Advertisement

International Journal of Hematology

, Volume 78, Issue 4, pp 357–361 | Cite as

Detection of Two Cell Populations Corresponding to Distinct Maturation Stages in API-2/MLT-Positive Mucosa-Associated Lymphoid Tissue Lymphoma Cells Proliferating in Pleural Effusion

  • Yuya Kunisaki
  • Tsuyoshi Muta
  • Yujiro Yamano
  • Yukio Kobayashi
Case Report

Abstract

A 66-year-old man was admitted to our hospital because of an intra-abdominal tumor and pleural effusion (PE). Immunoelectrophoresis of the serum showed immunoglobulin M (IgM) κ paraprotein (7330 mg/dL). Abnormal plasmacytoid cells were seen in both the peripheral blood (PB) and the bone marrow (BM). Computed tomography scans showed extensive thickening of the gastric wall and bilateral massive PE without lymph node or pulmonary involvement. A histologic examination of the gastric mucosa showed a diffuse infiltration of small- to medium-sized lymphoid CD20-bearing cells, some of which showed a plasmacytoid morphology. Lymphoepithelial lesions were demonstrated with an immunohistochemical stain. The diagnosis was gastric mucosa-associated lymphoid tissue (MALT) lymphoma infiltrating to the PE, PB, and BM.The PE contained numerous lymphoid cells with plasmacytoid morphology that Southern blotting analysis showed to have a monoclonal IgH gene rearrangement pattern. The cells seemed to be divided into two populations according to their surface markers: mature B-cells (CD19+CD20+CD22+CD21+CD38-) and secretory B-cells (CD19+CD20dimCD22-CD21-CD38+). The reverse transcriptase-polymerase chain reaction technique detected the API-2/MLT transcript in the PE and PB. The patient had a good response to fludarabine treatment, which was followed with rituximab therapy. In general, gastric MALT lymphoma cells have a tendency to differentiate into plasma cells. In this article, we show that the cell character of API-2/MLT-positive MALT lymphoma is preserved even when the cells are disseminated. This is the first published case, to our knowledge, in which two differentiation stages of MALT lymphoma cells infiltrating into PE have been confirmed by flow cytometric analysis.

Key words

Gastric MALT lymphoma Macroglobulinemia Pleural effusion API-2/MLT transcripts T(11:18)(Q21:Q21) 

Preview

Unable to display preview. Download preview PDF.

Unable to display preview. Download preview PDF.

References

  1. 1.
    Jaffe ES, Harris NL, Diebold J, Muller-Herrnelink HK. World Health Organization classification of neoplastic diseases of the hematopoietic and lymphoid tissues: a progress report.Am J Clin Pathol. 1999;111(suppl 1):S8-S12.PubMedGoogle Scholar
  2. 2.
    Wotherspoon AC, Ortiz-Hidalgo C, Falzon M, Isaacson P.Helicobacter pylori-associated gastritis and primary B-cell gastric lymphoma.Lancet. 1991;338:1175–1176.CrossRefPubMedGoogle Scholar
  3. 3.
    Greiner A, Knorr C, Qin Y, et al. Low-grade B cell lymphomas of mucosa-associated lymphoid tissue (MALT-type) require CD40-mediated signaling and Th2-type cytokines for in vitro growth and differentiation.Am J Pathol. 1997;150:1583–1593.PubMedCentralPubMedGoogle Scholar
  4. 4.
    Dogan A, Du M, Koulis A, Briskin MJ, Isaacson PG. Expression of lymphocyte homing receptors and vascular addressins in low-grade gastric B-cell lymphomas of mucosa-associated lymphoid tissue.Am J Pathol. 1997;151:1361–1369.PubMedCentralPubMedGoogle Scholar
  5. 5.
    Du MQ, Peng HZ, Dogan A, et al. Preferential dissemination of Bcell gastric lymphoma mucosa-associated lymphoid tissue (MALT) lymphoma to the splenic marginal zone.Blood. 1997;90:4071–4077.PubMedGoogle Scholar
  6. 6.
    Thieblemont C, Berber F, Dumontet C, et al. Mucosa-associated lymphoid tissue lymphoma is a disseminated disease in one third of 158 patients analyzed.Blood. 2000;95:802–806.PubMedGoogle Scholar
  7. 7.
    Valdex R, Finn W, Ross C, Singleton T, Tworek J, Schnitzer B. Waldenstrom macroglobulinemia caused by extranodal marginal zone B-cell lymphoma.Am J Clin Pathol. 2001;116:683–690.CrossRefGoogle Scholar
  8. 8.
    Iwase S, Takahara S, Sekikawa T, et al. Disseminated MALT lymphoma associated with macroglobulinemia [in Japanese].Rinsho Ketsueki. 2000;41:1183–1188.PubMedGoogle Scholar
  9. 9.
    Abe K, Hori Y, Ohtsu SY, Koike Y. A case of non-Hodgkin’s lymphoma with macroglobulinemia.Acta Otolaryngol Suppl. 1996;523:259–262.PubMedGoogle Scholar
  10. 10.
    Griesser H, Kaiser U, Augener W, Tiemann M, Lennert K. B-cell lymphoma of the mucosa-associated lymphatic tissue (MALT) presenting with bone marrow and peripheral blood involvement.Leuk Res. 1990;14:617–622.CrossRefPubMedGoogle Scholar
  11. 11.
    Hirase N, Yufu Y, Abe Y, et al. Primary macroglobulinemia with t(11; 18)(q21;q21).Cancer Genet Cytogenet. 2000;117:113–117.CrossRefPubMedGoogle Scholar
  12. 12.
    Yonezumi M, Suzuki R, Suzuki H, et al. Detection of AP12-MALT1 chimaeric gene in extranodal and nodal marginal zone B-cell lymphoma by reverse transcription polymerase chain reaction (PCR) and genomic long and accurate PCR analyses.Br J Haematol. 2001;115:588–594.CrossRefPubMedGoogle Scholar
  13. 13.
    Ott G, Katzenberger T, Greiner A, et al. The t(11;18)(q21;q21) chromosomal translocation is a frequent and specific aberration in low-grade but not high-grade malignant non-Hodgkin’s lymphomas of the mucosa-associated lymphoid tissue (MALT-) type.Cancer Res. 1997;57:3944–3948.PubMedGoogle Scholar
  14. 14.
    Zucca E, Bertol F, Roggero E, Cavalli F. The gastric marginal zone B-cell lymphoma of MALT type.Blood. 2000;96:410–419.PubMedGoogle Scholar
  15. 15.
    Harris NL, Jaffe ES, Stein H, et al. A revised European-American classification of lymphoid neoplasms: a proposal from the International Lymphoma Study Group.Blood. 1994;84:1361–1392.PubMedGoogle Scholar
  16. 16.
    Carbone A, Gaidano G. HHV-8-positive body-cavity-based lymphoma: a novel lymphoma entity.Br J Haematol. 1997;97:515–522.CrossRefPubMedGoogle Scholar
  17. 17.
    Quiding-Jarbrink M, Ahlstedt I, Lindholm C, Hohansson E-L, Lonroth H. Homing commitment of lymphocytes activated in the human gastric and intestinal mucosa.Gut. 2001;49:519–525.CrossRefPubMedPubMedCentralGoogle Scholar
  18. 18.
    Liu YX, Yoshida T, Ohhata N, et al. Loss of expression of α4β7 integrin and L-selectin is associated with high-grade progression of low-grade MALT lymphoma.Mod Pathol. 2001;14:798–805.CrossRefPubMedGoogle Scholar
  19. 19.
    Starostik P, Patzner J, Greiner A, et al. Gastric marginal zone B-cell lymphomas of MALT type develop along 2 distinct pathogenetic pathways.Blood. 2002;99:3–9.CrossRefPubMedGoogle Scholar
  20. 20.
    Berlin C, Berg EL, Briskin M, et al. α4β7 integrin mediates lymphocyte binding to the mucosal vascular addressin MAdCAM-1.Cell. 1993;74:185–195.CrossRefPubMedGoogle Scholar
  21. 21.
    Greiner A, Knorr C, Qin Y, et al. Low-grade B cell lymphomas of mucosa-associated lymphoid tissue (MALT-type) require CD40-mediated signaling and Th2-type cytokines for in vitro growth and differentiation.Am J Pathol. 1997;150:1583–1593.PubMedCentralPubMedGoogle Scholar
  22. 22.
    Knorr C, Amrehn C, Seeberger H, et al. Expression of costimulatory molecules in low-grade mucosa associated lymphoid tissue-type lymphomas in vivo.Am J Pathol. 1999;155:2019–2027.CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Nakamura T, Nakamura S, Yunezumi M, et al.Helicobacter pylori and t(11;18)(q21;q21) translocation in gastric low-grade B-cell lymphoma of mucosa-associated lymphoid tissue type.Jpn J Cancer Res. 2000;91:301–309.CrossRefPubMedPubMedCentralGoogle Scholar
  24. 24.
    Grillo-Lopez AJ. Monoclonal antibody therapy for B-cell lymphoma.Int J Hematol. 2002;76:385–393.CrossRefPubMedGoogle Scholar
  25. 25.
    Myron S, Fallon A, Mohr A, et al. Rituximab in combination with CHOP or fludarabine in low-grade lymphoma.Semin Oncol. 2002;29(suppl 2):36–40.Google Scholar
  26. 26.
    Kobayashi Y, Nakata M, Takahashi M, et al. Detection of t(11;18) MALT lymphoma with double color FISH and/or RT-PCR [abstract].Blood. 1999;94:385a.Google Scholar
  27. 27.
    Kobayashi Y, Nakata M, Maekawa M, et al. Detection of t(11;18) in MALT lymphoma with dual-color fluorescence in situ hybridization and reverse transcriptase-polymerase chain reaction analysis.Diagn Mol Pathol. 2001;10:207–213.CrossRefPubMedGoogle Scholar

Copyright information

© The Japanese Society of Hematology 2003

Authors and Affiliations

  • Yuya Kunisaki
    • 1
  • Tsuyoshi Muta
    • 1
  • Yujiro Yamano
    • 1
  • Yukio Kobayashi
    • 2
  1. 1.Department of Internal MedicineKyushu Kousei-Nenkin HospitalFukuoka
  2. 2.Hematology DivisionNational Cancer Center HospitalTokyoJapan

Personalised recommendations