|IMAGE IN HEMATOLOGY
|Year : 2020 | Volume
| Issue : 2 | Page : 91-92
Extensive bone marrow light-chain amyloidosis associated with lymphoplasmacytic lymphoma
Shano Naseem, Ganesh Kumar
Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
|Date of Submission||24-Nov-2019|
|Date of Decision||16-Dec-2019|
|Date of Acceptance||27-Dec-2019|
|Date of Web Publication||28-Jul-2020|
Dr. Shano Naseem
Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Naseem S, Kumar G. Extensive bone marrow light-chain amyloidosis associated with lymphoplasmacytic lymphoma. J Appl Hematol 2020;11:91-2
A 58-year-old male presented with 6 months duration of dyspnea and intermittent epistaxis. Physical examination showed pallor and generalized lymphadenopathy. Laboratory investigations showed severe anemia (6.5 g/dl), thrombocytopenia (66 × 109/L), and mild leukocytosis (12.7 × 109/L), including lymphocytosis. Blood film showed rouleaux formation and many lymphoplasmacytic cells. Serum biochemistry showed reversed albumin: globulin ratio. Serum protein electrophoresis did not show any monoclonal band; serum free light chain assay showed lambda restriction (369 mg/L). Bone marrow aspirate was hypercellular and had lymphocytosis (70% of all nucleated cells) including lymphoplasmacytic cells (12%) and a few plasma cells. Flowcytometry showed a CD5- and CD10-negative B-cell clonal population. Trephine biopsy [Figure 1] showed extensive deposition of amyloid confirmed by congophilia and apple-green birefringence; intermittent cellular areas showed sheets of lymphocytes, lymphoplasmacytic cells, and some plasma cells. Immunohistochemistry was negative for serum amyloid-A excluding secondary amyloidosis. MYD88-L265P mutation, done on bone marrow aspirate, was positive. A diagnosis of AL amyloid with lymphoplasmacytic lymphoma was made. AL amyloid deposition is a rare entity in lymphoplasmacytic lymphoma (3%);, bone marrow examination can be useful in the diagnosis of amyloid when abdominal fat pad is negative.
|Figure 1: (a) Extensive amyloid deposits in bone marrow biopsy (×5). (b) Amyloid interspersed with lymphocytes (×10); (c) (×100). (d) Interstitial increase in lymphocytes and lymphoplasmacytic cells (×40); (e) (×100). (f) Apple-green birefringence of the congophilic material on polarizing microscope (×100)|
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