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Shi X, Wu J, Jiang Q, Zhang S, Chen W, Yu X, Liu Y, Chen M, Peng J, Li T, Zhu Y, Xi X. Synchronous diagnosis of anaplastic large cell lymphoma and multiple myeloma in a patient: A case report. Medicine (Baltimore) 2020; 99:e22931. [PMID: 33126356 PMCID: PMC7598776 DOI: 10.1097/md.0000000000022931] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
RATIONALE Synchronous development of both anaplastic large cell lymphoma (ALCL) and multiple myeloma (MM) in a patient is rare. To our knowledge, until now only one case has been reported. Treatment needs to cover both and is a challenge. Here we reported another case and discussed the diagnosis and treatment. PATIENT CONCERNS This is a 63-year old woman who presented with a mass in upper abdominal skin. Positron emission tomography/computed tomography (PET/CT) showed the high metabolism in left abdominal skin and left axillary lymph nodes. Histopathologic and immunohistochemical evaluation identified the cutaneous mass as an ALK-negative ALCL. Bone marrow smear showed increased plasma cells which expressed CD38, CD138, and cLambda concomitantly. The increased monoclonal immunoglobulin IgD λ was detected by immunofixation electrophoresis. DIAGNOSES Diagnosis of both ALCL and MM was confirmed. INTERVENTIONS The patient successively received 6 cycles of B-CHOD regimen, one cycle of ID regimen, 2 cycles of DHAX regimen, one cycle of L-DA-EPOCH and autologous stem cell transplantation (ASCT). Then lenalidomide was performed as a maintenance therapy. OUTCOMES Both ALCL and MM achieved complete remission. LESSONS We reported a very rare case with synchronous development of ALCL and MM, in whom a good therapeutic response to chemotherapies followed by ASCT has been observed.
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Affiliation(s)
- Xiaofeng Shi
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
- The Second Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu
| | - Jiannong Wu
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Qian Jiang
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Shuo Zhang
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Wanru Chen
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Xianqiu Yu
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Yichen Liu
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Min Chen
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Jie Peng
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Tiantian Li
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Yan Zhu
- Affiliated Hospital of Jiangsu University, No. 438, North Jiefang Road, Zhenjiang, Jiangsu, PR
| | - Xiaodong Xi
- Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, PR China
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Sharma A, Kaul N, Singh N, Mehta A, Gupta G. Synchronous T-Non Hodgkins Lymphoma and Multiple Myeloma: A Rare Association. Indian J Hematol Blood Transfus 2019; 36:434-437. [PMID: 32425410 DOI: 10.1007/s12288-019-01160-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2019] [Accepted: 07/11/2019] [Indexed: 10/26/2022] Open
Affiliation(s)
- Abhimanyu Sharma
- Department of Pathology and Lab Services, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi India
| | - Namrata Kaul
- Department of Pathology and Lab Services, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi India
| | - Neha Singh
- Department of Pathology and Lab Services, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi India
| | - Anurag Mehta
- Department of Pathology and Lab Services, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi India
| | - Gurudutt Gupta
- Department of Pathology and Lab Services, Rajiv Gandhi Cancer Institute and Research Center, Rohini, Delhi India
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Rapid Fatal Acute Peripheral T-Cell Lymphoma Associated With IgG Plasma Cell Leukemia and IgA Hypergammaglobulinemia. Appl Immunohistochem Mol Morphol 2017; 24:e89-e93. [PMID: 27824644 DOI: 10.1097/pai.0000000000000361] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Simultaneous occurrence of T-cell and B-cell neoplasms is rare, and etiologic relationships between these 2 malignancies are poorly understood. We describe the case of a 66-year-old woman who was admitted to the hospital because of fever, hemoptysis, lymphadenopathy, and skin rash. Enlarged lymph nodes in axillary, pectoral, paratracheal, and periportal regions as well as slight hepatomegaly and splenomegaly were confirmed. A peripheral blood smear revealed rouleaux formation and numerous circulating plasma cells, with plasmacytoid lymphocytes. Immunofixation-electrophoresis detected a monoclonal band defined as immunoglobulin (IgG)-lambda light chains with broad-band polyclonal IgA. The patient died from abrupt splenic rupture before diagnostic work-up was finished. Postmortem examination revealed infiltration of atypical lymphoid cells exhibiting high proliferative activity admixed with typical and atypical plasma cells in several organs. Thus, plasma cell leukemia (IgG-lambda) as a rare and aggressive variant of plasma cell myeloma in the present case was associated with aggressive peripheral T-cell lymphoma and polyclonal (IgA) plasmacytosis.
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Xu J, Tang Y, Zhao S, Zhang W, Xiu Y, Liu T, Wu Y. Angioimmunoblastic T-cell lymphoma with coexisting plasma cell myeloma: a case report and review of the literature. TOHOKU J EXP MED 2015; 235:283-8. [PMID: 25816919 DOI: 10.1620/tjem.235.283] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Angioimmunoblastic T-cell lymphoma (AITL) is recognized as a distinct clinicopathological subtype of peripheral T-cell lymphomas. Its clinical features include generalized lymphadenopathy, constitutional symptoms, and autoimmune-related findings, such as hemolytic anemia. Pathologically, AITL is characterized by a polymorphous infiltrate in lymph nodes with prominent proliferation of high endothelial venules and follicular dendritic cells. We present an 80-year-old Chinese man with generalized lymphadenopathy and pulmonary infection, diagnosed as AITL based on the distinctive pathological findings and T-cell receptor gamma (TCR-γ) gene rearrangement analysis of lymph nodes. Importantly, the patient suffered from a coexisting plasma cell myeloma, as judged by monoclonal immunoglobulin in the serum, immature plasma cells, and rearrangement of the immunoglobulin heavy-chain (IgH) gene in the bone marrow. The patient received two courses of the chemotherapy but died of pneumonia 6 months after diagnosis. AITL can be accompanied by polyclonal or clonal proliferation of B lymphocytes; however, AITL are rarely associated with plasma cell proliferation. In fact, 14 AITL cases with plasma cell proliferation have been reported in the literature, but none of them manifested the infiltration of monoclonal immature plasma cells in the bone marrow. To the best of our knowledge, this is the first report of newly diagnosed, concurrent AITL and plasma cell myeloma, providing the evidence for the interplay between malignant T cells and plasma cell proliferation. A review of the literature has also supported a relationship between AITL and plasma cell proliferation. Awareness of this relationship is important for correct diagnosis and appropriate treatment of AITL.
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Affiliation(s)
- Juan Xu
- Department of Hematology and Hematology Research Laboratory, West China Hospital, Sichuan University
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Tangour M, Chelly I, Haouet S, Zitouna M, Kchir N. Multiple myeloma and cutaneous anaplastic large T-cell lymphoma in the same patient: Is there a causal relation? J Cutan Pathol 2011; 38:298-300. [DOI: 10.1111/j.1600-0560.2009.01447.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Hwang JE, Cho SH, Kim OK, Shim HJ, Lee SR, Ahn JS, Yang DH, Kim YK, Lee JJ, Kim HJ, Chung IJ. Newly developed multiple myeloma in a patient with primary T-cell lymphoma of bone. J Korean Med Sci 2008; 23:544-7. [PMID: 18583898 PMCID: PMC2526528 DOI: 10.3346/jkms.2008.23.3.544] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Primary non-Hodgkin's lymphoma of bone (PLB) is rare, and generally presents as a single extensive and destructive bone lesion. Histopathologically, most cases present as diffuse large B-cell lymphoma, and T-cell lymphoma is rare. By contrast, multiple myeloma is a disease defined as the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. We report a case of multiple myeloma that developed during treatment of PLB in a type of T-cell. A 48-yr-old man was diagnosed as T-cell PLB, stage IE, 18 months ago. The patient received the chemoradiotherapy and salvage chemotherapy for PLB. However, the lymphoma progressed with generalized bone pain, and laboratory findings showed bicytopenia and acute renal failure. On bone marrow biopsy, the patient was diagnosed as having multiple myeloma newly developed with primary T-cell lymphoma of bone. In spite of chemotherapy, the patient died of renal failure.
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Affiliation(s)
- Jun-Eul Hwang
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Sang-Hee Cho
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Ok-Ki Kim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyun-Jeong Shim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Se-Ryeon Lee
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Jae-Sook Ahn
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Duk-Hwan Yang
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Yeo-Kyeoung Kim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Je-Jung Lee
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Hyeoung-Joon Kim
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
| | - Ik-Joo Chung
- Department of Internal Medicine, Division of Hemato-Oncology, Chonnam National University Medical School, Gwangju, Korea
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Qian YW, Siegel D, Bhattacharyya P. Multiple Skin Lesions in a Patient With Multiple Myeloma. Arch Pathol Lab Med 2006; 130:e41-3. [PMID: 16519585 DOI: 10.5858/2006-130-e41-msliap] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- You-Wen Qian
- Department of Pathology, University of Medicine and Dentistry of New Jersey, Newark, NJ, USA
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Hamurcu Z, Demirtas H, Ascioglu O, Dönmez-Altuntas H, Aktas E. Micronucleus evaluation in mitogen-stimulated lymphocytes of PUVA treated patients. TOHOKU J EXP MED 2002; 198:11-21. [PMID: 12498310 DOI: 10.1620/tjem.198.11] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
PUVA describes the treatment of patients with psoralens plus an exposure to a source of UV light of 320-400 nm (UVA). Contradictory results have been reported on the chromosomal damage of PUVA when assayed by sister chromatid exchange (SCE) method. Micronucleus (MN) test is used to detect both clastogenic (breaking) and aneugenic (abnormal segregation) effect of physical/chemical agents on the chromosomes. No data have been found on the MN formation in the cells of PUVA treated patients. Frequency of micronuclei in 72 hours cultivated/mitogen-stimulated lymphocytes of patients have been evaluated at zero time and after 20, 40, 60 sessions of PUVA treatment. While the beginning MN frequency was approximately 0.22% (n=23), it raised to approximately 0.32 (n=23), approximately 0.42 (n=14) and approximately 0.53% (n=10) corresponding respectively to 20, 40 and 60 sessions. These sessions correspond reciprocally to 54+/-23, 172+/-48, 300+/-61 joules/cm2 of UVA and 13, 26, 39 mg/kg of 8-metoxypsoralen (8-MOP). While large interindividual variances were apparent, highly significant differences have been observed between initial MN frequency and after that of the 20, 40 and 60 sessions, (p = 0.000, p = 0.004, p = 0.005, reciprocally, Wilcoxon two-related samples test). The coefficient of correlation between MN frequency and UVA doses starting from zero to 60 sessions of treatment has been found as r = 0.61. This indicates a significant relationship between UVA doses and MN frequencies. However, MN inducibility and synergistic property of 8-MOP with UVA should be taken into account. Gradual MN increase during different sessions of PUVA treatment shows that--once appeared--a part of MN at least persist in the cells of patients from a few days to a few weeks. Smoking as a confounding factor seems to increase MN frequency (p = 0.053, Mann-Whitney U-test) in the beginning population, taken as the control population. This is the first report on the kinetics of MN formation during different sessions of PUVA treatment. Based on our results, we concluded that PUVA treatment causes a detectable chromosome damaging effect on the relatively profound cells/tissues of its human users. Therapists should be careful with its use, especially on the patients who may be more susceptible to carcinogenesis (e.g. immunosuppressed and/or elderly subjects).
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Affiliation(s)
- Zuhal Hamurcu
- Medical Biology and Genetics Department, Medical Faculty, Erciyes University, 38039 Kayseri, Turkey.
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