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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.
Hum Pathol. 2014 Oct; 45(10):2063-76.HP

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+Show Affiliations

Department of Pathology, People's Hospital of Guangxi Zhuang Autonomous Region, Nanning, Guangxi, People's Republic of China 530021; Department of Pathology, Duke University Medical Center, Durham, NC 27710.Department of Pathology, Duke University Medical Center, Durham, NC 27710.Department of Pathology, Duke University Medical Center, Durham, NC 27710.Department of Pathology, Duke University Medical Center, Durham, NC 27710.Department of Pathology, Duke University Medical Center, Durham, NC 27710. Electronic address: endi.wang@duke.edu.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

25179408

Citation

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." Human Pathology, vol. 45, no. 10, 2014, pp. 2063-76.
Wei Q, Sebastian S, Papavassiliou P, 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. 2014;45(10):2063-76.
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. Human Pathology, 45(10), 2063-76. https://doi.org/10.1016/j.humpath.2014.06.021
Wei Q, 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. 2014;45(10):2063-76. PubMed PMID: 25179408.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Metachronous/concomitant B-cell neoplasms with discordant light-chain or heavy-chain isotype restrictions: evidence of distinct B-cell neoplasms rather than clonal evolutions. AU - Wei,Qiang, AU - Sebastian,Siby, AU - Papavassiliou,Paulie, AU - Rehder,Catherine, AU - Wang,Endi, Y1 - 2014/07/17/ PY - 2014/03/27/received PY - 2014/06/23/revised PY - 2014/06/25/accepted PY - 2014/9/3/entrez PY - 2014/9/3/pubmed PY - 2014/12/17/medline KW - B-cell neoplasms KW - Clonal identities KW - Concomitant/metachronous KW - Discordant heavy-chain isotype restrictions KW - Discordant light-chain isotype restrictions KW - Genotypic analysis SP - 2063 EP - 76 JF - Human pathology JO - Hum. Pathol. VL - 45 IS - 10 N2 - 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. SN - 1532-8392 UR - https://www.unboundmedicine.com/medline/citation/25179408/Metachronous/concomitant_B_cell_neoplasms_with_discordant_light_chain_or_heavy_chain_isotype_restrictions:_evidence_of_distinct_B_cell_neoplasms_rather_than_clonal_evolutions_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0046-8177(14)00277-9 DB - PRIME DP - Unbound Medicine ER -