MALT lymphoma accompanied by elevated serum IgM levels mimicking Waldenström's macroglobulinemia

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  • IZUMI Shintaro
    Department of Hematology, Chiba University Hospital
  • KIMURA Kenji
    Department of Hematology, Chiba University Hospital
  • TAKEDA Yusuke
    Department of Hematology, Chiba University Hospital
  • TSUKAMOTO Shokichi
    Department of Hematology, Chiba University Hospital
  • YAMAZAKI Miki
    Department of Hematology, Chiba University Hospital
  • MISHINA Tatsuzo
    Department of Hematology, Chiba University Hospital
  • NAGAI Yurie
    Department of Hematology, Chiba University Hospital
  • TAKAISHI Koji
    Department of Hematology, Chiba University Hospital
  • NAGAO Yuhei
    Department of Hematology, Chiba University Hospital Department of Hematology, Chiba Aoba Municipal Hospital
  • OSHIMA-HASEGAWA Nagisa
    Department of Hematology, Chiba University Hospital
  • MITSUKAWA Shio
    Department of Hematology, Chiba University Hospital Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital
  • MIMURA Naoya
    Department of Hematology, Chiba University Hospital Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital
  • TAKEUCHI Masahiro
    Department of Hematology, Chiba University Hospital
  • OHWADA Chikako
    Department of Hematology, Chiba University Hospital
  • ISEKI Tohru
    Department of Hematology, Chiba University Hospital Department of Transfusion Medicine and Cell Therapy, Chiba University Hospital
  • OTA Satoshi
    Department of Pathology, Chiba University Hospital
  • NAKASEKO Chiaki
    Department of Hematology, Chiba University Hospital Department of Hematology, International University of Health and Welfare School of Medicine
  • SAKAIDA Emiko
    Department of Hematology, Chiba University Hospital

Bibliographic Information

Other Title
  • 高IgM血症を伴いWaldenströmマクログロブリン血症との鑑別を要したMALTリンパ腫
  • 症例報告 第7回日本血液学会関東甲信越地方会 優秀演題 高IgM血症を伴いWaldenstromマクログロブリン血症との鑑別を要したMALTリンパ腫
  • ショウレイ ホウコク ダイ7カイ ニホン ケツエキ ガッカイ カントウ コウシンエツチホウカイ ユウシュウ エンダイ コウIgM ケッショウ オ トモナイ Waldenstrom マクログロブリン ケッショウ ト ノ カンベツ オ ヨウシタ MALT リンパシュ

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Abstract

<p>A 60-year-old man with chronic hepatitis C was referred to our hospital with significantly elevated total protein and serum IgM (9,500 mg/dl) levels identified via a routine checkup. Blood examination revealed increased serum IgM-monoclonal protein and serum-soluble IL-2 receptor (sIL2R) levels. Computed tomography and fluorodeoxyglucose positron emission tomography revealed pulmonary masses, abnormal soft tissue masses surrounding the bilateral kidneys, and thickened mucous membrane of the bladder with high fluorodeoxyglucose uptake. Pathological examination of the pulmonary mass revealed infiltration of medium-sized lymphocytes and plasma cells. Immunohistochemical analysis revealed tumor cells positive for CD138 and IgM, with a low positive rate of Ki-67 expression. Notably, the tumor cell-surrounding lymphocytes were positive for CD20. Although the patient was initially regarded as having Waldenström's macroglobulinemia owing to the significantly increased serum IgM levels, based on positive IgH-MALT1 translocation and negative MYD88 L265P mutation findings, he was further diagnosed with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma). Complete remission was achieved following six cycles of rituximab + CHOP therapy. This study data suggest that analysis of the MYD88 L265P mutation in tumor cells is suitable for accurately diagnosing hematopoietic malignancies with increased IgM monoclonal protein.</p>

Journal

  • Rinsho Ketsueki

    Rinsho Ketsueki 59 (12), 2600-2605, 2018

    The Japanese Society of Hematology

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