Department of Pathology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Arch Pathol Lab Med. 2013 Apr;137(4):503-17. doi: 10.5858/arpa.2011-0696-OA.
Plasma cell myeloma and chronic lymphocytic leukemia are both common hematologic malignancies, sharing many epidemiologic features. Concomitant detection of the 2 conditions poses special diagnostic challenges for the pathologist.
To describe the pathologic findings in cases of concomitant bone marrow involvement by myeloma and CD5(+) monoclonal B cells and to outline the differential diagnostic possibilities, suggest a workup for correct diagnosis, and examine clinical outcome.
Fifteen cases that met the diagnostic criteria were identified from pathology databases at 4 participating institutions. Morphologic findings were reviewed, additional immunohistochemical stains performed, and flow cytometric, cytogenetic, and relevant laboratory and clinical information was summarized. Previously published cases were searched from electronic databases and cross-references.
Most patients (13 of 15) were older males. Often (11 of 15) they presented clinically with myeloma, yet had both monotypic plasma cells and B cells in the diagnostic marrow. In 4 patients, myeloma developed 24 months or later after chronic lymphocytic leukemia. In 7 patients, myeloma and CD5(+) B cells showed identical immunoglobulin light-chain restriction. Primary differential diagnoses include lymphoplasmacytic lymphoma, marginal zone lymphoma, and chronic lymphocytic leukemia with plasmacytoid differentiation. CD56 and/or cyclin D1 expression by plasma cells was helpful for correct diagnosis. Most patients in our cohort and published reports were treated for plasma cell myeloma.
Concomitant detection of myeloma and chronic lymphocytic leukemia in the bone marrow is a rare event, which must be carefully differentiated from lymphomas with lymphoplasmacytic differentiation for correct treatment.
浆细胞骨髓瘤和慢性淋巴细胞白血病均为常见的血液系统恶性肿瘤，具有许多流行病学特征。这两种疾病同时存在会给病理学家带来特殊的诊断挑战。
描述骨髓瘤和 CD5(+)单克隆 B 细胞同时累及骨髓的病例的病理发现，并概述鉴别诊断的可能性，提出正确诊断的检查方法，检查临床转归。
从 4 个参与机构的病理学数据库中确定了符合诊断标准的 15 例病例。回顾形态学发现，进行了额外的免疫组织化学染色，并总结了流式细胞术、细胞遗传学以及相关的实验室和临床信息。从电子数据库和交叉引用中搜索了已发表的病例。
大多数患者（15 例中的 13 例）为老年男性。他们通常（15 例中的 11 例）以骨髓瘤的临床表现就诊，但在诊断性骨髓中既有单克隆浆细胞又有 B 细胞。在 4 例患者中，骨髓瘤在慢性淋巴细胞白血病后 24 个月或更晚才出现。在 7 例患者中，骨髓瘤和 CD5(+)B 细胞显示相同的免疫球蛋白轻链限制。主要的鉴别诊断包括淋巴浆细胞淋巴瘤、边缘区淋巴瘤和伴有浆细胞样分化的慢性淋巴细胞白血病。浆细胞表达 CD56 和/或 cyclin D1 有助于正确诊断。我们队列中的大多数患者和已发表的报告中的患者均接受了浆细胞骨髓瘤的治疗。
骨髓中同时检测到骨髓瘤和慢性淋巴细胞白血病是一种罕见事件，必须仔细与具有淋巴浆细胞分化的淋巴瘤区分，以进行正确的治疗。
