Journal of Applied Hematology

IMAGE IN HEMATOLOGY
Year
: 2020  |  Volume : 11  |  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

Correspondence Address:
Dr. Shano Naseem
Department of Hematology, Postgraduate Institute of Medical Education and Research, Chandigarh - 160 012
India




How to cite this article:
Naseem S, Kumar G. Extensive bone marrow light-chain amyloidosis associated with lymphoplasmacytic lymphoma.J Appl Hematol 2020;11:91-92


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 Sep 23 ];11:91-92
Available from: http://www.jahjournal.org/text.asp?2020/11/2/91/290966


Full Text

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}

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Conflicts of interest

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References

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