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)?
Plasmacytic tumor