Unusual biclonal IgA plasma cell myeloma with aberrant expression of high-risk immunophenotypes: first report of a new diagnostic and clinical challenge
0
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
IgA plasma cell myeloma (PCM) has been linked to molecular abnormalities that confer a higher risk for adverse patient outcomes. However, since IgA PCM only accounts for approximately 20% of all PCM, there are very few reports on high-risk IgA PCM. Moreover, no such reports are found on the more infrequent biclonal IgA PCM. Hence, we present a 65-year-old Puerto Rican female with acute abdominal pain, concomitant hypercalcemia, and acute renal failure. Protein electrophoresis with immunofixation found high IgA levels and detected a biclonal IgA gammopathy with kappa specificity. Histomorphologically, bone marrow showed numerous abnormal plasma cells (32%) replacing over 50% of the marrow stroma. Immunophenotyping analysis detected CD45-negative plasma cells aberrantly expressing CD33, CD43, OCT-2, and c-MYC. Chromosomal analysis revealed multiple abnormalities including the gain of chromosome 1q. Thus, we report on an unusual biclonal IgA PCM and the importance of timely diagnosing aggressive plasma cell neoplasms.
Abstract
IgA plasma cell myeloma (PCM) has been linked to molecular abnormalities that confer a higher risk for adverse patient outcomes. However, since IgA PCM only accounts for approximately 20% of all PCM, there are very few reports on high-risk IgA PCM. Moreover, no such reports are found on the more infrequent biclonal IgA PCM. Hence, we present a 65-year-old Puerto Rican female with acute abdominal pain, concomitant hypercalcemia, and acute renal failure. Protein electrophoresis with immunofixation found high IgA levels and detected a biclonal IgA gammopathy with kappa specificity. Histomorphologically, bone marrow showed numerous abnormal plasma cells (32%) replacing over 50% of the marrow stroma. Immunophenotyping analysis detected CD45-negative plasma cells aberrantly expressing CD33, CD43, OCT-2, and c-MYC. Chromosomal analysis revealed multiple abnormalities including the gain of chromosome 1q. Thus, we report on an unusual biclonal IgA PCM and the importance of timely diagnosing aggressive plasma cell neoplasms.
참고문헌 (18)
- Habermehl GK, "IgA plasma cell neoplasms are characterized by poorer long-term survival and increased genomic complexity compared to IgG neoplasms", Ann Diagn Pathol, 44, pp.151449~ (2020)
- McKenna RW, "Hematopathology", pp.473~506 (2017), Elsevier
- Rajkumar SV, "Multiple myeloma : 2020 update on diagnosis, riskstratification and management", Am J Hematol, 95, pp.548~567 (2020)
- Palumbo A, "Revised International Staging System for Multiple Myeloma : a report from International Myeloma Working Group", J Clin Oncol, 33, pp.2863~2869 (2015)
- Thiele J, "European consensus on grading bone marrow fibrosis and assessment of cellularity", Haematologica, 90, pp.1128~1132 (2005)
- Willrich MA, "Laboratory testing requirements for diagnosis and follow-up of multiple myeloma and related plasma cell dyscrasias", Clin Chem Lab Med, 54, pp.907~919 (2016)
- Keren DF, "Challenges of measuring monoclonal proteins in serum", Clin Chem Lab Med, 54, pp.947~961 (2016)
- Rossi F, "Proposal and validation of prognostic scoring systems for IgG and IgA monoclonal gammopathies of undetermined significance", Clin Cancer Res, 15, pp.4439~4445 (2009)
- Cardona-Benavides IJ, "Genetic abnormalities in multiple myeloma : prognostic and therapeutic implications", Cells, 10, pp.336~ (2021)
- Annibali O, "Relapse of IgA lambda multiple myeloma presenting as obstructive jaundice and abdominal pain", Onkologie, 32, pp.119~121 (2009)
- Cerqueira A, "Acute kidney failure:when multiple myeloma doesn’t give additional clues", Cureus, 12, pp.e7664~ (2020)
- Suo L, "Extramedullary multiple myeloma involving the liver and periportal lymph node, diagnosed by EUSFNA in a patient with cirrhosis", Diagn Cytopathol, 48, pp.657~661 (2020)
- Yamane F, "Left lower abdominal pain as an initial symptom of multiple myeloma", Cureus, 13, pp.e20652~ (2021)
- Muchtar E, "The colorful landscape of multiple myeloma", Leuk Lymphoma, 60, pp.2099~2100 (2019)
- Ning X, "CD43 expression is an adverse prognostic factor in newly diagnosed multiple myeloma", Blood, 138(Suppl 1), pp.4753~ (2021)
- Toman I, "Expression and prognostic significance of Oct2 and Bob1 in multiple myeloma : implications for targeted therapeutics", Leuk Lymphoma, 52, pp.659~667 (2011)
- Kodali S, "Assessing MYC expression in multiple myeloma", J Hematol Thrombo Dis, 3, pp.e119~ (2015)
- Castaneda-Avila MA, "Trends in cause of death among patients with multiple myeloma in Puerto Rico and the United States SEER population, 1987-2013", Int J Cancer, 146, pp.35~43 (2020)