsterdam UMC, University of Amsterdam, Cancer Center Amsterdam and LYMMCARE (Lymphoma and Myeloma Center Amsterdam), Amsterdam, The Netherlands
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9
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Askari E, Rodriguez S, Garcia-Sanz R. Waldenström's Macroglobulinemia: An Exploration into the Pathology and Diagnosis of a Complex B-Cell Malignancy. J Blood Med 2021; 12:795-807. [PMID: 34512060 PMCID: PMC8416181 DOI: 10.2147/jbm.s267938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/19/2021] [Indexed: 12/22/2022] Open
Abstract
After 77 years since the initial description, Waldenström macroglobulinemia (WM) remains as a bone marrow neoplastic disorder with lymphoplasmacytic differentiation oversecreting a monoclonal immunoglobulin M (IgM). However, many biological and genetic aspects of this entity have been unraveled and it is now easy to correctly diagnose patients with this illness. The diagnosis requires the presence of a monoclonal IgM component and bone marrow lymphoid infiltration must be demonstrated. In addition, other small B-cell lymphoid neoplasms with plasma cell differentiation must be discarded. Although the clinical picture is highly heterogeneous, the diagnosis is much easier today compared to the past, since now we can demonstrate the presence of somatic mutations, especially the L265P mutation in the MYD88 gene, highly characteristic of WM (>90% of the patients), followed by the WHIM-like mutations in the CXCR4 gene (~35%). The identification of these mutations is very important, because they can modulate the response to new treatments with Bruton's tyrosine kinase (BTK) inhibitors. Thus, the conventional prognostic factors that predict the outcome of these patients (anemia, thrombopenia, high M component, high B2M, and advanced age), must be complemented with the genetic evaluation of the patient, that can help us in the prediction of the risk of transformation from asymptomatic to symptomatic forms (Del6q) and/or from indolent forms of the disease to aggressive lymphomas (CD79b mutations).
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Affiliation(s)
- Elham Askari
- Hematology Department, Fundación Jiménez Díaz, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369, Madrid, Spain
| | - Sara Rodriguez
- Clinica Universidad de Navarra, Centro de Investigación Medica Aplicada (CIMA), Instituto de Investigación Sanitaria de Navarra (IDISNA), Accelerator project, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369, Pamplona, Spain
| | - Ramon Garcia-Sanz
- Haematology Department, University Hospital of Salamanca, Research Biomedical Institute of Salamanca (IBSAL), Accelerator project, Centro de Investigación Biomédica en Red-Cáncer (CIBERONC) CB16/12/00369 and Center for Cancer Research-IBMCC (USAL-CSIC), Salamanca, Spain
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10
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Ruiz-Villaverde R, Rueda-Villafranca B, Galvez-Moreno M. Progressive Asymptomatic Thickening of a Lip. ACTAS DERMO-SIFILIOGRAFICAS 2021. [DOI: 10.1016/j.adengl.2021.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Ruiz-Villaverde R, Rueda-Villafranca B, Galvez-Moreno M. Progressive Asymptomatic Thickening of a Lip. ACTAS DERMO-SIFILIOGRAFICAS 2021; 112:S0001-7310(21)00102-2. [PMID: 33675728 DOI: 10.1016/j.ad.2019.07.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/25/2019] [Accepted: 07/14/2019] [Indexed: 11/16/2022] Open
Affiliation(s)
- R Ruiz-Villaverde
- Servicio de Dermatología. Hospital Universitario San Cecilio, Granada, España.
| | - B Rueda-Villafranca
- Servicio de Dermatología. Hospital Universitario San Cecilio, Granada, España
| | - M Galvez-Moreno
- Servicio de Dermatología. Hospital Universitario San Cecilio, Granada, España
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12
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Immunoglobulin M Paraproteinaemias. Cancers (Basel) 2020; 12:cancers12061688. [PMID: 32630470 PMCID: PMC7352433 DOI: 10.3390/cancers12061688] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Revised: 06/14/2020] [Accepted: 06/23/2020] [Indexed: 12/11/2022] Open
Abstract
Monoclonal paraproteinaemia is an increasingly common reason for referral to haematology services. Paraproteinaemias may be associated with life-threatening haematologic malignancies but can also be an incidental finding requiring only observation. Immunoglobulin M (IgM) paraproteinaemias comprise 15–20% of monoclonal proteins but pose unique clinical challenges. IgM paraproteins are more commonly associated with lymphoplasmacytic lymphoma than multiple myeloma and can occur in a variety of other mature B-cell neoplasms. The large molecular weight of the IgM multimer leads to a spectrum of clinical manifestations more commonly seen with IgM paraproteins than others. The differential diagnosis of B-cell and plasma cell dyscrasias associated with IgM gammopathies can be challenging. Although the discovery of MYD88 L265P and other mutations has shed light on the molecular biology of IgM paraproteinaemias, clinical and histopathologic findings still play a vital role in the diagnostic process. IgM secreting clones are also associated with a number of “monoclonal gammopathy of clinical significance” entities. These disorders pose a novel challenge from both a diagnostic and therapeutic perspective. In this review we provide a clinical overview of IgM paraproteinaemias while discussing the key advances which may affect how we manage these patients in the future.
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13
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Tsunemine H, Zushi Y, Sasaki M, Nishikawa Y, Tamura A, Aoyama Y, Kodaka T, Itoh T, Takahashi T. Gamma heavy chain disease (γ-HCD) as iatrogenic immunodeficiency- associated lymphoproliferative disorder: Possible emergent subtype of rheumatoid arthritis-associated γ-HCD. J Clin Exp Hematop 2020; 59:196-201. [PMID: 31866621 PMCID: PMC6954170 DOI: 10.3960/jslrt.19025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Gamma heavy chain disease (γ-HCD) is a rare B-cell neoplasm that produces a truncated immunoglobulin γ-heavy chain lacking the light chain. The clinical features of γ-HCD are heterogeneous, resembling different types of B-cell lymphomas. Although rheumatoid arthritis (RA) is one of the common underlying diseases of γ-HCD, the therapeutic modality for RA has changed greatly in recent years; therefore, γ-HCD as iatrogenic immunodeficiency-associated lymphoproliferative disorder (LPD) should be taken into consideration. Here, we report such a γ-HCD case. A 69-year-old female was admitted because of fever, multiple lymph node swelling in the abdominal cavity, and peritoneal effusion. She had been treated using methotrexate for RA for 14 years, and using infliximab and adalimumab for Crohn’s disease for one year. The serum concentration of IgG was 3,525 mg/dL, which was revealed to be monoclonal IgG lacking the light chain by rocket immunoselection assay. CD19+/CD20-/smκ−/smλ− large abnormal lymphocytes were observed in the peritoneal fluid, which were demonstrated to be clonal B-cells by PCR examination. Discontinuation of methotrexate did not improve her condition and she died of pneumonia. Many abnormal lymphocytes positive for IgG and EBER but negative for the light chain were found on immunohistological examination of necropsy specimens from the spleen and bone marrow.
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14
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Narita K, Kobayashi H, Suzuki T, Ichikawa D, Yamazaki K, Terawaki H, Suehara Y, Miura D, Takeuchi M, Matsue K. Light Chain Deposition Disease in a Patient With MYD88 L265P Mutation-positive Low-grade B-cell Lymphoma and Monoclonal Immunoglobulin G κ. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2020; 20:e805-e808. [PMID: 32660905 DOI: 10.1016/j.clml.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Revised: 05/15/2020] [Accepted: 06/04/2020] [Indexed: 11/24/2022]
Affiliation(s)
- Kentaro Narita
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Chiba, Japan.
| | - Hiroki Kobayashi
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Chiba, Japan
| | - Tomo Suzuki
- Department of Nephrology, Kameda Medical Center, Chiba, Japan
| | - Daisuke Ichikawa
- Division of Nephrology and Hypertension, Department of Internal Medicine, St. Marianna University School of Medicine, Kanagawa, Japan
| | - Kazuto Yamazaki
- Department of Pathology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Hiroyuki Terawaki
- Department of Internal Medicine, Nephrology, Teikyo University Chiba Medical Center, Chiba, Japan
| | - Yasuhito Suehara
- Department of Hematology, Graduate School of Comprehensive Human Sciences, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Daisuke Miura
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Chiba, Japan
| | - Masami Takeuchi
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Chiba, Japan
| | - Kosei Matsue
- Division of Hematology/Oncology, Department of Medicine, Kameda Medical Center, Chiba, Japan
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15
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Lymphoplasmacytic lymphoma and Waldenström macroglobulinaemia: clinicopathological features and differential diagnosis. Pathology 2020; 52:6-14. [DOI: 10.1016/j.pathol.2019.09.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2019] [Revised: 09/04/2019] [Accepted: 09/09/2019] [Indexed: 12/27/2022]
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16
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Tracy SI, Larson MC, Feldman AL, Maurer MJ, Novak AJ, Slager SL, Villasboas JC, Allmer C, Habermann TM, Farooq U, Syrbu S, Cerhan JR, Link BK. The utility of prognostic indices, early events, and histological subtypes on predicting outcomes in non-follicular indolent B-cell lymphomas. Am J Hematol 2019; 94:658-666. [PMID: 30916801 DOI: 10.1002/ajh.25473] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 02/22/2019] [Accepted: 03/25/2019] [Indexed: 02/06/2023]
Abstract
Indolent B-cell lymphomas other than follicular lymphoma account for up to 10% of all B-cell neoplasms. While they typically follow a slowly progressive course, some patients experience rapid progression and early mortality. Prognostic scoring systems have not been adopted, hindering the ability of clinicians or researchers to predict outcomes, or risk-stratify patients during clinical trials. To address this, we evaluated the utility of existing prognostic indices and novel, early disease-related outcomes, to predict subsequent long term survival. Baseline characteristics and outcomes data were generated from a longitudinal cohort study that prospectively enrolled 632 patients newly diagnosed with marginal zone lymphoma, lymphoplasmacytic lymphomas, or B-cell lymphomas not otherwise specified, beginning in 2002. The International Prognostic Index (IPI), Follicular Lymphoma International Prognostic Index (FLIPI), and MALT International prognostic index (MALT-IPI) demonstrated c-statistics that ranged from 0.593-0.612 for event-free survival (EFS), and 0.683-0.714 for overall survival (OS). Patients who attained event-free survival at 12 months (EFS12) experienced similar mortality to the US general population (standardized mortality ratio [SMR] 1.19; 95% CI 0.95-1.46). Patients who did not attain EFS12 had subsequent worse morality (SMR 3.14 (95% CI 2.05-4.59). The MALT-IPI demonstrated utility in predicting subsequent long-term outcomes among patients with non-follicular indolent B-cell lymphomas. This index should be used by clinicians giving guidance to patients at the time of initial diagnosis, and risk stratification during clinical studies. The divergent long-term outcomes experienced by patients who do or do not attain EFS12 suggest there exists a subset of patients who harbor high-risk disease. Future research efforts should focus on methods to identify these patients at the time of diagnosis, in order to enable risk-tailored therapy.
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Affiliation(s)
- Sean I. Tracy
- Division of Hematology, Oncology, and Bone Marrow TransplantationUniversity of Minnesota Minneapolis Minnesota
| | | | | | | | - Anne J. Novak
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Susan L. Slager
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Cristine Allmer
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | | | - Umar Farooq
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
| | - Sergei Syrbu
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
| | - James R. Cerhan
- Department of Internal MedicineMayo Clinic Rochester Minnesota
| | - Brian K. Link
- Division Hematology, Oncology, and Bone Marrow TransplantationUniversity of Iowa Iowa City Iowa
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17
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Uminski K, Houston BL, Moltzan C, Sun P. A Case of Waldenstrom's Macroglobulinemia Morphologically Resembling Plasma Cell Myeloma. J Hematol 2019; 8:26-28. [PMID: 32300437 PMCID: PMC7153673 DOI: 10.14740/jh469] [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: 11/01/2018] [Accepted: 11/30/2018] [Indexed: 11/11/2022] Open
Abstract
Although both are characterized by the presence of an IgM monoclonal gammopathy, IgM multiple myeloma and Waldenstrom's macroglobulinemia are two distinct hematologic entities. Differentiation of each however, may be challenging, but obviously critical to ensuring appropriate therapeutic decision-making and patient prognostication. Herein we report a case of a patient with Waldenstrom's macroglobulinemia presenting with bone marrow morphology mimicking plasma cell myeloma, highlighting the importance of clinical correlation and ancillary studies to reach an appropriate diagnosis.
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Affiliation(s)
- Kelsey Uminski
- Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Brett L Houston
- Section of Hematology and Medical Oncology, Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Catherine Moltzan
- Section of Hematology and Medical Oncology, Department of Internal Medicine, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Ping Sun
- Department of Pathology, Rady Faculty of Health Sciences, Max Rady College of Medicine, University of Manitoba, Winnipeg, MB, Canada
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18
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Willenbacher E, Willenbacher W, Wolf DG, Zelger B, Peschel I, Manzl C, Haun M, Brunner A. Digital PCR in bone marrow trephine biopsies is highly sensitive for MYD88 L265P detection in lymphomas with plasmacytic/plasmacytoid differentiation. Br J Haematol 2019; 186:189-191. [PMID: 30763982 DOI: 10.1111/bjh.15792] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Ella Willenbacher
- Internal Medicine V. Haematology and Oncology, Innsbruck Medical University, Innsbruck, Austria
| | - Wolfgang Willenbacher
- Internal Medicine V. Haematology and Oncology, Innsbruck Medical University, Innsbruck, Austria.,Oncotyrol, Centre for Personalized Cancer Medicine, Innsbruck, Austria
| | - Dominik G Wolf
- Internal Medicine V. Haematology and Oncology, Innsbruck Medical University, Innsbruck, Austria.,Medical Clinic 3, Oncology, Haematology, Rheumatology and Immunoncology, University Clinic Bonn (UKB), Bonn, Germany
| | - Bettina Zelger
- Institute of Pathology, Neuropathology and Molecular Pathology, Innsbruck Medical University, Innsbruck, Austria
| | - Ines Peschel
- Institute for Medical and Chemical Laboratory Diagnostics, Medical University Innsbruck, Innsbruck, Austria
| | - Claudia Manzl
- Division of General Pathology, Department of Pathology, Innsbruck Medical University, Innsbruck, Austria
| | - Margot Haun
- Institute of Pathology, Neuropathology and Molecular Pathology, Innsbruck Medical University, Innsbruck, Austria
| | - Andrea Brunner
- Institute of Pathology, Neuropathology and Molecular Pathology, Innsbruck Medical University, Innsbruck, Austria
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19
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IgM plasma cell myeloma in the era of novel therapy: a clinicopathological study of 17 cases. Hum Pathol 2019; 84:321-334. [DOI: 10.1016/j.humpath.2018.09.008] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Revised: 09/10/2018] [Accepted: 09/14/2018] [Indexed: 11/19/2022]
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20
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Seegmiller AC, Hsi ED, Craig FE. The current role of clinical flow cytometry in the evaluation of mature B-cell neoplasms. CYTOMETRY PART B-CLINICAL CYTOMETRY 2018; 96:20-29. [PMID: 30549186 DOI: 10.1002/cyto.b.21756] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 10/14/2018] [Accepted: 11/15/2018] [Indexed: 12/18/2022]
Abstract
Flow cytometry (FC) has a well-established role in the diagnostic evaluation of mature B-cell neoplasms. Effective assessment for lineage associated antigens, aberrant antigen expression, and immunoglobulin light chain restriction requires a well-designed, optimized, and controlled FC assay. However, it is important for hematopathologists to know when flow cytometry has a more limited role, and other modalities, such as immunohistochemistry, cytogenetic and molecular testing, are more important. This review will discuss the features of an optimal FC assay for the evaluation of mature B-cell neoplasms, and the current role of FC in the diagnosis and sub-classification, prognostic assessment, identification of therapeutic targets, and assessment for disease response to therapy. © 2018 International Clinical Cytometry Society.
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21
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Tanaka H, Kuwabara C, Isshiki Y, Suzuki Y. Multiple cystic lung lesions and autoimmune thrombocytopaenia developing after chemotherapy for pulmonary indolent B-cell lymphoma with plasmacytic differentiation. BMJ Case Rep 2018; 11:11/1/e227548. [PMID: 30567252 DOI: 10.1136/bcr-2018-227548] [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: 11/04/2022] Open
Abstract
Among lung malignancies, primary pulmonary lymphoma is rare and many of them are indolent B-cell lymphomas. We describe a case of primary pulmonary indolent B-cell lymphoma with plasmacytic differentiation, which exacerbated with the manifestation of macroglobulinaemia and was successfully treated using chemotherapy. The patient subsequently developed pulmonary cysts and thrombocytopaenia due to autoimmune pathology and was successfully treated using prednisolone. This case suggests that in indolent B-cell lymphoma with plasmacytic differentiation, immunoglobulin M level should be carefully followed even if it is within the normal range at lymphoma onset. Additionally, new cystic pulmonary infiltrates that develop during the post-treatment follow-up of an indolent pulmonary B-cell lymphoma may indicate pulmonary lymphoma recurrence, but there is also a possibility of an immunological complication.
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Affiliation(s)
- Hiroaki Tanaka
- Department of Hematology, Asahi General Hospital, Asahi, Chiba, Japan
| | - Chihiro Kuwabara
- Department of Hematology, Asahi General Hospital, Asahi, Chiba, Japan
| | - Yusuke Isshiki
- Department of Hematology, Chiba University Hospital, Chiba, Chiba, Japan
| | - Yoshio Suzuki
- Department of Pathology, Asahi General Hospital, Asahi, Chiba, Japan
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22
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Simultaneous Occurrence of Colonic Mucosa-Associated Lymphoid Tissue (MALT) Lymphoma (MALToma) and Lung Cancer. Case Rep Gastrointest Med 2018; 2018:3607101. [PMID: 30631608 PMCID: PMC6304642 DOI: 10.1155/2018/3607101] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2018] [Revised: 10/24/2018] [Accepted: 11/11/2018] [Indexed: 01/19/2023] Open
Abstract
Colonic MALToma accounts for 2.5% of all MALTomas. MALToma can be associated with certain chronic infections, autoimmune disorders, Waldenstrom's macroglobulinemia, and old age. Synchronous MALTomas can occur in multiple organs. Simultaneous occurrence of colonic MALToma and colon cancer has been reported. A case of colonic MALToma and lung cancer is described here.
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23
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Sorigue M, Junca J. Atypical chronic lymphocytic leukemia: Brief historical overview and current usage of an equivocal concept. Int J Lab Hematol 2018; 41:e17-e19. [DOI: 10.1111/ijlh.12930] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Affiliation(s)
- Marc Sorigue
- Hematology Laboratory ICO‐Hospital Germans Trias i Pujol Josep Carreras Leukemia Research Institute Universitat Autònoma de Barcelona Badalona Spain
| | - Jordi Junca
- Hematology Laboratory ICO‐Hospital Germans Trias i Pujol Josep Carreras Leukemia Research Institute Universitat Autònoma de Barcelona Badalona Spain
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24
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Raimbault A, Machherndl-Spandl S, Itzykson R, Clauser S, Chapuis N, Mathis S, Lauf J, Alary AS, Burroni B, Kosmider O, Fontenay M, Béné MC, Durrieu F, Bettelheim P, Bardet V. CD13 expression in B cell malignancies is a hallmark of plasmacytic differentiation. Br J Haematol 2018; 184:625-633. [PMID: 30198568 DOI: 10.1111/bjh.15584] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 07/24/2018] [Indexed: 11/30/2022]
Abstract
The diagnosis of Waldenström Macroglobulinaemia (WM)/lymphoplasmacytic lymphoma (LPL) remains one of exclusion because other B-cell lymphoproliferative disorders (B-LPD), such as marginal zone lymphoma (MZL), can fulfil similar criteria, including MYD88 L265P mutation. It has been suggested that expression of the myeloid marker CD13 (also termed ANPEP) is more frequent in LPL than in other B-LPD and has also been described on normal and malignant plasma cells. Here, CD13 expression was tested in a cohort of 1037 B-LPD patients from 3 centres by flow cytometry. The percentage of CD13-expressing cells was found to be variable among B-LPD but significantly higher in WM/LPL (median 31% vs. 0% in non-WM/LPL, P < 0·001). In multivariate linear regression, CD13 expression remained significantly associated with a diagnosis of WM/LPL (P < 0·001). A cut-off value of 2% of CD19+ cells co-expressing CD13 yielded the best diagnostic performance for WM/LPL assertion. This was further improved by association with the presence or absence of IgM paraprotein. Finally, given that previously published transcriptomic data revealed no difference in CD13 (also termed ANPEP) mRNA between normal and pathological B-cells, the hypothesis of some post-transcriptional regulation must be favoured. These results suggest that testing for CD13 expression in routine flow cytometry panels could help to discriminate WM/LPL from other B-LPD.
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Affiliation(s)
- Anna Raimbault
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Université Paris Descartes, Paris, France
| | - Sigrid Machherndl-Spandl
- Department of Haematology, Internal Oncology and Stem Cell Transplantation, Ordensklinikum Linz Elisabethinen Hospital, Linz, Austria
| | - Raphaël Itzykson
- Service d'Hématologie Clinique, Hôpitaux Universitaires Saint Louis, Lariboisière, Fernand Widal, Université Paris Diderot, Paris, France
| | - Sylvain Clauser
- Service d'Hématologie-Immunologie-Transfusion, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France
| | - Nicolas Chapuis
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Université Paris Descartes, Paris, France
| | - Stéphanie Mathis
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Université Paris Descartes, Paris, France.,Service d'Hématologie Clinique, Hôpitaux Universitaires Saint Louis, Lariboisière, Fernand Widal, Université Paris Diderot, Paris, France
| | - Jeroen Lauf
- Department of Haematology, Internal Oncology and Stem Cell Transplantation, Ordensklinikum Linz Elisabethinen Hospital, Linz, Austria
| | - Anne-Sophie Alary
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Université Paris Descartes, Paris, France
| | - Barbara Burroni
- Service d'Anatomopathologie, Hôpitaux Universitaires Paris Centre, Université Paris Descartes, Paris, France
| | - Olivier Kosmider
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Université Paris Descartes, Paris, France
| | - Michaela Fontenay
- Service d'Hématologie Biologique, Hôpitaux Universitaires Paris Centre, Université Paris Descartes, Paris, France
| | - Marie C Béné
- Service d'Hématologie Biologique, CHU et Université de Nantes, Nantes, France
| | | | - Peter Bettelheim
- Department of Haematology, Internal Oncology and Stem Cell Transplantation, Ordensklinikum Linz Elisabethinen Hospital, Linz, Austria
| | - Valérie Bardet
- Service d'Hématologie-Immunologie-Transfusion, Hôpitaux Universitaires Paris Ile De France Ouest, Université Versailles Saint Quentin, Boulogne, France
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25
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26
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Ma S, Jug R, Shen S, Zhang WL, Xu HT, Yang LH. Marginal zone lymphoma of palatine tonsil with prominent plasmacytic differentiation: A CARE-compliant article and review of literature. Medicine (Baltimore) 2018; 97:e9648. [PMID: 29480878 PMCID: PMC5943870 DOI: 10.1097/md.0000000000009648] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [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 The palatine tonsil is an important component of Waldeyer's ring and a site commonly involved by lymphoma. Interestingly, although it is a site of mucosa-associated lymphoid tissue (MALT), primary MALT lymphoma of the palatine tonsil is rare, especially with prominent plasmacytic differentiation. PATIENT CONCERNS A 59-year-old woman presented to the hospital with a 1-month history of odynophagia. The patient had no fever or pruritus during this period and she declared no family history of hematolymphoid malignancy. DIAGNOSIS Histopathological examination demonstrated effacement of tonsil architecture; normal follicles were replaced by plasmacytoid tumor cells and small lymphocytes. The tumor cells expanded the marginal zone and infiltrated interfollicular regions, as well as scattered residual follicles. Immunostaining showed tumor cells positive for cluster of differentiation (CD)20, CD79a, paired box-5, Mum 1, and B cell lymphoma (Bcl)-2, and negative for CD5, CD 23, cyclin D1, Bcl-6, and CD10. Staining for κ and λ showed prominent light chain restriction. The tumor was classified as tonsil MALT lymphoma with prominent plasmacytic differentiation. INTERVENTIONS After the patient was diagnosed with MALT lymphoma with prominent plasmacytic differentiation, she underwent complete surgical resection and radiotherapy. OUTCOMES There was no recurrence evident at 6-months follow-up. LESSONS Primary tonsil MALT lymphoma with prominent plasmacytic differentiation is very rare and difficult to distinguish from other B-cell lymphomas with plasmacytoid morphology, such as follicular lymphoma, lymphoplasmacytic lymphoma, and chronic lymphocytic leukemia/small lymphocytic lymphoma. Accurate diagnosis of this entity is important in guiding therapy so as to avoid overtreatment.
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Affiliation(s)
- Shuang Ma
- Department of Neurology, Sheng Jing Hospital of China Medical University, Shenyang, Liaoning
| | - Rachel Jug
- Department of Pathology, Duke University Medical Center, Durham, NC
| | - Shuai Shen
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Wan-Lin Zhang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Hong-Tao Xu
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
| | - Lian-He Yang
- Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, Liaoning, China
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27
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Primary Bone Lymphoma Exhibits a Favorable Prognosis and Distinct Gene Expression Signatures Resembling Diffuse Large B-Cell Lymphoma Derived From Centrocytes in the Germinal Center. Am J Surg Pathol 2017; 41:1309-1321. [DOI: 10.1097/pas.0000000000000923] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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28
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Law MF, Chan HN, Leung C, Wong CK, Lai HK, Ha CY, Ng C, Yeung YM, Yip SF. Marginal zone B-cell lymphoma mimicking extramedullary plasmacytoma and the clinical outcome after treatment. Arch Med Sci 2017; 13:698-701. [PMID: 28507591 PMCID: PMC5420643 DOI: 10.5114/aoms.2017.67290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/21/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Man Fai Law
- Department of Medicine, Tuen Mun Hospital, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Hay Nun Chan
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | | | | | - Ho Kei Lai
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Chung Yin Ha
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Celia Ng
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | | | - Sze Fai Yip
- Department of Medicine, Tuen Mun Hospital, Hong Kong
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29
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Abstract
B-cell non-Hodgkin lymphomas with plasmacytic differentiation are a diverse group of entities with extremely variable morphologic features. Diagnostic challenges can arise in differentiating lymphoplasmacytic lymphoma from marginal zone lymphoma and other low-grade B-cell lymphomas. In addition, plasmablastic lymphomas can be difficult to distinguish from diffuse large B-cell lymphoma or other high-grade lymphomas. Judicious use of immunohistochemical studies and molecular testing can assist in appropriate classification.
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MESH Headings
- Diagnosis, Differential
- Humans
- Immunophenotyping
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/immunology
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/pathology
- Plasmacytoma/diagnosis
- Plasmacytoma/immunology
- Plasmacytoma/pathology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/diagnosis
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/immunology
- Precursor Cell Lymphoblastic Leukemia-Lymphoma/pathology
- Prognosis
- Waldenstrom Macroglobulinemia/diagnosis
- Waldenstrom Macroglobulinemia/immunology
- Waldenstrom Macroglobulinemia/pathology
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Affiliation(s)
- Charles M Harmon
- Department of Pathology, University of Michigan Hospitals and Health Systems, 1301 Catherine Street, Ann Arbor, MI 48109, USA
| | - Lauren B Smith
- Department of Pathology, University of Michigan Hospitals and Health Systems, 5320 Medical Science I, 1301 Catherine Street, Ann Arbor, MI 48109-5602, USA.
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30
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Do ASM, Smith GA, Pace J, Hdeib A, Kasliwal MK. Primary spinal intradural extramedullary lymphoma: A novel management strategy. J Clin Neurosci 2016; 35:122-126. [PMID: 27839915 DOI: 10.1016/j.jocn.2016.10.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2016] [Accepted: 10/15/2016] [Indexed: 10/20/2022]
Abstract
Primary spinal intradural extramedullary lymphoma remains a very rare entity in spinal oncology. In this case report, we present the first treatment of a PSIEL diagnosed by cytopathologic analysis alone followed by urgent radio- and chemotherapy in the literature. At 18-month follow-up, our patient was ambulatory with near total imaging resolution of the lesion. In conclusion, surgical excision or biopsy may not be necessary when suspicion for PSIEL exists, and may delay prompt medical and radiation treatment due to necessity for wound healing. Further research into the management of extramedullary lymphoma treatment strategies is warranted.
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Affiliation(s)
- Angelique Sao-Mai Do
- Department of Neurological Surgery, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44122, USA.
| | - Gabriel A Smith
- Department of Neurological Surgery, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44122, USA.
| | - Jonathan Pace
- Department of Neurological Surgery, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44122, USA.
| | - Alia Hdeib
- Department of Neurological Surgery, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44122, USA.
| | - Manish K Kasliwal
- Department of Neurological Surgery, University Hospitals, 11100 Euclid Ave, Cleveland, OH 44122, USA.
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31
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King RL, Gonsalves WI, Ansell SM, Greipp PT, Frederick LA, Viswanatha DS, He R, Kyle RA, Gertz MA, Kapoor P, Morice WG, Howard MT. Lymphoplasmacytic Lymphoma With a Non-IgM Paraprotein Shows Clinical and Pathologic Heterogeneity and May Harbor MYD88 L265P Mutations. Am J Clin Pathol 2016; 145:843-51. [PMID: 27329639 DOI: 10.1093/ajcp/aqw072] [Citation(s) in RCA: 35] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES Lymphoplasmacytic lymphoma (LPL) with non-immunoglobulin M (IgM) paraproteinemia remains poorly understood. The goal of this study was to investigate the clinicopathologic features of LPL in the bone marrow in patients with immunoglobulin G (IgG) or immunoglobulin A (IgA) paraproteins and evaluate MYD88 L265P mutation status to determine the relationship of these cases to Waldenström macroglobulinemia (WM). METHODS Bone marrows from LPL cases with IgG or IgA paraproteins diagnosed between January 1, 2007, and June 30, 2014, were retrieved from the clinical archive. Clinicopathologic features were retrospectively reviewed. MYD88 L265P mutation status was assessed by allele-specific polymerase chain reaction prospectively on all cases. RESULTS Of 27 cases, four were reclassified as multiple myeloma, all MYD88 mutation negative. MYD88 L265P mutations were present in 10 (43%) of 23 remaining cases. No association between MYD88 status and bone marrow morphologic or phenotypic features, including the presence of Dutcher bodies, mast cells, expression of CD19 by plasma cells, or hemosiderin, was identified, although these features were present in a subset of cases, similar to WM. Clinical features of WM such as hyperviscosity were uncommon in this group and did not correlate with MYD88 status. CONCLUSIONS Non-IgM LPLs are a clinically and pathologically heterogeneous group and often harbor MYD88 L265P mutation, albeit at a lower rate than classic WM. MYD88 status does not correlate with any specific pathologic or clinical manifestations.
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Affiliation(s)
| | | | | | | | | | | | - Rong He
- From the Division of Hematopathology
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Porwit A, Fend F, Kremer M, Orazi A, Safali M, van der Walt J. Issues in diagnosis of small B cell lymphoid neoplasms involving the bone marrow and peripheral blood. Report on the Bone Marrow Workshop of the XVIIth meeting of the European Association for Haematopathology and the Society for Hematopathology. Histopathology 2016; 69:349-73. [PMID: 27208429 DOI: 10.1111/his.12999] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2015] [Revised: 05/12/2016] [Accepted: 05/19/2016] [Indexed: 01/01/2023]
Abstract
Small B cell lymphoid neoplasms are the most common lymphoproliferative disorders involving peripheral blood (PB) and bone marrow (BM). The Bone Marrow Workshop (BMW) organized by the European Bone Marrow Working Group (EBMWG) of the European Association for Haematopathology (EAHP) during the XVIIth EAHP Meeting in Istanbul, October 2014, was dedicated to discussion of cases illustrating how the recent advances in immunophenotyping, molecular techniques and cytogenetics provide better understanding and classification of these entities. Submitted cases were grouped into following categories: (i) cases illustrating diagnostic difficulties in chronic lymphocytic leukaemia (CLL); (ii) cases of BM manifestations of small B cell lymphoid neoplasms other than CLL; (iii) transformation of small B cell lymphoid neoplasms in the BM; and (iv) multiclonality and composite lymphomas in the BM. This report summarizes presented cases and conclusions of the BMW and provides practical recommendations for classification of the BM manifestations of small B cell lymphoid neoplasms based on the current state of knowledge.
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Affiliation(s)
- Anna Porwit
- Department of Clinical Sciences, Division of Oncology and Pathology, Faculty of Medicine, Lund University, Lund, Sweden.,Previous address: Department of Pathobiology and Laboratory Medicine, University Health Network, Toronto, ON, Canada
| | - Falko Fend
- Institute of Pathology and Neuropathology and Comprehensive Cancer Center, University Hospital Tübingen, Tübingen, Germany
| | - Marcus Kremer
- Institute of Pathology, Staedtisches Klinikum, München, Germany
| | - Attilio Orazi
- Department of Pathology and Laboratory Medicine, Weill Cornell Medical College, New York, NY, USA
| | | | - Jon van der Walt
- Department of Histopathology, Guy's and St Thomas' Hospitals, London, UK
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Plasma cell and terminal B-cell differentiation in mantle cell lymphoma mainly occur in the SOX11-negative subtype. Mod Pathol 2015; 28:1435-47. [PMID: 26360498 DOI: 10.1038/modpathol.2015.99] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 07/15/2015] [Indexed: 11/08/2022]
Abstract
Mantle cell lymphoma is a mature lymphoid neoplasm characterized by the t(11;14)(q13;q32) and cyclin D1 overexpression. SOX11 is a transcription factor commonly overexpressed in these tumors but absent in most other mature B-cell lymphomas whose function is not well understood. Experimental studies have shown that silencing of SOX11 in mantle cell lymphoma cells promotes the shift from a mature B cell into an early plasmacytic differentiation phenotype, suggesting that SOX11 may contribute to tumor development by blocking the B-cell differentiation program. The relationship between SOX11 expression and terminal B-cell differentiation in primary mantle cell lymphoma and its relationship to the plasmacytic differentiation observed in occasional cases is not known. In this study we have investigated the terminal B-cell differentiation phenotype in 60 mantle cell lymphomas, 41 SOX11-positive and 19 SOX11-negative. Monotypic plasma cells and lymphoid cells with plasmacytic differentiation expressing cyclin D1 were observed in 7 (37%) SOX11-negative but in none of 41 SOX11-positive mantle cell lymphomas (P<0.001). Intense cytoplasmic expression of a restricted immunoglobulin light chain was significantly more frequent in SOX11-negative than -positive tumors (58 vs 13%) (P=0.001). Similarly, BLIMP1 and XBP1 expression was also significantly more frequent in SOX11-negative than in -positive cases (83 vs 34% and 75 vs 11%, respectively) (P=0.001). However, no differences in the expression of IRF4/MUM1 were observed among these subtypes of mantle cell lymphoma. In conclusion, these results indicate that SOX11-negative mantle cell lymphoma may be a particular subtype of this tumor characterized by more frequent morphological and immunophenotypic terminal B-cell differentiation features that may be facilitated by the absence of SOX11 transcription factor.
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The many faces of small B cell lymphomas with plasmacytic differentiation and the contribution of MYD88 testing. Virchows Arch 2015; 468:259-75. [PMID: 26454445 DOI: 10.1007/s00428-015-1858-9] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/23/2015] [Indexed: 12/11/2022]
Abstract
Plasmacytic differentiation may occur in almost all small B cell lymphomas (SBLs), although it varies from being uniformly present (as in lymphoplasmacytic lymphoma (LPL)) to very uncommon (as in mantle cell lymphomas (MCLs)). The discovery of MYD88 L265P mutations in the vast majority of LPLs has had a major impact on the study of these lymphomas. Review of the cases contributed to the 2014 European Association for Haematopathology/Society for Hematopathology slide workshop illustrated how mutational testing has helped refine the diagnostic criteria for LPL, emphasizing the importance of identifying a clonal monotonous lymphoplasmacytic population and highlighting how LPL can still be diagnosed with extensive nodal architectural effacement, very subtle plasmacytic differentiation, follicular colonization, or uncommon phenotypes such as CD5 or CD10 expression. MYD88 L265P mutations were found in 11/11 LPL cases versus only 2 of 28 other SBLs included in its differential diagnosis. Mutational testing also helped to exclude other cases that would have been considered LPL in the past. The workshop also highlighted how plasmacytic differentiation can occur in chronic lymphocytic leukemia/small lymphocytic lymphoma, follicular lymphoma, SOX11 negative MCL, and particularly in marginal zone lymphomas, all of which can cause diagnostic confusion with LPL. The cases also highlighted the difficulty in distinguishing lymphomas with marked plasmacytic differentiation from plasma cell neoplasms. Some SBLs with plasmacytic differentiation can be associated with amyloid, other immunoglobulin deposition, or crystal-storing histiocytosis, which may obscure the underlying neoplasm. Finally, although generally indolent, LPL may transform, with the workshop cases suggesting a role for TP53 abnormalities.
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Tabata R, Yasumizu R, Tabata C, Kojima M. Bone marrow macrophages in Waldenström's macroglobulinemia: a report of four cases. J Clin Exp Hematop 2015; 54:103-10. [PMID: 25318942 DOI: 10.3960/jslrt.54.103] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
It is well known that some B-cell lymphomas are accompanied by a prominent epithelioid cell response, caused by activated macrophages, such as marginal zone B-cell lymphoma of a mucosa-associated lymphoid tissue. We investigated six bone marrow samples from four cases of Waldenström's macroglobulinemia and report a unique observation that large conjugates of tumor cells around a macrophage were prominent in all cases, particularly in one case, the bone marrow of which contained increased CD163-positive macrophages. Mast cells were increased in all the samples, some of which seemed to be in close contact with tumor cells. We consider that the conjugates represented close interactions of tumor cells, macrophages, and mast cells by cell-to-cell contact. Three of the present cases showed a favorable course. On the other hand, one case suffered from severe anemia and thrombocytopenia due to hemophagocytic syndrome at the second admission and showed a severe clinical course. Clinicians should be aware of the risk of lymphoma-associated hemophagocytic syndrome in this low-grade lymphoma, although many of the patients with hemophagocytic syndrome in Japan have aggressive lymphomas such as diffuse large B-cell lymphoma.
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Affiliation(s)
- Rie Tabata
- Departments of Hematology and Oncology, Hyogo Prefectural Tsukaguchi Hospital
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Bassarova A, Trøen G, Spetalen S, Micci F, Tierens A, Delabie J. Lymphoplasmacytic lymphoma and marginal zone lymphoma in the bone marrow: paratrabecular involvement as an important distinguishing feature. Am J Clin Pathol 2015; 143:797-806. [PMID: 25972321 DOI: 10.1309/ajcp6zodwv1cidme] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
OBJECTIVES The differential diagnosis between bone marrow involvement by lymphoplasmacytic lymphoma (LPL) and marginal zone lymphoma (MZL) is challenging because histology and immunophenotype of both diseases overlap. We revisited the diagnostic pathology features of both diseases in the bone marrow. METHODS We studied a series of bone marrow trephine biopsy specimens from 59 patients with Waldenström macroglobulinemia without extramedullary involvement and bone marrow biopsy specimens from 23 patients with well-characterized MZL who also had bone marrow involvement. H&E- and immunoperoxidase-stained sections of bone marrow trephine biopsy specimens as well as flow cytometry and classic cytogenetics performed on aspirations were reviewed. The study was complemented with MYD88 L265P mutation analysis of all samples. RESULTS The most distinguishing features of LPL with respect to MZL were focal paratrabecular involvement (P < .001), the presence of lymphoplasmacytoid cells (P < .001) and Dutcher bodies (P < .001), increased numbers of mast cells (P < .001), and the MYD88 L265P mutation (P < .001). CONCLUSIONS LPL can be reliably distinguished from MZL in the bone marrow by using a combination of pathology characteristics. Our findings stress the diagnostic importance of using the combination of the following parameters for a correct LPL diagnosis: paratrabecular infiltration, the presence of lymphoplasmacytoid cells and cells with Dutcher bodies, and an increased number of mast cells in addition to the presence of MYD88 mutation.
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Affiliation(s)
- Assia Bassarova
- Department of Pathology, Akershus University Hospital, Oslo, Norway
- University of Oslo, Oslo, Norway
| | - Gunhild Trøen
- University of Oslo, Oslo, Norway
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Signe Spetalen
- Department of Pathology, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
| | - Francesca Micci
- Section for Cancer Cytogenetics, Institute for Cancer Genetics and Informatics, The Norwegian Radium Hospital, Oslo University Hospital, Oslo, Norway
- Centre for Cancer Biomedicine, University of Oslo, Oslo, Norway
| | - Anne Tierens
- Department of Pathology, University Health Network, Toronto, Canada
| | - Jan Delabie
- University of Oslo, Oslo, Norway
- Department of Pathology, University Health Network, Toronto, Canada
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MYD88 L265P mutation analysis helps define nodal lymphoplasmacytic lymphoma. Mod Pathol 2015; 28:564-74. [PMID: 25216226 DOI: 10.1038/modpathol.2014.120] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 07/30/2014] [Indexed: 01/09/2023]
Abstract
The diagnosis of lymphoplasmacytic lymphoma is often challenging, especially in extramedullary tissues where the differential diagnosis includes nodal marginal zone lymphoma, splenic marginal zone lymphoma, or other small B-cell neoplasms with plasmacytic differentiation. The MYD88 L265P mutation has been recently identified in >90% of bone-marrow-based lymphoplasmacytic lymphoma, but the incidence of this abnormality and corresponding morphologic correlates in nodal lymphoplasmacytic lymphoma have not been established. We analyzed 87 cases of extramedullary lymphoplasmacytic lymphoma, splenic marginal zone lymphoma, unclassifiable splenic B-cell lymphomas, nodal marginal zone lymphoma with plasmacytic differentiation, and chronic lymphocytic leukemia/small lymphocytic lymphoma with plasmacytic differentiation for MYD88 L265P. Eighteen cases (21%) were positive, including 9/9 (100%) lymphoplasmacytic lymphomas with classic histologic features, 5/12 (42%) cases that met 2008 WHO criteria for lymphoplasmacytic lymphoma but with atypical morphologic features, 3/15 (20%) cases initially considered nodal marginal zone lymphoma with plasmacytic differentiation, and 1/6 (17%) unclassifiable splenic B-cell lymphomas. The presence of MYD88 L265P was associated with IgM paraprotein (P<0.001) and a trend for bone marrow involvement (P=0.09). Each of 44 splenectomy-defined splenic marginal zone lymphomas (19 with plasmacytic differentiation) and the chronic lymphocytic leukemia/small lymphocytic lymphoma with plasmacytic differentiation were negative for the mutation. Morphologic re-review with knowledge of MYD88 mutation status and all available clinical features suggested all MYD88 mutated cases were consistent with lymphoplasmacytic lymphoma (either classic or variant histology), except for one case which remained most consistent with nodal marginal zone lymphoma with plasmacytic differentiation. These results demonstrate the importance of MYD88 mutational analysis in better defining lymphoplasmacytic lymphoma as a relatively monomorphic small B-cell lymphoma with plasmacytic differentiation that may show total nodal architectural effacement and follicular colonization. Cases previously considered lymphoplasmacytic lymphoma that are more polymorphous and are often associated with histiocytes should no longer be included in the lymphoplasmacytic lymphoma category. Clinicopathologic review suggests that although MYD88 mutated non-lymphoplasmacytic lymphoma small B-cell neoplasms exist, they are very uncommon.
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Chen K, Xie Y, Zhao L, Zhao S, He H, Mo Z. A novel mutation of thyroid hormone receptor β in exon 10 in a case of thyroid hormone-resistant non-Hodgkin's lymphoma of the thyroid. Oncol Lett 2015; 9:614-618. [PMID: 25621029 PMCID: PMC4301484 DOI: 10.3892/ol.2014.2715] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Accepted: 10/29/2014] [Indexed: 01/09/2023] Open
Abstract
Only a few previous studies have demonstrated an association between resistance to thyroid hormone (RTH) and thyroid cancer. The current study presents the case of a 67-year-old female who was referred to the Third Xiangya Hospital of Central South University with an enlargement of the neck that had grown gradually over two years and subsequently, rapidly enlarged over the two months prior to admission, alongside a slight sensation of shortness of breath. Laboratory data revealed a significantly increased level of thyroid-stimulating hormone (TSH), total triiodothyronine, total thyroxine, free triiodothyronine, free thyroxine, thyroprotein and thyroglobulin antibody; however, the levels of thyroperoxidase and TSH receptor antibody were within the normal ranges. A thyroid hormone suppression test revealed a TSH reduction of 32%, Magnetic resonance imaging of the pituitary gland was negative for abnormalities. The patient's thyroid pathology revealed a non-Hodgkin's lymphoma of the thyroid. CHOP + nimustine chemotherapy significantly reduced the clinical symptoms. The genetic analysis revealed a novel point mutation of the thyroid hormone receptor β (THRB) gene in exon 10 (g1680 G to A) in the 3'-untranslated region of the patient. To the best of our knowledge, this is the first case report of RTH with thyroid non-Hodgkin's lymphoma, which involved a mutation (g1680 G to A) in exon 10 of THRB.
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Affiliation(s)
- Ke Chen
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Yanhong Xie
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Liling Zhao
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Shaoli Zhao
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Honghui He
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
| | - Zhaohui Mo
- Department of Endocrinology, Third Xiangya Hospital of Central South University, Changsha, Hunan 410013, P.R. China
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Chong Y, Kang CS, Oh WJ, Kim TJ, Lee EJ. Nodal involvement of extranodal marginal zone lymphoma with extreme plasmacytic differentiation (Mott cell formation) simulating plasma cell neoplasm and lymphoplasmacytic lymphoma. Blood Res 2014; 49:275-85. [PMID: 25548763 PMCID: PMC4278011 DOI: 10.5045/br.2014.49.4.275] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2014] [Revised: 05/16/2014] [Accepted: 11/06/2014] [Indexed: 11/17/2022] Open
Affiliation(s)
- Yosep Chong
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Chang Suk Kang
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Woo Jin Oh
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Tae-Jung Kim
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Eun Jung Lee
- Department of Hospital Pathology, College of Medicine, The Catholic University of Korea, Seoul, Korea
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40
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Metcalf RA, Monabati A, Vyas M, Roncador G, Gualco G, Bacchi CE, Younes SF, Natkunam Y, Freud AG. Myeloid cell nuclear differentiation antigen is expressed in a subset of marginal zone lymphomas and is useful in the differential diagnosis with follicular lymphoma. Hum Pathol 2014; 45:1730-6. [DOI: 10.1016/j.humpath.2014.04.004] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/03/2013] [Revised: 04/09/2014] [Accepted: 04/11/2014] [Indexed: 02/07/2023]
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41
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Hussein S, Gill K, Baer LN, Hoehn D, Mansukhani M, Jobanputra V, Bhagat G, Alobeid B. Practical diagnostic approaches to composite plasma cell neoplasm and low grade B-cell lymphoma/clonal infiltrates in the bone marrow. Hematol Oncol 2014; 33:31-41. [DOI: 10.1002/hon.2129] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 11/16/2013] [Accepted: 11/19/2013] [Indexed: 01/01/2023]
Affiliation(s)
- Shafinaz Hussein
- Department of Pathology and Cell Biology; New York Presbyterian Hospital/Columbia University Medical Center; New York NY USA
| | - Kamraan Gill
- Department of Pathology and Cell Biology; New York Presbyterian Hospital/Columbia University Medical Center; New York NY USA
| | - Lea N. Baer
- Department of Medicine, Division of Hematology and Oncology; New York Presbyterian Hospital/Columbia University Medical Center; New York NY USA
| | - Daniela Hoehn
- Department of Pathology and Cell Biology; New York Presbyterian Hospital/Columbia University Medical Center; New York NY USA
| | - Mahesh Mansukhani
- Department of Pathology and Cell Biology; New York Presbyterian Hospital/Columbia University Medical Center; New York NY USA
| | - Vaidehi Jobanputra
- Department of Pathology and Cell Biology; New York Presbyterian Hospital/Columbia University Medical Center; New York NY USA
| | - Govind Bhagat
- Department of Pathology and Cell Biology; New York Presbyterian Hospital/Columbia University Medical Center; New York NY USA
| | - Bachir Alobeid
- Department of Pathology and Cell Biology; New York Presbyterian Hospital/Columbia University Medical Center; New York NY USA
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42
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Biclonal IgD and IgM Plasma Cell Myeloma: A Report of Two Cases and a Literature Review. Case Rep Hematol 2013; 2013:293150. [PMID: 24349805 PMCID: PMC3855939 DOI: 10.1155/2013/293150] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2013] [Accepted: 09/17/2013] [Indexed: 11/25/2022] Open
Abstract
Biclonal plasma cell myelomas producing two different isotypes of immunoglobulins are extremely rare entities; to date, the combination of IgD and IgM secretion by a biclonal plasma cell myeloma has not been reported. Bone marrow biopsy immunohistochemical studies in two cases revealed neoplastic plasma cells coexpressing IgD and IgM, but serum protein electrophoresis identified only the IgM monoclonal paraprotein in both cases. Biclonal plasma cell myelomas, while currently not well characterized in terms of their clinical behavior, should be distinguished from B-cell lymphoma with plasmacytic differentiation, given the different therapeutic implications. Both cases reported herein demonstrated chemotherapy-resistant clinical courses.
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43
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Butrym A, Prochorec-Sobieszek M, Dzietczenia J, Mazur G. Unclassifiable small B-cell lymphoma with marked plasmacytic differentiation and Mott cell formation. Leuk Lymphoma 2013; 55:1681-3. [PMID: 24083817 DOI: 10.3109/10428194.2013.848983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Aleksandra Butrym
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation
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44
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Prestes PDOP, Zenatti CT, de Sousa LFA, Nagamine AC, Felipe-Silva A. Renal small B-cell lymphoma with plasmacytic differentiation presenting with monoclonal gammopathy and disseminated intravascular coagulation syndrome. AUTOPSY AND CASE REPORTS 2013; 3:31-40. [PMID: 31528616 PMCID: PMC6671892 DOI: 10.4322/acr.2013.026] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Accepted: 09/20/2013] [Indexed: 01/13/2023] Open
Abstract
Primary renal lymphomas are very rare. However, the kidney may be a site of metastasis, usually from a disseminated aggressive lymphoma. A 58-year-old woman was brought to the medical facility due to acute mental confusion, severe hypotension, septic shock, and signs of disseminated intravascular coagulation. Laboratory tests showed severe leukopenia, renal failure, altered liver function, and elevated serum lactate dehydrogenase levels. Protein electrophoresis revealed hypergammaglobulinemia with a monoclonal peak of IgG lambda. The clinical outcome was fulminant and the patient died less than 24 hours after admission. Autopsy revealed an indolent B-cell lymphoma with extensive plasmacytic differentiation infiltrating the right renal sinus and involving the submandibular and sublingual glands, cervical and peri-aortic lymph nodes, multiple microscopic foci in pituitary and adrenal glands, lung, breast, liver, thyroid, and bone marrow. Numerous IgG4-positive plasma cells were detected by immunohistochemistry although other histological features of IgG4-related disease were missing. There was also extensive hemorrhagic necrosis of the adrenal glands and purulent cystitis, which was probably responsible for the septic shock. The authors concluded that the kidney was most likely the primary site of the indolent lymphoma, as that was the site with the largest tumor mass. Infiltration of other organs was considered as dissemination of the disease. The differential diagnosis with mucosa-associated lymphoid tissue and lymphoplasmacytic lymphoma is discussed.
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Affiliation(s)
- Paula de Oliveira Pádua Prestes
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | | | - Luiz Felipe Adsuara de Sousa
- Department of Internal Medicine - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Artur Chinen Nagamine
- Physical Medicine and Rehabilitation Department - Hospital das Clínicas - Faculdade de Medicina - Universidade de São Paulo, São Paulo/SP - Brazil
| | - Aloísio Felipe-Silva
- Anatomic Pathology Service - Hospital Universitário - Universidade de São Paulo, São Paulo/SP - Brazil
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Abstract
A 54 year old Japanese man was introduced to Saiseikai General hospital for an evaluation of an abnormal chest X-ray film. Abnormal soft tissue area was observed in the mediastinum surrounding anterior area of the trachea on chest CT. Because the mediastinal tumor showed slow enlargement after temporal decrease and surgical resection of the tumor was performed 3 years after the first visit. Pathologically, diffuse proliferation of oval-shaped plasmacytic or small lymphocytic cells with eccentrically-located nuclei with rough chromatin were observed in the tumor. Immunohistochemically, these cells were positive for CD20, weakly positive for IgM, negative for CD3, CD5, CD10, suggesting lymphoplasmacytic lymphoma (LPL). The patient was treated with rituximab after the surgical treatment, and showed no exacerbation for 3.5 years after surgery. LPL localized to the paratracheal mediastinum is rare, and a surgical approach is important for prompt and proper diagnosis.
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46
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Abstract
Lymphoplasmacytic lymphoma (LPL) is a low-grade, B-cell neoplasm composed of small lymphocytes, plasmacytoid lymphocytes, and plasma cells that typically involve the bone marrow, and it is associated with an immunoglobulin M (IgM) gammopathy. The definition of Waldenström macroglobulinemia (WM) and its relationship to LPL has been confusing in the past. In addition, the diagnosis of LPL itself can be challenging because LPL lacks disease-specific morphologic, immunophenotypic, and genetic features to differentiate it from other mature B-cell neoplasms. Accurate diagnosis of LPL/WM rests on recognition of the differential diagnostic features between LPL and other diagnostic possibilities and the use of the recently refined definition of WM and its relationship with LPL: The presence of an IgM monoclonal gammopathy of any level in the setting of bone marrow involvement by LPL. This review summarizes the clinical, laboratory, and histologic features of LPL/WM, with particular emphasis on unique aspects of LPL/WM that may aid in accurate diagnosis.
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Affiliation(s)
- Nadia Naderi
- Department of Pathology and Laboratory Medicine, University of Wisconsin, Madison, WI 53792-2472, USA
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47
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Tabata R, Yasumizu R, Tabata C, Kojima M. CD20-negative low-grade B cell lymphoma showing immunophenotypic and genotypic features resembling plasma cell myeloma. Pathol Res Pract 2013; 209:459-62. [PMID: 23707547 DOI: 10.1016/j.prp.2013.04.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2013] [Revised: 03/01/2013] [Accepted: 04/16/2013] [Indexed: 11/26/2022]
Abstract
Here we demonstrate a unique case of CD20-negative low-grade B cell lymphoma showing immunophenotypic and genotypic features resembling multiple myeloma. The female patient had no abnormal masses, splenomegaly, swelled lymph nodes, or bone lesions. Although serum levels of IgG, IgA, and IgM were decreased without M protein, κ-type Bence-Jones protein was observed. In bone marrow, monotonous proliferation of small to medium-sized lymphoid cells was observed without classical myeloma cells, the same histological findings as lymphoplasmacytic lymphoma. The cells were CD38+, CD138+, CD43+, CD44+, CD3-, CD4-, CD5-, CD7-, CD8-, CD10-, CD11b-, CD19-, CD20-, CD21-, CD23-, CD24-, CD25-, CD27-, CD40-, CD45-, and CD56-. Surface or cytoplasmic IgM, κ, or λ were all negative. Chromosomal analysis demonstrated t(11;14)(q13;q32). The present case may belong to a new entity of low-grade B cell lymphoma with the same histological findings as lymphoplasmacytic lymphoma, mainly proliferated in bone marrow whose immunophenotype and genotype are similar to plasma cell myeloma.
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Affiliation(s)
- Rie Tabata
- Department of Internal Medicine, Hyogo Prefectural Tsukaguchi Hospital, Hyogo, Japan.
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48
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Snyman H, Fromstein J, Vince A. A Rare Variant of Multicentric Large B-cell Lymphoma with Plasmacytoid and Mott Cell Differentiation in a Dog. J Comp Pathol 2013; 148:329-34. [DOI: 10.1016/j.jcpa.2012.08.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2012] [Revised: 07/24/2012] [Accepted: 08/11/2012] [Indexed: 10/27/2022]
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49
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[B-cell neoplasms with plasmacellular and plasmablastic differentiation]. DER PATHOLOGE 2013; 34:198-209. [PMID: 23462793 DOI: 10.1007/s00292-013-1743-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Plasma cell malignancies are tumors of terminally differentiated B-cells in which the neoplastic plasma cells are the dominant and proliferating tumor cell component. Plasma cell myeloma (PCM) is one of the most common hematological neoplasms and typically does not cause diagnostic problems. A morphologically and immunophenotypically detectable plasmacellular orplasmablastic differentiation is, however, commonly observed in a wide range of mature B-cell lymphomas. A confident separation of the distinct entities requires the integration of clinical and morphological findings as well as an adequate phenotyping of both the plasma cell and the B-cell component if present. Detection of lymphotropic viruses, specific translocations and novel molecular markers, such as the MYD88 L265P mutation occurring in the vast majority of lymphoplasmacytic lymphomas complement our diagnostic repertoire. In this review we describe the most commonly observed diagnostic problems in separating small B-cell lymphomas from PCM and high-grade B-cell non-Hodgkin lymphoma (B-NHL) with plasmablastic differentiation from extramedullary spread of aggressive PCM and provide helpful criteria for routine diagnostics.
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50
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Abstract
The small B-cell neoplasms represent some of the most frequently encountered lymphoproliferative disorders in routine surgical pathology practice. This report reviews the current diagnostic criteria for classifying small B-cell neoplasms and distinguishing them from newly recognized precursor conditions that do not appear to represent overt lymphomas. Newly available immunohistochemical stains and molecular studies that may assist in the diagnosis and classification of these neoplasms are also discussed.
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Affiliation(s)
- James R Cook
- Pathology and Laboratory Medicine Institute, Cleveland Clinic, 9500 Euclid Ave., Cleveland, OH 44195, USA.
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