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Plasmacytic tumor (382533)
Plasmacytic tumornew
Subtitle: B11-22874		 Type:
Lung		 Sender:
yoolioos 		2011-09-05 15:58
INCTR - EBMWG Hematopathology Online
 
A 63 yo patient was diagnosed with a peripheral right lung tumor and right hydroTx. The tumor was removed. The diagnosis: marginal zone lymphoma. The evaluation by flow showed no evidence of lymphoma spread in his right hydrotorax fluid, blood or bone marrow. Body CT scan was negative for any masses. There is no paraprotein in his blood or urine by immunofixation. Free light chains, b2 microglobulin, LDH are all within normal limits. The bone Xray survey showed no destruction.
 
His medical history is significant for Hodgkin lymphoma that was diagnosed and treated by chemotherapy and mantle irradiation 30 years ago. There is cardiac valvular sclerosis post radiation.
 
Primary tumor histology and immunoprofile was rewieved: Lung tumor consisted of plasmacytes with some small lymphocytic admixture. Immunoprofile: CD20-, CD79a/CD138+, IgM/IgD/IgG-, IgA-/+ , CD10-, Bcl6/MUM1+, Cyclin D1/CD56-, with Ig Kappa light chain restriction.
 
Bone marrow: ~5% of bone marrow population consisted of plasmacytes CD138+, Cyclin D1/CD56- with Ig Kappa light chain restriction.
 
Could these changes be interpreted as nonsecretory plasma cell myeloma/plasmocytoma or just NHL with plasmacytic diff. (MZL)?
 
Thank You for Your help.
 
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tzankov
2011-09-07 10:14
Considering th lung, the moprhological appearence ant the phenotype (CD79a>>CD138, Cyclin D1-, CD56-, bcl6+ and IgA+) favor marginal zone lymphoma of BALT. Detection of lympho-epithelial lesions would be helpfull as well. You can add CD19 to support you assumption, since plamsam cell neoplasms are negative and lymphomas are at least focally positive.  
 
The interpreation of the bone marrow biopsy is more difficult. I would suggest additional stainings for heavy chains and for CD79a to look if the expression pattern is like that in the lung. I am aware of this problem. There are some reports, that "occult" bone marrow spread of MZL is much more common than anticipated (e.g. PMID: 19141118), but the prognostic importance of such findings is still a matter of debates. Finally, if you have any doubts, you can try comparing the B-cell clones of both, the lung tumor and the bone marrow plasmocytoid cells.
vrugt
2011-09-07 11:02
I support the proposed diagnosis of a MZL with plasmacytoid differentiation. A keratin stain might be helpful in the search for lymphoepithethelial lesions whereas a CD21 would be helpful in the detection of germinal centers.
Last modified: 2011-10-27 11:11:56