Zusammenfassung
Ein Plasmozytomfall zeigte histologisch eine monotone, gleichmäßige Proliferation reifer Myelomzellen und eine IgG-Kappa-Paraproteinämie. Im Gegensatz zu histologischen Färbungen erbrachten die Immunperoxidase-Reaktionen für Kappa und Gamma ein inhomogenes Ergebnis. Leichte und schwere Ketten wurden von verschiedenen Subpopulationen der Plasmozytomzellen gebildet. Serienschnitte zeigten, daß Kappa-positive Areale Gamma-negativ waren und umgekehrt. So erwies sich dies morphologisch homogene Plasmozytom als immunhistochemisch heterogen. Wir nehmen an, daß sich zwei Subpopulationen entwickelt haben, die getrennt Kappa- und Gamma-Ketten bilden. Es ist möglich, daß diese Ketten auch getrennt zirkulierten und nicht als vollständige IgG-Kappa-Moleküle. Auf der Grundlage dieser Ergebnisse werden entsprechende Resultate anderer Untersucher diskutiert. Theoretische Überlegungen zum immunhistochemischen Nachweis einer Tumorzellmonoclonalität zeigen die fragwürdige Relevanz dieser Methodik für die Diagnostik der Nicht-Hodgkin-Lymphome auf, insbesondere für die sogenannten Immunozytome der Kiel-Klassifikation.
Summary
A case of myeloma showed histologically a monotonous pattern of relatively mature myeloma cells and an IgG-kappa paraproteinemia. In contrast to ordinary stains, the immunoperoxidase reactions for kappa and gamma gave inhomogeneous results. Light and heavy chains were formed by clusters of different subpopulations of myeloma cells. Serial sections showed that kappa-positive clusters were gamma-negative and vice versa. Thus, this morphologically homogeneous myeloma turned out to be immunohistochemically heterogeneous. We assume that two subpopulations have developed that produced separately kappa- and gamma-chains. Therefore, these chains might have been circulating separately and not as complete IgG-kappa molecules. Guided by our findings, the results of other investigators are discussed. Some considerations on the validity of immunohistochemical demonstration of tumor cell monoclonality are given implicating the diagnostic equivocation of immunohistochemistry for non-Hodgkin's lymphomas, especially for so-called “immunocytomas”.
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Metz, K., Leder, L.D. Myeloma with immunohistochemically different cell populations: Implication for the validity of immunohistochemical assessment of lymphoma cell monoclonality. Klin Wochenschr 58, 409–414 (1980). https://doi.org/10.1007/BF01477506
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DOI: https://doi.org/10.1007/BF01477506