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

Publication ,  Journal Article
Wei, Q; Sebastian, S; Papavassiliou, P; Rehder, C; Wang, E
Published in: Hum Pathol
October 2014

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.

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Published In

Hum Pathol

DOI

EISSN

1532-8392

Publication Date

October 2014

Volume

45

Issue

10

Start / End Page

2063 / 2076

Location

United States

Related Subject Headings

  • Polymorphism, Single Nucleotide
  • Pathology
  • Neoplasms, Second Primary
  • Neoplasms, Multiple Primary
  • Male
  • Lymphoma, B-Cell
  • Leukemia, Lymphocytic, Chronic, B-Cell
  • In Situ Hybridization, Fluorescence
  • Immunoglobulin Light Chains
  • Immunoglobulin Isotypes
 

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Wei, Q., Sebastian, S., Papavassiliou, P., Rehder, C., & Wang, E. (2014). Metachronous/concomitant B-cell neoplasms with discordant light-chain or heavy-chain isotype restrictions: evidence of distinct B-cell neoplasms rather than clonal evolutions. Hum Pathol, 45(10), 2063–2076. https://doi.org/10.1016/j.humpath.2014.06.021
Wei, Qiang, Siby Sebastian, Paulie Papavassiliou, Catherine Rehder, and Endi Wang. “Metachronous/concomitant B-cell neoplasms with discordant light-chain or heavy-chain isotype restrictions: evidence of distinct B-cell neoplasms rather than clonal evolutions.Hum Pathol 45, no. 10 (October 2014): 2063–76. https://doi.org/10.1016/j.humpath.2014.06.021.
Wei, Qiang, et al. “Metachronous/concomitant B-cell neoplasms with discordant light-chain or heavy-chain isotype restrictions: evidence of distinct B-cell neoplasms rather than clonal evolutions.Hum Pathol, vol. 45, no. 10, Oct. 2014, pp. 2063–76. Pubmed, doi:10.1016/j.humpath.2014.06.021.
Journal cover image

Published In

Hum Pathol

DOI

EISSN

1532-8392

Publication Date

October 2014

Volume

45

Issue

10

Start / End Page

2063 / 2076

Location

United States

Related Subject Headings

  • Polymorphism, Single Nucleotide
  • Pathology
  • Neoplasms, Second Primary
  • Neoplasms, Multiple Primary
  • Male
  • Lymphoma, B-Cell
  • Leukemia, Lymphocytic, Chronic, B-Cell
  • In Situ Hybridization, Fluorescence
  • Immunoglobulin Light Chains
  • Immunoglobulin Isotypes