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IMAGE IN HEMATOLOGY
Year : 2020  |  Volume : 11  |  Issue : 2  |  Page : 91-92

Extensive bone marrow light-chain amyloidosis associated with lymphoplasmacytic lymphoma


Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh, India

Date of Submission24-Nov-2019
Date of Decision16-Dec-2019
Date of Acceptance27-Dec-2019
Date of Web Publication28-Jul-2020

Correspondence Address:
Dr. Shano Naseem
Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/joah.joah_80_19

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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

How to cite this URL:
Naseem S, Kumar G. Extensive bone marrow light-chain amyloidosis associated with lymphoplasmacytic lymphoma. J Appl Hematol [serial online] 2020 [cited 2020 Aug 6];11:91-2. Available from: http://www.jahjournal.org/text.asp?2020/11/2/91/290966

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,[1] was positive. A diagnosis of AL amyloid with lymphoplasmacytic lymphoma was made. AL amyloid deposition is a rare entity in lymphoplasmacytic lymphoma (3%);[2],[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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Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Argentou N, Vassilopoulos G, Ioannou M, Germenis AE, Speletas M. Rapid detection of MYD88-L265P mutation by PCR-RFLP in B-cell lymphoproliferative disorders. Leukemia 2014;28:447-9.  Back to cited text no. 1
    
2.
Swerdlow SH, Cook JR, Sohani AR, Pileri SA, Harris NL, Jaffe ES, et al. Lymphoplasmacytic lymphoma. In: Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. (eds): WHO classification of tumours of haematopoietic and lymphoid tissues, Revised 4th ed., IARC: Lyon 2017. p. 232-5.  Back to cited text no. 2
    
3.
Gertz MA, Merlini G, Treon SP. Amyloidosis and Waldenström's macroglobulinemia. Hematology Am Soc Hematol Educ Program 2004;2004:257-82.  Back to cited text no. 3
    


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