Authors: Wing Y Au Lau WaiHung Kai Y Wong William W L Choi
Publish Date: 2012/03/08
Volume: 91, Issue: 10, Pages: 1649-1651
Abstract
a Computerized tomogram scan showing a gallbladder lesion arrow b Positron emission tomogram scan showing FDG avid uptake arrows in the porta hepatis as well as in the sternum ribs and femur c Magnetic resonance imaging showing osteolytic lesions in multiple vertebra levels d–f Marrow aspirate and trephine biopsy showing heavy lymphoma infiltration with no evidence of plasma cell dyscrasia The B cells were highlighted by CD20 staining f g–i The gallbladder lesion showed sheets of plasma cells with CD138 expression g negative for kappa light chain h but expressing lambda light chain i j Polymerase chain reaction using IgH primers on DNA extracted from marrow and gallbladder lesions showing bands of similar band size asterisk and arrow MW molecular weight control PC positive control NC negative control BM bone marrow TM tissue material from gallbladder H 2 O water blank k Cloning sequencing and alignment showing homology between clones from the two discordant lesionsThis case is interesting in terms of pathogenesis and treatment In terms of pathogenesis cases of concomitant B cell lymphoproliferation and plasma cell dyscrasia are rare and usually of independent clones 2 The immunophenotyping and light chain expression do not suggest a common evolution from a lymphoplasmacytoid lymphoma Our case is characterized by clonal homology but discordant light chain expression immunophenotype and morphology Plasma cell myeloma with discordant light chain secretion is well documented 3 Posttreatment switch in monoclonal protein may also occur after SCT 4 More dramatically changes in immunophenotype morphology and light chain expression in B cell malignancies after rituximab treatment are also recognized 1 5 6 However in our case the clones occurred concomitantly and upfront in distinct cell lineages This may theoretically result from plasma cell differentiation of the malignant B lymphocytes or a divergent evolution from a primordial B cell clone Pools of malignant clonotypic B cells are known to exist in PCM patients 7 In terms of treatment a combination of lymphoma and PCM treatment seems to be effective in controlling both lesions with minimal overlap of toxicity It is uncertain whether this patient may have survival benefit from an autologous SCTThis article is published under an open access license Please check the Copyright Information section for details of this license and what reuse is permitted If your intended use exceeds what is permitted by the license or if you are unable to locate the licence and reuse information please contact the Rights and Permissions team
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