Concomitant Waldenstrom macroglobulinemia and IgA plasmablastic myeloma in a patient with untreated IgM paraproteinemia: sequential development of biclonal B-cell neoplasms over a 10-year period in a single individual

Wang, Endi; Kulbacki, Evan; Stoecker, Maggie

doi:10.1016/j.humpath.2011.11.001

Cited by 17 publications

(11 citation statements)

References 11 publications

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“…The monotypic B‐cell component in one case met criteria for CLL/SLL. Prior studies report CLL/SLL to be the most common B‐NHL occurring concomitantly with PCN, with the PCN component diagnosed 1–15 years after CLL/SLL diagnosis . This distribution is not reflected in our series because of our small sample size.…”

Section: Discussionmentioning

confidence: 72%

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Practical diagnostic approaches to composite plasma cell neoplasm and low grade B‐cell lymphoma/clonal infiltrates in the bone marrow

Hussein

Gill

Baer

et al. 2014

Hematological Oncology

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Composite plasma cell neoplasm (PCN) and low grade B-cell lymphoma (B-NHL) in the bone marrow are uncommon and raise the differential diagnosis of B-NHL with plasmacytic differentiation and PCN with lymphoplasmacytic morphology. This can be a challenging differential diagnosis, and the distinctions are important because of differences in management. We report five cases of composite PCN with B-NHL or clonal B-cell infiltrates involving the bone marrow. By using multiple different diagnostic modalities, including immunophenotyping by flow cytometry and immunohistochemistry, cytogenetic analysis and IGH gene rearrangement studies by polymerase chain reaction, we were able to distinguish two distinct clonally unrelated neoplasms in all cases. We describe the utility and pitfalls of these different diagnostic modalities. Flow cytometric analysis with a panel of antibodies that includes CD19, CD56, CD138, CD45 and other aberrant markers commonly expressed by PCN will allow identification of clonally unrelated PCN and B-NHL in a composite neoplasm, and distinguish them from B-NHL with plasmacytic differentiation and PCN with lymphoplasmacytic morphology. Cytogenetic and molecular analyses can give false-negative or false-positive results. In summary, a multimodal approach utilizing these different tools, including clinical data, should be used to arrive at the correct diagnosis.

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Section: Discussionmentioning

confidence: 72%

“…Low grade B‐cell non‐Hodgkin lymphoma coexisting with clonally unrelated PCN is uncommon and has been reported in the past as case reports and series . Although uncommon, it should be part of the differential diagnosis when faced with B‐NHL exhibiting PD or a PCN with lymphoplasmacytic morphology .…”

Section: Discussionmentioning

confidence: 99%

Practical diagnostic approaches to composite plasma cell neoplasm and low grade B‐cell lymphoma/clonal infiltrates in the bone marrow

Hussein

Gill

Baer

et al. 2014

Hematological Oncology

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“…Flow cytometric and molecular assays were not available. In the second case, describedin 2012 by Wang E, et al, 4 a patient developed a sequential development of WM and plasmablastic IgA multiple myeloma over a 10-year period of untreated IgM gammopathy. Another, but very rare possibility, is represented by evolution of WM into an IgM-producing MM.…”

Section: Discussionmentioning

confidence: 99%

“…In these instances, acute myeloid leukemia and diffuse large Bcell lymphoma can occur, always being therapy-related. 2 So far, an association of WM with multiple myeloma (MM) has been reported in only two cases, 3,4 and in a single case the evolution of WM into an aggressive form of IgMpositive multiple myeloma has been described. 5 On the other hand, MM is a more frequent disease and is characterized by the proliferation of a single clone of plasma cells derived from B cells in the bone marrow and, in most cases, by the production of a monoclonal protein such as IgG, IgA or light chain only.…”

Section: Introductionmentioning

confidence: 99%

Simultaneous Presentation of Waldenstr^|^ouml;m Macroglobulinemia and Multiple Myeloma: Multidisciplinary Diagnosis, Treatment and 30-Month Follow-up

Carulli

Ciancia

Azzarà

et al. 2013

J Clin Exp Hematopathol

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Waldenström macroglobulinemia and multiple myeloma are mature B-cell neoplasms deriving from post-germinal cells at different stages of differentiation. The simultaneous presentation of Waldenström macroglobulinemia and multiple myeloma in the same patient is a very rare phenomenon and, so far, only two cases have been described. We report the case of a 75-year Caucasian female patient, with a silent clinical history, who presented with anemia and two different monoclonal proteins (IgMk and IgGk). The trephine biopsy showed the presence of a dual population, represented by small lymphoplasmacytoid cells and by plasma cells, which infiltrated the bone marrow with a clearly different pattern. Both immunohistochemistry and flow cytometry demonstrated the biclonal origin such neoplastic cells, since lymphoplasmacytoid cells resulted IgMk while plasma cells were IgGk. This biclonal pattern was further confirmed by the demonstration of a different IgH gene rearrangement of the two neoplasms. The patient was treated with bortezomib, dexamethasone and rituximab, achieving partial remission of both Waldenström macroglobulinemia and multiple myeloma. After a 30-month follow-up, she is in stable disease. Multiple myeloma has been described in association with other indolent B-cell neoplasms, mostly chronic lymphocytic leukemia, while Waldenström macroglobulinemia can be followed by diffuse large B-cell lymphoma in some instances, after chemotherapy. The association of Waldenström macroglobulinemia and multiple myeloma seems to be very rare. Our study shows that an integrated diagnostic work-up is very useful in such cases, with an interesting role for flow cytometry. 〔J Clin Exp Hematop 53(1): 29-36, 2013〕

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“…One large series (25) reported 15 cases, in which bone marrow showed simultaneous presence of monotypic and/or atypical plasma cells and a monotypic B-cell population with CLL immunophenotype. Prior studies report CLL/SLL/MBL to be the most common LPD occurring concomitantly with PCN (24)(25)(26)(27)(28)(29). In our study, four cases of a concurrent B-LPD and PCM were found (10%).…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Lymphoproliferative Disorders with More Than One Aberrant Cell Population as Detected by 10‐Color Flow Cytometry

Mahdi

Rajab

Padmore

et al. 2016

Cytometry Part B Clinical

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Concomitant Waldenstrom macroglobulinemia and IgA plasmablastic myeloma in a patient with untreated IgM paraproteinemia: sequential development of biclonal B-cell neoplasms over a 10-year period in a single individual

Cited by 17 publications

References 11 publications

Practical diagnostic approaches to composite plasma cell neoplasm and low grade B‐cell lymphoma/clonal infiltrates in the bone marrow

Practical diagnostic approaches to composite plasma cell neoplasm and low grade B‐cell lymphoma/clonal infiltrates in the bone marrow

Simultaneous Presentation of Waldenstr^|^ouml;m Macroglobulinemia and Multiple Myeloma: Multidisciplinary Diagnosis, Treatment and 30-Month Follow-up

Characteristics of Lymphoproliferative Disorders with More Than One Aberrant Cell Population as Detected by 10‐Color Flow Cytometry

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