Gomyo Hiroshi, Kajimoto Kazuyoshi, Maeda Akio, Mizuno Ishikazu, Funada Yasuhiro, Koizumi Tamio, Fukui Eiji, Hanioka Keisuke, Ogura Michinori, Murayama Tohru
Hematology Division, Department of Medicine, Hyogo Cancer Center, Akashi, Hyogo, Japan.
Hematology. 2007 Aug;12(4):315-8. doi: 10.1080/10245330701383866.
A 67-year-old woman presented with a pleural effusion and a tumor in the right pleural wall. Histological examination of thoracoscopic tumor and pleural biopsy specimens showed infiltration by medium sized cells, some of which showed plasmacytoid differentiation. In view of the presence of IgM paraproteinemia and bone marrow involvement by lymphoma cells, the patient was diagnosed tentatively as having lymphoplasmacytic lymphoma (LPL). However, chromosomal analysis of the cells in the pleural fluid detected t(14;18)(q32;q21), while fluorescence in situ hybridization was positive for 11% of the MALT1 split signal. Because of the presence of characteristic genetic abnormalities and notable extranodal involvement, the patient was diagnosed as having MALT lymphoma. She was treated with three courses of cladribine and rituximab, and achieved complete regression of the tumor. In this case the detection of t(14;18)(q32;q21) involving IGH and MALT1 was useful for the differential diagnosis of LPL and MALT lymphoma.
一名67岁女性因右侧胸腔积液及右胸壁肿物就诊。胸腔镜下肿瘤及胸膜活检标本的组织学检查显示为中等大小细胞浸润，部分细胞呈浆细胞样分化。鉴于存在IgM副蛋白血症及淋巴瘤细胞累及骨髓，该患者初步诊断为淋巴浆细胞性淋巴瘤（LPL）。然而，对胸腔积液中的细胞进行染色体分析检测到t(14;18)(q32;q21)，而荧光原位杂交显示11%的MALT1分裂信号呈阳性。由于存在特征性基因异常及显著的结外受累，该患者被诊断为黏膜相关淋巴组织淋巴瘤（MALT淋巴瘤）。她接受了三个疗程的克拉屈滨和利妥昔单抗治疗，肿瘤完全消退。在本病例中，检测到涉及IGH和MALT1的t(14;18)(q32;q21)对LPL和MALT淋巴瘤的鉴别诊断有帮助。
