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Abstract
A 70-yr-old woman was hospitalized with a history of dry cough. Bronchial endoscopy and trans-bronchial lung biopsy were performed. However, the findings of histopathology and immunohistochemistry were not sufficient to decide whether the lesion was benign or malignant, because of the presence of crush artifacts in the biopsy specimens. We performed B-cell clonality studies using BIOMED-2 multiplex PCR (InVivoScribe Technologies, USA) to detect clonal rearrangements in the immunoglobulin gene. The results of multiplex PCR showed clonal rearrangements of both kappa and lambda immunoglobulin light chain genes. The findings of immunochemistry revealed that the lesion expressed lambda light chain, but not kappa light chain. Based on the clinical, pathologic, and molecular findings, this case was diagnosed as pulmonary MALT lymphoma. We report the first case in Korea of lambda-expressing MALT lymphoma that is shown to have dual clonal rearrangements of kappa and lambda immunoglobulin light chain gene by multiplex PCR.
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Fig. 1.
Histologic section of lung biopsy from this case. The section demonstrates diffuse infiltration of lymphoid cells with crush artifact (Hematoxylin and eosin, original magnification, ×100).
Fig. 2.
Immunohistochemical stain for lambda immunoglobulin light chain is strongly positive within the lesion (A), but stain for kappa light chain is, negative (B) (×100).
Fig. 3.
The results of BIOMED-2 multiplex PCR. (A) The result of IdentiClone™ IGK Gene Clonality Assay (InVivoScribe Technologies). The PCR product of this patient shows a clonal band within positive size range. (B) The result of IdentiClone™ IGL Gene Clonality Assay (InVivoScribe Technologies). The PCR products of this patient show a clonal band within positive size range.
Lane M, φ× 174/HindIII DNA size marker (TaKaRa, Siga, Japan); Pt, patient; P, P1, and P2, positive controls; N, negative control.
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