Metachronous/concomitant B-cell neoplasms with discordant light-chain or heavy-chain isotype restrictions: evidence of distinct B-cell neoplasms rather than clonal evolutions.

Abstract

Metachronous/concomitant B-cell neoplasms with distinct morphology are usually considered clonally related. We retrospectively analyzed 4 cases of metachronous/concomitant B-cell neoplasms with discordant light-chain/heavy-chain restrictions. The primary diagnoses included chronic lymphocytic leukemia (CLL; n = 2), lymphoplasmacytic lymphoma (n = 1), and pediatric follicular lymphoma (FL; n = 1). The respective secondary diagnoses included diffuse large B-cell lymphoma (DLBCL; n = 2), plasmablastic myeloma, and pediatric FL. The secondary B-cell neoplasm occurred after the primary diagnosis in 3 cases, with the median interval of 120 months (range, 21-216), whereas the remaining 1 case had the 2 neoplasms (CLL/DLBCL) diagnosed concurrently. Histology suggested aggressive transformation in 3 cases and recurrence in 1 case (FL). Nonetheless, 3 cases showed discordant light-chain restrictions between the 2 B-cell neoplasms, whereas in the remaining case (lymphoplasmacytic lymphoma/plasmablastic myeloma), the 2 neoplasms shared κ light-chain restriction but expressed different heavy-chain isotypes (IgM versus IgA). The 2 CLL/DLBCL cases had polymerase chain reaction-based IGH/K gene rearrangement study and amplicon sequence analysis performed, which demonstrated distinct clonal amplicons between the 2 B-cell neoplasms in each case. Concomitant/metachronous B-cell neoplasms may be clonally unrelated, which can be confirmed by immunoglobulin isotype analysis and/or genotypic studies. We advocate analysis of clonal identities in large cell transformation or recurrent disease compared with primary indolent B-cell neoplasm because of a potential difference in prognosis between clonally related and unrelated secondary B-cell neoplasms.

• Authors: Qiang Wei, Siby Sebastian, Paulie Papavassiliou, Catherine Rehder, Endi Wang
• Journal: Human pathology (Hum Pathol) Vol. 45 Issue 10 Pg. 2063-76 (Oct 2014) ISSN: 1532-8392 [Electronic] United States
• PMID: 25179408 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 Elsevier Inc. All rights reserved.

Chemical References

• Immunoglobulin Heavy Chains
• Immunoglobulin Isotypes
• Immunoglobulin Light Chains

Topics

• Aged
• B-Lymphocytes (immunology, pathology)
• Child
• Clonal Evolution
• Female
• Flow Cytometry
• Gene Rearrangement, B-Lymphocyte (genetics, immunology)
• Humans
• Immunoglobulin Heavy Chains (genetics, immunology)
• Immunoglobulin Isotypes (genetics, immunology)
• Immunoglobulin Light Chains
• In Situ Hybridization, Fluorescence
• Leukemia, Lymphocytic, Chronic, B-Cell (genetics, immunology, pathology)
• Lymphoma, B-Cell (genetics, immunology, pathology)
• Male
• Neoplasms, Multiple Primary (genetics, immunology, pathology)
• Neoplasms, Second Primary (genetics, immunology, pathology)
• Polymorphism, Single Nucleotide