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| IMAGE IN HEMATOLOGY |
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| Year : 2020 | Volume
: 11
| Issue : 2 | Page : 91-92 |
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Extensive bone marrow light-chain amyloidosis associated with lymphoplasmacytic lymphoma
Shano Naseem, Ganesh Kumar
Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| Date of Submission | 24-Nov-2019 |
| Date of Decision | 16-Dec-2019 |
| Date of Acceptance | 27-Dec-2019 |
| Date of Web Publication | 28-Jul-2020 |
Correspondence Address:
Dr. Shano Naseem
Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/joah.joah_80_19
How to cite this article:
Naseem S, Kumar G. Extensive bone marrow light-chain amyloidosis associated with lymphoplasmacytic lymphoma. J Appl Hematol 2020;11:91-2 |
A 58-year-old male presented with 6 months duration of dyspnea and intermittent epistaxis. Physical examination showed pallor and generalized lymphadenopathy. Laboratory investigations showed severe anemia (6.5 g/dl), thrombocytopenia (66 × 109/L), and mild leukocytosis (12.7 × 109/L), including lymphocytosis. Blood film showed rouleaux formation and many lymphoplasmacytic cells. Serum biochemistry showed reversed albumin: globulin ratio. Serum protein electrophoresis did not show any monoclonal band; serum free light chain assay showed lambda restriction (369 mg/L). Bone marrow aspirate was hypercellular and had lymphocytosis (70% of all nucleated cells) including lymphoplasmacytic cells (12%) and a few plasma cells. Flowcytometry showed a CD5- and CD10-negative B-cell clonal population. Trephine biopsy [Figure 1] showed extensive deposition of amyloid confirmed by congophilia and apple-green birefringence; intermittent cellular areas showed sheets of lymphocytes, lymphoplasmacytic cells, and some plasma cells. Immunohistochemistry was negative for serum amyloid-A excluding secondary amyloidosis. MYD88-L265P mutation, done on bone marrow aspirate,[1] was positive. A diagnosis of AL amyloid with lymphoplasmacytic lymphoma was made. AL amyloid deposition is a rare entity in lymphoplasmacytic lymphoma (3%);[2],[3] bone marrow examination can be useful in the diagnosis of amyloid when abdominal fat pad is negative. | Figure 1: (a) Extensive amyloid deposits in bone marrow biopsy (×5). (b) Amyloid interspersed with lymphocytes (×10); (c) (×100). (d) Interstitial increase in lymphocytes and lymphoplasmacytic cells (×40); (e) (×100). (f) Apple-green birefringence of the congophilic material on polarizing microscope (×100)
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Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
| References | |  |
| 1. | Argentou N, Vassilopoulos G, Ioannou M, Germenis AE, Speletas M. Rapid detection of MYD88-L265P mutation by PCR-RFLP in B-cell lymphoproliferative disorders. Leukemia 2014;28:447-9.  |
| 2. | Swerdlow SH, Cook JR, Sohani AR, Pileri SA, Harris NL, Jaffe ES, et al. Lymphoplasmacytic lymphoma. In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. (eds): WHO classification of tumours of haematopoietic and lymphoid tissues, Revised 4 th ed., IARC: Lyon 2017. p. 232-5. |
| 3. | Gertz MA, Merlini G, Treon SP. Amyloidosis and Waldenström's macroglobulinemia. Hematology Am Soc Hematol Educ Program 2004;2004:257-82. |
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