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Seili-Bekafigo I, Torlakovic E, Grenko Malnar T, Damić MS, Prka Ž, Matušan Ilijaš K, Hadžisejdić I. Atypical Plasma Cell Leukemia Mistaken for Acute Leukemia: A Case Report. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:1351. [PMID: 39202633 PMCID: PMC11356772 DOI: 10.3390/medicina60081351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2024] [Revised: 07/31/2024] [Accepted: 08/07/2024] [Indexed: 09/03/2024]
Abstract
The patient we present here had many clinical, morphological, and laboratory findings characteristic of acute leukemia. During the course of the disease, the diagnosis changed from acute leukemia to chronic small B-cell lymphoproliferative disease, a blastoid variant of mantle cell lymphoma, and finally to atypical plasma cell leukemia. Atypical plasma cell leukemia is a rare condition with aggressive biological behavior. Our patient relapsed a short time after achieving complete remission, in spite of aggressive therapy and autologous stem cell transplantation. During relapse, it was possible to morphologically identify malignant cells as being of plasma cell origin, although immature and atypical. Atypical plasma cell leukemia presents a diagnostic challenge as it may mimic other neoplasms both morphologically and clinically. It is also recognized that plasma cell neoplasm immunophenotype may not be entirely specific for its lineage where common diagnostic biomarkers are applied by immunohistochemistry or flow cytometry. Where this is the case, only focused investigation for plasma cell lineage will be more informative. This patient has unusual clinical presentation, a nondescript morphology of the circulating plasma cells, as well as an immunophenotype, detected by the initial panels used for flow cytometry and immunohistochemistry, that was not entirely specific for plasma cells. Such cases present a good reminder of the diagnostic complexity of atypical plasma cell leukemia and emphasize that plasma cell differentiation needs to be interrogated in cases where the initial work-up shows unusual results.
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Affiliation(s)
- Irena Seili-Bekafigo
- Department of Cytology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia
| | - Emina Torlakovic
- Department of Pathology and Laboratory Medicine, College of Medicine, University of Saskatchewan, Saskatoon, SK S7N 5A2, Canada;
| | - Tajana Grenko Malnar
- Department of Hematology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
| | - Marija Stanić Damić
- Department of Hematology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, Krešimirova 42, 51000 Rijeka, Croatia
| | - Željko Prka
- Department of Hematology, University Hospital Dubrava, 10000 Zagreb, Croatia;
| | - Koviljka Matušan Ilijaš
- Department of Pathology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (K.M.I.)
| | - Ita Hadžisejdić
- Department of Pathology, Faculty of Medicine, University of Rijeka, Clinical Hospital Center Rijeka, 51000 Rijeka, Croatia; (K.M.I.)
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Foiani G, Zanardello C, Carminato A, Melchiotti E, Roccabianca P, Tecilla M, Vascellari M. Chromogenic in situ hybridization for the detection of lambda and kappa immunoglobulin light chains as a potential auxiliary diagnostic technique in canine plasmacytomas. J Vet Diagn Invest 2020; 32:675-682. [PMID: 32627692 PMCID: PMC7488974 DOI: 10.1177/1040638720938687] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
The heterogeneous morphologic features of canine plasmacytomas (PCTs) can make their differentiation from other round cell tumors challenging. Immunohistochemistry (IHC) for lambda (λ) and kappa (к) immunoglobulin (Ig) light chains is often equivocal because of high background staining. The chromogenic in situ hybridization (CISH) technique for light chains has shown higher sensitivity compared to IHC in human plasma cell tumors. Therefore, we aimed to validate automated CISH for light chains in canine tissues and to evaluate its diagnostic potential in canine PCTs, in conjunction with routinely used IHC markers. CISH for light chains demonstrated a clear signal in plasma cell populations of canine control tissues (lymph nodes, lymphoplasmacytic inflammation) showing a polyclonal pattern with a prevalence of λ-producing cells. CISH detected monotypic light chain expression in 33 of 53 (62%) PCTs, 31 expressing λ and 2 expressing к. CISH was more sensitive than IHC for λ light chain (58% vs. 47%, respectively) and more easily interpretable given the absence of confounding background staining. The absence of CISH staining for both λ and к in a considerable subset of tumors may be the result of lower light chain production by neoplastic cells. Multiple myeloma oncogene 1 (MUM1) was expressed by all but 2 PCTs (96%), which showed λ expression by CISH and IHC. The identification of poorly differentiated canine PCTs requires the assessment of a panel of IHC markers, with the potential support of CISH for Ig light chains.
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Affiliation(s)
- Greta Foiani
- Greta Foiani, Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, Viale dell’Università 10, Legnaro, Padua, 35020, Italy.
| | - Claudia Zanardello
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy (Foiani, Zanardello, Carminato, Melchiotti, Vascellari)
- Department of Veterinary Medicine (DIMEVET), University of Milano, Milano, Italy (Roccabianca, Tecilla)
| | - Antonio Carminato
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy (Foiani, Zanardello, Carminato, Melchiotti, Vascellari)
- Department of Veterinary Medicine (DIMEVET), University of Milano, Milano, Italy (Roccabianca, Tecilla)
| | - Erica Melchiotti
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy (Foiani, Zanardello, Carminato, Melchiotti, Vascellari)
- Department of Veterinary Medicine (DIMEVET), University of Milano, Milano, Italy (Roccabianca, Tecilla)
| | - Paola Roccabianca
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy (Foiani, Zanardello, Carminato, Melchiotti, Vascellari)
- Department of Veterinary Medicine (DIMEVET), University of Milano, Milano, Italy (Roccabianca, Tecilla)
| | - Marco Tecilla
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy (Foiani, Zanardello, Carminato, Melchiotti, Vascellari)
- Department of Veterinary Medicine (DIMEVET), University of Milano, Milano, Italy (Roccabianca, Tecilla)
| | - Marta Vascellari
- Laboratory of Histopathology, Istituto Zooprofilattico Sperimentale delle Venezie, Legnaro, Padua, Italy (Foiani, Zanardello, Carminato, Melchiotti, Vascellari)
- Department of Veterinary Medicine (DIMEVET), University of Milano, Milano, Italy (Roccabianca, Tecilla)
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