Seth Neha, Naing Phyu Thin, Singh Ram, Geetha Saroja, Reddy Kalpana, Zhang Xinmin, Yang Tianyu, Caro Jessica, Tam Wayne
Department of Pathology and Laboratory Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New Hyde Park, New York, USA,
Department of Hematology/Oncology, Department of Medicine, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, Lake Success, New York, USA.
Pathobiology. 2025 Jun 8:1-11. doi: 10.1159/000546669.
INTRODUCTION: Transdifferentiation of multiple myeloma (MM) into histiocytic sarcoma (HS) is exceptionally rare. We report a unique case, confirming this phenomenon through cytogenetics and molecular analyses. CASE PRESENTATION: A 46-year-old woman with high-risk light chain MM developed extramedullary disease despite multiple lines of therapy. Biopsies revealed atypical histiocytic proliferation consistent with HS. Shared immunoglobulin gene rearrangements, cytogenetic alterations, and gene mutations, including a rare BRAF L485F, confirmed clonal relatedness between the two neoplasms. IGH::MAF translocation specific to MM and IGVH somatic hypermutation in HS suggests divergent evolution from a putative germinal center B-cell (GCB) precursor. CONCLUSIONS: This case highlights lineage plasticity of MM to undergo HS transdifferentiation, potentially mediated through a mutated common GCB precursor antecedent to the plasma cell stage, and the subsequent development of HS and MM through acquisition of additional genetic events. Recognition of this exceptional phenomenon and understanding its underlying mechanism have implications for diagnosis, classification, and personalized treatment.
引言:多发性骨髓瘤(MM)向组织细胞肉瘤(HS)的转分化极为罕见。我们报告了一例独特病例,通过细胞遗传学和分子分析证实了这一现象。 病例介绍:一名46岁患有高危轻链MM的女性,尽管接受了多线治疗仍发生了髓外疾病。活检显示与HS一致的非典型组织细胞增殖。共享的免疫球蛋白基因重排、细胞遗传学改变和基因突变,包括罕见的BRAF L485F,证实了这两种肿瘤之间的克隆相关性。MM特有的IGH::MAF易位和HS中的IGVH体细胞超突变提示从假定的生发中心B细胞(GCB)前体发生了不同的进化。 结论:该病例突出了MM发生HS转分化的谱系可塑性,可能是通过浆细胞阶段之前的突变共同GCB前体介导的,以及随后通过获得额外的遗传事件发展为HS和MM。认识到这一特殊现象并了解其潜在机制对诊断、分类和个性化治疗具有重要意义。
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