A case of AL amyloidosis associated with follicular lymphoma with plasmacytic differentiation
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CASE REPORT
A case of AL amyloidosis associated with follicular lymphoma with plasmacytic differentiation Yosuke Matsumoto1,2,3 · Tetsuya Masuda3 · Ayako Nishimura4 · Hideki Horie5 · Kenichi Harada6 · Mihoko Yoshida2 · Kazuho Shimura2 · Hiroto Kaneko2 · Masafumi Taniwaki2,3,7 Received: 10 April 2019 / Revised: 9 September 2019 / Accepted: 12 September 2019 © Japanese Society of Hematology 2019
Abstract A 58-year-old woman underwent emergency surgical resection of the small intestine for intussusception as diagnosed at our hospital. Histopathological diagnosis of the resected specimen of the ileum was amyloid light chain (AL) amyloidosis. The colonoscopy after the surgical resection and following histopathological analysis of the biopsied specimens of the colon revealed follicular lymphoma (FL) grade 1 with plasmacytic differentiation. Histological findings of these ileal and colonic lesions were characteristic. In the ileum, CD10-positive lymphoid follicles and CD38-positive interfollicular plasma cell infiltration into villi were detected. The amyloid deposition was localized to the ileum and was adjacent to lymphoid follicles and interfollicular plasma cells. Furthermore, fluorescence in situ hybridization (FISH) for paraffin-embedded tissue sections (tissue-FISH) revealed that both the B cells in follicular lesions and the interfollicular plasma cells showed IGH/BCL2 fusion signals, which means the interfollicular plasma cells were originated from the differentiated neoplastic follicular B cells. The patient was treated with six courses of lymphoma chemotherapy and attained complete remission without any symptoms associated with amyloidosis. Further case analyses are needed to clarify the clinicopathological findings and to establish therapeutic strategy of AL amyloidosis associated with FL and FL with plasmacytic differentiation. Keywords AL amyloidosis · Follicular lymphoma · Plasmacytic differentiation · BCL2 · t(14;18)
Introduction
* Yosuke Matsumoto yosuke‑[email protected]‑m.ac.jp 1
Department of Hematology, Japanese Red Cross Kyoto Daiichi Hospital, 15‑749, Honmachi, Higashiyama‑ku, Kyoto 605‑8981, Japan
2
Department of Hematology, Aiseikai Yamashina Hospital, Kyoto, Japan
3
Department of Laboratory Medicine, Aiseikai Yamashina Hospital, Kyoto, Japan
4
Department of Surgical Pathology, Aiseikai Yamashina Hospital, Kyoto, Japan
5
Department of Gastoroenterology, Aiseikai Yamashina Hospital, Kyoto, Japan
6
Department of Surgery, Aiseikai Yamashina Hospital, Kyoto, Japan
7
Center for Molecular Diagnostics and Therapeutics, Kyoto Prefectural University of Medicine, Kyoto, Japan
Follicular lymphoma (FL) is the most common type of indolent B cell non-Hodgkin lymphoma (B-NHL). FL reportedly has accounted for13.5% of all lymphomas in Japan [1]. Tumor cells of FL originate from germinal center (GC) B cells and commonly express B cell markers of CD19 and CD20 and GC markers of CD10 and BCL6 [2, 3]. t(14;18) (q32;q21) involving IGH/BCL2 genes is the most frequent cytogenetic abnormality in FL
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