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多发性骨髓瘤向组织细胞肉瘤的转分化:一种高度罕见现象的病例报告

Transdifferentiation of Multiple Myeloma into Histiocytic Sarcoma: Case Report of a Highly Unusual Phenomenon.

作者信息

Seth Neha, Naing Phyu Thin, Singh Ram, Geetha Saroja, Reddy Kalpana, Zhang Xinmin, Yang Tianyu, Caro Jessica, Tam Wayne

机构信息

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.

出版信息

Pathobiology. 2025 Jun 8:1-11. doi: 10.1159/000546669.


DOI:10.1159/000546669
PMID:40484006
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC12270463/
Abstract

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.

摘要

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。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27ad/12270463/ea6fd09057a7/pat-2025-0000-0000-546669_F02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27ad/12270463/0d98a9f891e9/pat-2025-0000-0000-546669_F01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27ad/12270463/ea6fd09057a7/pat-2025-0000-0000-546669_F02.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27ad/12270463/0d98a9f891e9/pat-2025-0000-0000-546669_F01.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/27ad/12270463/ea6fd09057a7/pat-2025-0000-0000-546669_F02.jpg

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[1]
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本文引用的文献

[1]
Transformation of Chronic Lymphocytic Leukemia/Small Lymphocytic Lymphoma to Histiocytic/Dendritic Cell Sarcoma.

J Hematol. 2024-10

[2]
Transdifferentiation of diffuse large B-cell lymphoma to a poorly differentiated neoplasm following CAR T-cell therapy.

J Hematop. 2024-9

[3]
Histiocytic sarcoma following CAR T-cell therapy: a case report.

Int J Hematol. 2024-3

[4]
T-cell redirecting bispecific and trispecific antibodies in multiple myeloma beyond BCMA.

Curr Opin Oncol. 2023-11-1

[5]
Mechanisms of Resistance and Treatment of Relapse after CAR T-cell Therapy for Large B-cell Lymphoma and Multiple Myeloma.

Transplant Cell Ther. 2023-7

[6]
Significance of RB Loss in Unlocking Phenotypic Plasticity in Advanced Cancers.

Mol Cancer Res. 2023-6-1

[7]
B-cell lineage neoplasms transdifferentiating into histiocytic/dendritic cell neoplasms: diversity, differentiation lineage, genomic alterations, and therapy: Report from the 2021 SH/EAHP Workshop.

Am J Clin Pathol. 2023-6-1

[8]
BRAF L485-P490 deletion mutant metastatic melanoma sensitive to BRAF and MEK inhibition: A case report and literature review.

Front Pharmacol. 2023-1-6

[9]
The 5th edition of the World Health Organization Classification of Haematolymphoid Tumours: Myeloid and Histiocytic/Dendritic Neoplasms.

Leukemia. 2022-7

[10]
Partial response to dabrafenib and trametinib in relapsed BRAF V600E-Mutated multiple myeloma and possible mechanisms of resistance.

BMJ Case Rep. 2022-4-8

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