Plasmablastic Lymphoma in an Immunocompetent Patient

Abstract

An 84-year-old female was admitted to the State University of New York University Hospital (Syracuse, NY) with complaints of persistent right hip pain for longer than 1 month. Her past medical history was significant for Wolff-Parkinson-White syndrome and osteoarthritis. The physical exam was unremarkable except for some decreased range of motion of the right hip. Computed tomography scan of the abdomen and pelvis showed a massive (8.5 ϫ 7.0 cm), asymmetric, and heterogeneous mass in the right psoas muscle (Fig 1). Radiologically, the mass appeared to be a well-circumscribed hematoma. Biopsy showed a diffuse infiltrate of large neoplastic cells with plasmablastic (cells with rounded nuclei, coarser chromatin, and smaller two to three nucleoli) and immunoblastic morphology (cells with vesicular enlarged nuclei and single prominent nucleolus, Fig 2A). High proliferative index, frequent apoptosis, and focal necrosis were seen. The neoplastic cells were essentially CD20 negative ( Fig 2B) and showed strong positivity with CD138 ( Fig 2C) and CD79a ( Fig 2D). Additionally kappa light chain restriction was noted by in situ hybridization (Figs 3A, kappa; 3B, lambda). Multiple myeloma oncogene-1 (Fig 3C) showed diffuse strong nuclear positivity and paired box gene-5 (PAX-5; Fig 3D) was positive in more than 50% of the tumor cells. Pancytokeratin, markers for breast carcinoma (GCDFP-15 and mammoglobulin), lung malignancy (TTF-1 and CK-7), melanoma (S-100 and MART-1) and other lymphoid markers (CD10, CD3, CD4, CD8, CD56, CD68, Bcl-6, ALK, and CD30) were all negative. Staining for Epstein-Barr virus (EBV) both by immunohistochemistry (EBV latent member protein 1) and in situ hybridization (EBV-encoded RNA) was also negative. Further staging work-up including computed tomography of the thorax and bone scan were

Extraoral Plasmablastic Lymphoma Detected Using Ascitic Fluid Cytology and Flow Cytometry: A Case Report with a Review of the Literature

“…This clearly implicates a causal relationship of EBV with EoPL [7]. Interestingly, the oldest patient in this review was not immunocompromised and did not have EBV infection [12]. HHV-8 was positive in only 1 of 20 cases studied; this corroborates the already established fact that HHV-8 is not often seen in PL [9].…”

“…It is also important to distinguish PL from plasmablastic myelomas, as the immunophenotypic profile is quite similar [16]. The latter usually involves bone marrow, shows lytic lesions [16] as well as M-spike on serum protein electrophoresis [12], and they tend to have some scattered mature plasma cells, which are usually not seen in PL [16]. …”

Cutaneous presentation of an aggressive plasmablastic neoplasm indiscriminate between lymphoma and myeloma

“…The cutaneous presentation and high proliferation index supported a diagnosis of PBL [3,4]. However, PBL is generally associated with HIV and EBV, which were negative in the patient presented here [1,2,5,6]. Bone marrow involvement in the absence of lymphadenopathy, and CD56-positivity of the plasmablasts, favoured a diagnosis of PBM [7,1].…”

“…However, PBL is generally associated with HIV and EBV, which were negative in the patient presented here [1,2,5,6]. Bone marrow involvement in the absence of lymphadenopathy, and CD56-positivity of the plasmablasts, favoured a diagnosis of PBM [7,1]. However, the absence of osteolytic bone lesions and a paraprotein, and the presence of normal free light chain, calcium, haemoglobin and creatinine levels were strong features against the diagnosis of myeloma.…”

“…However, the distinction can be difficult as both morphology and immunophenotype of the tumour cells are largely identical [1,2]. The case presented here demonstrates that the distinction can be impossible.…”