Composite monoclonal B-cell lymphocytosis and MYD88 L265P-positive lymphoplasmacytic lymphoma in a patient with IgM light chain amyloidosis: Case report.
IgM light chain (AL) amyloidosis
MYD88 L265P
laser-capture microdissection
lymphoplasmacytic lymphoma
monoclonal B-cell lymphocytosis
Journal
Pathology international
ISSN: 1440-1827
Titre abrégé: Pathol Int
Pays: Australia
ID NLM: 9431380
Informations de publication
Date de publication:
Jul 2020
Jul 2020
Historique:
received:
28
02
2020
revised:
23
03
2020
accepted:
06
04
2020
pubmed:
24
4
2020
medline:
1
5
2021
entrez:
24
4
2020
Statut:
ppublish
Résumé
Monoclonal B-cell lymphocytosis (MBL) is an early or precursor asymptomatic proliferation of chronic lymphocytic lymphoma (CLL)-like B-cells. Lymphoplasmacytic lymphoma (LPL), often clinically associated with Waldenström macroglobulinemia, is a B-cell neoplasm characterized by frequent MYD88 L265P mutation. Here, we report a rare composite MBL and LPL in a patient with IgM light chain (AL) amyloidosis. A 74-year-old male with a known IgM monoclonal protein developed proteinuria. No lymphocytosis was detected. Renal biopsy showed deposition of AL λ amyloid in the glomeruli and vessels. Subsequent bone marrow biopsy revealed nodular atypical CLL-like small B-cell proliferation and scattered peripheral LPL. Immunohistochemistry and/or flow cytometry revealed that the atypical CLL-like population expressed CD19, CD20, CD5, weak CD23, LEF-1 and diminished surface Igκ. The LPL was positive for CD19, CD20 and surface Igλ. Using laser-capture microdissection and allele-specific polymerase chain reaction, we confirmed that MYD88 L265P was detectable in the LPL but not in the atypical CLL-like population. Thus, we demonstrated that these two populations were clonally independent, and made the diagnosis of composite MBL and LPL. An integrated clinical, pathological, immunophenotypic and genetic assessment is essential in such complicated cases, and especially 'clone-specific' MYD88 genotyping may facilitate the differential diagnoses of low-grade B-cell lymphomas.
Substances chimiques
MYD88 protein, human
0
Myeloid Differentiation Factor 88
0
Types de publication
Case Reports
Langues
eng
Sous-ensembles de citation
IM
Pagination
458-462Informations de copyright
© 2020 Japanese Society of Pathology and John Wiley & Sons Australia, Ltd.
Références
Mailankody S, Landgren O. Monoclonal gammopathy of undetermined significance and Waldenström's macroglobulinemia. Best Pract Res Clin Haematol 2016; 29: 187-93.
Treon SP, Xu L, Yang G et al. MYD88 L265P somatic mutation in Waldenström's macroglobulinemia. N Engl J Med 2012; 367: 826-33.
Improgo MR, Tesar B, Klitgaard JL et al. MYD88 L265P mutations identify a prognostic gene expression signature and a pathway for targeted inhibition in CLL. Br J Haematol 2019; 184: 925-36.
Oishi N, Kondo T, Nakazawa T et al. High prevalence of the MYD88 mutation in testicular lymphoma: Immunohistochemical and genetic analyses. Pathol Int 2015; 65: 528-35.
Kraan W, Horlings HM, van Keimpema M et al. High prevalence of oncogenic MYD88 and CD79B mutations in diffuse large B-cell lymphomas presenting at immune-privileged sites. Blood Cancer J 2013; 3: e139.
Ganapathi KA, Pittaluga S, Odejide OO, Freedman AS, Jaffe ES. Early lymphoid lesions: Conceptual, diagnostic and clinical challenges. Haematologica 2014; 99: 1421-32.
Fend F, Cabecadas J, Gaulard P et al. Early lesions in lymphoid neoplasia: Conclusions based on the Workshop of the XV. Meeting of the European Association of Hematopathology and the Society of Hematopathology, in Uppsala, Sweden. J Hematop 2012; 5: 169-99.
Xu D. Dual surface immunoglobulin light-chain expression in B-cell lymphoproliferative disorders. Arch Pathol Lab Med 2006; 130: 853-56.
Milani P, Merlini G. Monoclonal IgM-related AL amyloidosis. Best Pract Res Clin Haematol 2016; 29: 241-48.
Sidana S, Larson DP, Greipp PT et al. IgM AL amyloidosis: Delineating disease biology and outcomes with clinical, genomic and bone marrow morphological features. Leukemia 2019 https://doi.org/10.1038/s41375-019-0667-6
Shi M, Spurgeon S, Press R, Olson S, Fan G. MYD88 mutation analysis of a rare composite chronic lymphocyte leukemia and lymphoplasmacytic lymphoma by flow cytometry cell sorting. Ann Hematol 2015; 94: 1941-44.