Plasmablastic lymphomas and plasmablastic plasma cell myelomas have nearly identical immunophenotypic profiles

Vega, Francisco; Chang, Chung Che; Medeiros, L. Jeffrey; Udden, Mark M.; Cho‐Vega, Jeong Hee; Lau, Ching C.; Finch, Chris J.; Vilchez, Regis A.; McGregor, David K.; Jorgensen, Jeffrey L.

doi:10.1038/modpathol.3800355

Cited by 322 publications

(333 citation statements)

References 37 publications

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“…The presence of c-MYC rearrangement has been reported in 15% of cases of multiple myeloma or primary plasma cell leukemia in a study by Avet-Loiseau et al 20 Although plasmablastic myeloma and plasmablastic lymphoma can be indistinguishable by immunophenotype and morphology, the strong cyclin D1 positivity and absence of Epstein-Barr virus support the diagnosis of plasmablastic myeloma over plasmablastic lymphoma in this case. 21 In the low-grade B-cell lymphoma, we demonstrated a higher percentage of cells showing IGH/BCL2 fusion signals than c-MYC rearrangement, raising the possibility of c-MYC rearrangement as a secondary event. However, as the FISH analyses were performed on two separate peripheral blood smears, and the conventional cytogenetics showed all of the evaluated metaphases contained either both abnormalities, or neither abnormality, we were unable to confirm this possibility.…”

Section: Discussionmentioning

confidence: 70%

Lymphoid neoplasms associated with concurrent t(14;18) and 8q24/c-MYC translocation generally have a poor prognosis

et al. 2006

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We identified 14 B-cell neoplasms with concurrent t(14;18) and chromosome 8q24 or c-MYC translocations shown by conventional cytogenetics or fluorescence in situ hybridization analysis. All cases assessed by conventional cytogenetics had a complex karyotype. There were 10 men and four women, with a median age of 55 years (range, 29-72). None of these patients had a history of follicular lymphoma. The biopsy specimens were obtained from bone marrow, lymph node, and extranodal sites. Morphologically, nine neoplasms had features of Burkitt or atypical Burkitt lymphoma/leukemia and three were diffuse large B-cell lymphoma with high-grade cytologic features. The remaining two cases were plasmablastic myeloma and low-grade B-cell lymphoma, respectively. All cases expressed BCL-2. The proliferation index assessed by using Ki-67 (MIB1) was 5% in the low-grade B-cell lymphoma, 80% in the plasmablastic myeloma, 90-95% in three cases of diffuse large B-cell lymphoma, and ranged from 90 to 499% in most Burkitt and atypical Burkitt neoplasms. The patient with low-grade B-cell lymphoma was treated with rituximab. All other patients received intensive combination chemotherapy. Two of these patients underwent bone marrow transplantation, and one patient received radiation therapy in addition to transplantation. The median follow-up period was 9 months (range, 3-81). In all, 10 patients died with a median survival of 9 months (range, 3-81). We conclude that most B-cell lymphomas with concurrent t(14;18) and 8q24/c-MYC translocations fall within the morphologic spectrum of diffuse large B-cell and Burkitt lymphoma. These neoplasms are high-grade and are associated with a poor prognosis. However, this combination of molecular abnormalities can also rarely occur in other neoplasms, such as the cases of low-grade B-cell lymphoma and plasmablastic myeloma in this study.

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Section: Discussionmentioning

confidence: 70%

Lymphoid neoplasms associated with concurrent t(14;18) and 8q24/c-MYC translocation generally have a poor prognosis

et al. 2006

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“…In our analysis, the overall survival of these two stages did not statistically differ. Several reasons that may account for this unexpected finding include: (1) differences in treatment between these two stages (e.g., a more aggressive and effective treatment of stage IV disease may offset its inherently worse prognosis than stage I disease), (2) inaccuracy in diagnosing or staging of PBL, (3) biological aggressiveness of lymphomas with plasmablastic morphology [43], (4) similarities of PBL with plasma cell myeloma [44] (e.g., myeloma staging and therapy differ greatly from those of lymphoma), (5) the retrospective nature and limitations of our data, and (6) inadequate reporting of survival in the analyzed articles. Because of these shortcomings, HIV-associated PBL cases should be followed prospectively to observe the outcome of these patients in the HAART era.…”

Section: Discussionmentioning

confidence: 99%

HIV‐associated plasmablastic lymphoma: Lessons learned from 112 published cases

2008

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Plasmablastic lymphoma (PBL) is a distinct subtype of non-Hodgkin B-cell lymphoma, originally described with a strong predilection to the oral cavity of human immunodeficiency virus (HIV)-infected individuals. Data regarding patient age and gender, HIV status, initiation of and response to highly active antiretroviral therapy (HAART), tumor extent, pathology, treatment, and outcome were extracted from 112 cases of PBL identified in the literature. The median age at presentation was 38 years with a male predominance of 7:1, and the median CD41 count was 178 cells/mm 3 . PBL presented on average 5 years after diagnosis of HIV. Common primary sites of presentation included the oral cavity, gastrointestinal tract, and lymph nodes. Most cases presented with either stage I or stage IV disease. There was a variable expression of B-cell markers in tumor cells, but plasma cell markers were expressed in all cases. EBV was detected in 74%. Chemotherapy was used to treat 55% patients and was combined with radiotherapy in 21% cases. Complete response was obtained in 66% of treated cases; the majority of these responses were seen after CHOP (cyclophosphamide, doxorubicin, vincristine, prednisone). The refractory/relapsed disease rate was 54%. Death occurred in 53% of patients, with a median overall survival of 15 months. Sex, CD41 count, viral load, clinical stage, EBV status, primary site of involvement, and use of CHOP failed to show an association with survival. PBL is an aggressive B-cell lymphoma that presents in both oral and extra-oral sites of chronically HIV-infected immunosuppressed young men. Am. J. Hematol. 83:804-809, 2008. V

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“…Despite the relatively low incidence of plasma cell malignancies in HIV+ patients, plasmablastic plasmacytoma or myeloma, should be included in the differential diagnosis. A study published by Vega et al was not able to reliably distinguish between PBL and plasmablastic plasma cell myeloma by morphology and immunohistochemistry alone, since no statistically significant difference in frequency of lymphoid and plasma cell-related markers was seen between these malignancies [11]. All cases showed strong uniform expression of the post-germinal center associated B-cell-and plasma cell-associated markers MUM-1, CD38 and CD138.…”

Section: Discussionmentioning

confidence: 87%

Plasmablastic Lymphoma of Head and Neck: Report of Two New Cases and Correlation with c-myc and IgVH Gene Mutation Status

Hassan

Kreisel

Gardner

et al. 2007

Head and Neck Pathol

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Plasmablastic lymphoma (PBL) is a rare acquired immunodeficiency syndrome-associated nonHodgkin's lymphoma (AIDS-NHL), with predilection for the mucosa of oral cavity. It usually has a plasmablastic morphology, expressing plasma cell-associated antigens with weak or absent expression of B-cell-associated markers. To further define the immunophenotypic and molecular genetics of these tumors, we investigated two cases of plasmablastic lymphomas of the head and neck for c-myc gene rearrangement and immunoglobulin heavy chain (IgV H ) hypermutation status. For the first time we report a case of AIDS-related PBL that, by fluorescence in situ hybridization (FISH), shows a c-myc gene rearrangement. Although current literature suggests that most cases of c-myc gene rearranged AIDS-NHL are Burkitt's lymphoma, our case has an immunophenotype characteristic for PBL. In this case, IgV H hypermutation analysis showed a somatic hypermutation, indicative of germinal center transit. The concurrent B-cell immunophenotype of BCL-6 -/CD138 + /MUM-1 + also suggests a post-germinal center B-cell origin of this lymphoma. The immunophenotype of our second case (BCL-6 -/CD138 + /MUM-1 + ) also suggests a post-germinal center B-cell origin. However, IgV H hypermutation analysis was not possible in this case.

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Plasmablastic lymphomas and plasmablastic plasma cell myelomas have nearly identical immunophenotypic profiles

Cited by 322 publications

References 37 publications

Lymphoid neoplasms associated with concurrent t(14;18) and 8q24/c-MYC translocation generally have a poor prognosis

Lymphoid neoplasms associated with concurrent t(14;18) and 8q24/c-MYC translocation generally have a poor prognosis

HIV‐associated plasmablastic lymphoma: Lessons learned from 112 published cases

Plasmablastic Lymphoma of Head and Neck: Report of Two New Cases and Correlation with c-myc and IgVH Gene Mutation Status

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