Woo Yong Shin; Hae In Bang; Jieun Kim; Rojin Park; Jeong Won Shin; Tae Youn Choi

doi:10.3343/lmo.2019.9.4.263

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Shin, Bang, Kim, Park, Shin, and Choi: A Case of Lymphoplasmacytic Lymphoma/Waldenström's Macroglobulinemia with IgM-κ and IgA-λ Biclonal Gammopathy

Case Report

Laboratory Medicine Online 2019; 9(4): 263-268.

Published online: 1 October 2019

DOI: https://doi.org/10.3343/lmo.2019.9.4.263

A Case of Lymphoplasmacytic Lymphoma/Waldenström's Macroglobulinemia with IgM-κ and IgA-λ Biclonal Gammopathy

Woo Yong Shin, M.D., Hae In Bang, M.D.

, Jieun Kim, M.D., Rojin Park, M.D., Jeong Won Shin, M.D., Tae Youn Choi, M.D.

Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea.

Corresponding author: Hae In Bang, M.D. Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital, 59 Daesagwan-ro, Yongsan-gu, Seoul 04401, Korea. Tel: +82-2-709-9430, Fax: +82-2-710-3088, genuine43@schmc.ac.kr

Received 4 January 2019 Revised 10 May 2019 Accepted 22 May 2019

Laboratory Medicine Online

(open-access):

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Lymphoplasmacytic lymphoma (LPL) is a low-grade B-cell neoplasm, composed of small B lymphocytes, plasmacytoid lymphocytes, and plasma cells, usually involving bone marrow and sometimes lymph nodes or spleen. LPL with bone marrow involvement and an IgM monoclonal gammopathy of any concentration is designated as Waldenström macroglobulinemia (WM). LPL associated with non-IgM monoclonal gammopathy or biclonal gammopathy is rarely observed. LPL diagnosis was based on clinical, morphological, and immunophenotypic findings. Recently, the test for L265P mutation of the myeloid differentiation factor 88 (MYD88) gene has been helpful in the diagnosis of LPL. Here, we reported the first case of LPL/WM with IgM-κ/IgA-λ biclonal gammopathy in Korea.

Keywords: Lymphoplasmacytic lymphoma, Waldenström's macroglobulinemia, Myeloid differentiation factor 88, Multiple myeloma, Biclonal paraproteinemia

Figures and Tables

Fig. 1

Immunofixation electrophoresis (serum). Two monoclonal peaks, IgA-λ and IgM-κ types, are observed in gamma-region. IgA-λ type monoclonal peak is dominant. M protein was 3.04 g/dL.

Fig. 2

Bone marrow observations. (A) Microscopic observation of bone marrow (×1,000). Hypercellular marrow with markedly increased lymphocytes. Mixture of small lymphocytes, plasma cells, and plasmacytic lymphocytes formed clusters. Mast cells increased in number. (B) Bone marrow biopsy shows interstitial infiltration of plasmacytic lymphocytes (×400). (C) Immunophenotypic investigation revealed that neoplastic cells express CD19+ and CD56− and exhibit cytoplasmic lambda restriction. The Neoplastic cell population shows cells with a range of CD138 expression, from CD138 dim plasmacytic lymphocytes to CD138 bright mature plasma cells. (D) Next-generation sequencing (NGS) revealed MYD88 L265P mutation in 4.36% of bone marrow cells (depth: 436).

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ORCID iDs: Hae In Bang
https://orcid.org/0000-0001-7854-3011
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