Concomitant Presence of Two Distinct Clones of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in a Patient

A 74 years old male patient, presented with history of generalized weakness, fatigue, loss of appetite and breathlessness on exertion for past one and a half months. On examination, he was found to have significant pallor and generalized lymphadenopathy (cervical, axillary and inguinal). The skeleta...

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Publicado no:Indian J Hematol Blood Transfus
Main Authors: Langer, Sabina, Mehta, Meenal, Saraf, Amrita, Gupta, Aastha, Pipliya, Keyur, Kakar, Atul, Bhargava, Manorama
Formato: Artigo
Idioma:Inglês
Publicado em: Springer India 2015
Assuntos:
Case Report
Acesso em linha:https://ncbi.nlm.nih.gov/pmc/articles/PMC4925489/
https://ncbi.nlm.nih.gov/pubmed/27408384
https://ncbi.nlm.nih.govhttp://dx.doi.org/10.1007/s12288-015-0512-7
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spelling pubmed-49254892017-06-01 Concomitant Presence of Two Distinct Clones of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in a Patient Langer, Sabina Mehta, Meenal Saraf, Amrita Gupta, Aastha Pipliya, Keyur Kakar, Atul Bhargava, Manorama Indian J Hematol Blood Transfus Case Report A 74 years old male patient, presented with history of generalized weakness, fatigue, loss of appetite and breathlessness on exertion for past one and a half months. On examination, he was found to have significant pallor and generalized lymphadenopathy (cervical, axillary and inguinal). The skeletal survey showed punched out lytic lesions in skull and pelvic bones. The peripheral smear examination showed lymphocytosis with absolute lymphocyte count of 25,000/μL. The bone marrow aspirates revealed a hypercellular marrow with 74 % lymphocytes & 14 % plasma cells, suggestive of chronic lymphoplasmacytic disorder. The bone marrow biopsy had two morphologically distinct populations of lymphocytes & plasma cells. The immunohistochemical markers on bone marrow biopsy showed hat plasma cells were positive for CD138 with kappa light chain restriction. Flow cytometry showed B cell population with CD19/CD5 co expression, CD5/CD23 coexpression, were positive for CD22, CD20 and negative for FMC-7 and lambda light chain. In addition, plasma cells were also identified as CD45 negative cells and showed CD38/CD138 co-expression with variable CD19 and CD56 positivity. Serum protein electrophoresis revealed M band, serum immunofixation electrophoresis corresponded to IgA -Kappa. The final diagnosis of chronic lymphocytic leukemia with concomittant presence of plasma cell myeloma was concluded. This case imparts an important message to look for presence of coexisting entities in a single specimen and highlights the benefits of testing both plasma cell and B-cell compartments when the clinical features are not entirely consistent Flow cytometry together with protein electrophoresis can help to clinch difficult and rare dual diagnosis. These cases are rare and pose therapeutic challenge. Springer India 2015-03-01 2016-06 /pmc/articles/PMC4925489/ /pubmed/27408384 http://dx.doi.org/10.1007/s12288-015-0512-7 Text en © Indian Society of Haematology & Transfusion Medicine 2015
institution US NLM
collection PubMed Central
language Inglês
format Artigo
topic Case Report
spellingShingle Case Report
Langer, Sabina
Mehta, Meenal
Saraf, Amrita
Gupta, Aastha
Pipliya, Keyur
Kakar, Atul
Bhargava, Manorama
Concomitant Presence of Two Distinct Clones of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in a Patient
description A 74 years old male patient, presented with history of generalized weakness, fatigue, loss of appetite and breathlessness on exertion for past one and a half months. On examination, he was found to have significant pallor and generalized lymphadenopathy (cervical, axillary and inguinal). The skeletal survey showed punched out lytic lesions in skull and pelvic bones. The peripheral smear examination showed lymphocytosis with absolute lymphocyte count of 25,000/μL. The bone marrow aspirates revealed a hypercellular marrow with 74 % lymphocytes & 14 % plasma cells, suggestive of chronic lymphoplasmacytic disorder. The bone marrow biopsy had two morphologically distinct populations of lymphocytes & plasma cells. The immunohistochemical markers on bone marrow biopsy showed hat plasma cells were positive for CD138 with kappa light chain restriction. Flow cytometry showed B cell population with CD19/CD5 co expression, CD5/CD23 coexpression, were positive for CD22, CD20 and negative for FMC-7 and lambda light chain. In addition, plasma cells were also identified as CD45 negative cells and showed CD38/CD138 co-expression with variable CD19 and CD56 positivity. Serum protein electrophoresis revealed M band, serum immunofixation electrophoresis corresponded to IgA -Kappa. The final diagnosis of chronic lymphocytic leukemia with concomittant presence of plasma cell myeloma was concluded. This case imparts an important message to look for presence of coexisting entities in a single specimen and highlights the benefits of testing both plasma cell and B-cell compartments when the clinical features are not entirely consistent Flow cytometry together with protein electrophoresis can help to clinch difficult and rare dual diagnosis. These cases are rare and pose therapeutic challenge.
author Langer, Sabina
Mehta, Meenal
Saraf, Amrita
Gupta, Aastha
Pipliya, Keyur
Kakar, Atul
Bhargava, Manorama
author_facet Langer, Sabina
Mehta, Meenal
Saraf, Amrita
Gupta, Aastha
Pipliya, Keyur
Kakar, Atul
Bhargava, Manorama
author_sort Langer, Sabina
title Concomitant Presence of Two Distinct Clones of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in a Patient
title_short Concomitant Presence of Two Distinct Clones of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in a Patient
title_full Concomitant Presence of Two Distinct Clones of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in a Patient
title_fullStr Concomitant Presence of Two Distinct Clones of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in a Patient
title_full_unstemmed Concomitant Presence of Two Distinct Clones of Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in a Patient
title_sort concomitant presence of two distinct clones of chronic lymphocytic leukemia and plasma cell myeloma in a patient
publisher Springer India
container_title Indian J Hematol Blood Transfus
publishDate 2015
url https://ncbi.nlm.nih.gov/pmc/articles/PMC4925489/
https://ncbi.nlm.nih.gov/pubmed/27408384
https://ncbi.nlm.nih.govhttp://dx.doi.org/10.1007/s12288-015-0512-7
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