Lin B T, Weiss L M
Division of Pathology, City of Hope National Medical Center, Duarte, CA 91010, USA.
Hum Pathol. 1997 Sep;28(9):1083-90. doi: 10.1016/s0046-8177(97)90063-0.
Primary plasmacytoma of the lymph nodes is very rare, and there are fewer than 20 reported cases. These cases appeared to have a better prognosis than other extramedullary plasmacytomas, with rare recurrence and no progression to myeloma after treatment. To better characterize the clinicopathological features and the pathogenesis of primary plasmacytoma of the lymph nodes, we reviewed our consultation files and retrieved seven such cases. The age of presentation ranged from 39 to 76 years (median age, 59 years), with three women and four men. The clinical follow-up varied from 1 to 14 years. All patients presented with enlarged lymph nodes and had an indolent clinical course, except for one patient with slow progression and increasing numbers of bone marrow plasma cells. Five patients were treated with excision only and two with excision and chemotherapy. None of the patients had recurrence or developed multiple myeloma. All cases showed immunoglobulin light chain restriction, four with monotypic lambda and three with monotypic kappa. One patient had extensive nodal amyloid deposition. Four cases had monoclonal heavy chain expression, three with monoclonal immunoglobulin (Ig) G and one with monoclonal IgM. All cases were negative for CD20 and CD43, and six cases expressed CD79a. Overexpression of p53 and bcl-2 was not detected by immunostaining in any of the cases. Epstein-Barr viral (EBV) RNA was not detected in all seven cases by in situ hybridization, and no Kaposi's sarcoma-associated herpesvirus (KSHV) DNA sequences were detected by polymerase chain reaction in five cases. Our results confirm a more favorable outcome and rare progression to multiple myeloma in primary nodal plasmacytomas after excision or chemotherapy. The results of oncoprotein and viral studies suggest that the pathogenesis of primary nodal plasmacytoma may not be due to bcl-2- and p53-associated changes or viral-induced changes by EBV and KSHV.
淋巴结原发性浆细胞瘤非常罕见，报告病例少于20例。这些病例的预后似乎比其他髓外浆细胞瘤更好，复发罕见，治疗后无进展为骨髓瘤的情况。为了更好地描述淋巴结原发性浆细胞瘤的临床病理特征及发病机制，我们查阅了会诊档案并检索到7例此类病例。发病年龄为39至76岁（中位年龄59岁），其中女性3例，男性4例。临床随访时间为1至14年。所有患者均表现为淋巴结肿大，临床病程呈惰性，仅有1例患者病情进展缓慢且骨髓浆细胞数量增加。5例患者仅接受了手术切除，2例接受了手术切除及化疗。所有患者均未复发或发展为多发性骨髓瘤。所有病例均显示免疫球蛋白轻链限制，4例为单型λ，3例为单型κ。1例患者有广泛的淋巴结淀粉样沉积。4例有单克隆重链表达，3例为单克隆免疫球蛋白（Ig）G，1例为单克隆IgM。所有病例CD20和CD43均为阴性，6例表达CD79a。免疫组化未在任何病例中检测到p53和bcl-2的过表达。原位杂交在所有7例病例中均未检测到爱泼斯坦-巴尔病毒（EBV）RNA，聚合酶链反应在5例病例中未检测到卡波西肉瘤相关疱疹病毒（KSHV）DNA序列。我们的结果证实，淋巴结原发性浆细胞瘤在切除或化疗后预后更有利，进展为多发性骨髓瘤的情况罕见。癌蛋白和病毒研究结果提示，淋巴结原发性浆细胞瘤的发病机制可能并非由于bcl-2和p53相关改变或EBV和KSHV诱导的病毒改变。
