TY - JOUR
T1 - Despite apparent morphologic and immunophenotypic heterogeneity, Waldenstrom's macroglobulinemia is consistently composed of cells along a morphologic continuum of small lymphocytes, plasmacytoid lymphocytes, and plasma cells
AU - Remstein, Ellen D.
AU - Hanson, Curtis A.
AU - Kyle, Robert A.
AU - Hodnefield, Janice M.
AU - Kurtin, Paul J.
PY - 2003/4
Y1 - 2003/4
N2 - We studied the clinical, morphologic, and immunophenotypic features of 26 Waldenstrom's macroglobulinemia (WM) cases, each with an IgM spike of ≥3.0 g/dL. The neoplastic cells were consistently composed of a spectrum of small lymphocytes, plasmacytoid lymphocytes, and plasma cells. Bone marrow (BM) involvement ranged from 10% to 90%, showed four histologic patterns (nodular [75%], interstitial [75%], paratrabecular [42%], and diffuse [4%]), two histologic subtypes (lymphoplasmacytic [87%] and lymphoplasmacytoid [13%]), and several cytologic variants (monocytoid [n = 2], signet-ring cell [n = 2], and hairy cell leukemia-like [n = 1]). By flow cytometry (FC), all cases expressed monoclonal surface immunoglobulin, CD 19, and CD20. Most cases (58%) lacked expression of CD5, CD10, and CD23. However, variants such as CD5+CD10-CD23- (n = 3), CD5+CD10-CD23+ (n = 1), and CD5-CD10+CD23+/-(n = 2) were seen. At last follow-up, 18 of 26 patients were alive (median survival, 94 months). Causes of death included WM (n = 1), large cell lymphoma (n = 1), acute myeloid leukemia (likely therapy-related [n =2]), and nonhematologic/unknown. When individual WM cases are compared, apparent morphologic diversity is suggested. However, every WM case is comprised of cells along a morphologic continuum from small lymphocytes to plasma cells, delineating a uniform, consistent pathology. As WM shows immunophenotypic heterogeneity, morphology must be the cornerstone of the diagnosis.
AB - We studied the clinical, morphologic, and immunophenotypic features of 26 Waldenstrom's macroglobulinemia (WM) cases, each with an IgM spike of ≥3.0 g/dL. The neoplastic cells were consistently composed of a spectrum of small lymphocytes, plasmacytoid lymphocytes, and plasma cells. Bone marrow (BM) involvement ranged from 10% to 90%, showed four histologic patterns (nodular [75%], interstitial [75%], paratrabecular [42%], and diffuse [4%]), two histologic subtypes (lymphoplasmacytic [87%] and lymphoplasmacytoid [13%]), and several cytologic variants (monocytoid [n = 2], signet-ring cell [n = 2], and hairy cell leukemia-like [n = 1]). By flow cytometry (FC), all cases expressed monoclonal surface immunoglobulin, CD 19, and CD20. Most cases (58%) lacked expression of CD5, CD10, and CD23. However, variants such as CD5+CD10-CD23- (n = 3), CD5+CD10-CD23+ (n = 1), and CD5-CD10+CD23+/-(n = 2) were seen. At last follow-up, 18 of 26 patients were alive (median survival, 94 months). Causes of death included WM (n = 1), large cell lymphoma (n = 1), acute myeloid leukemia (likely therapy-related [n =2]), and nonhematologic/unknown. When individual WM cases are compared, apparent morphologic diversity is suggested. However, every WM case is comprised of cells along a morphologic continuum from small lymphocytes to plasma cells, delineating a uniform, consistent pathology. As WM shows immunophenotypic heterogeneity, morphology must be the cornerstone of the diagnosis.
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U2 - 10.1053/sonc.2003.50073
DO - 10.1053/sonc.2003.50073
M3 - Article
C2 - 12720133
AN - SCOPUS:0037398681
SN - 0093-7754
VL - 30
SP - 182
EP - 186
JO - Seminars in oncology
JF - Seminars in oncology
IS - 2
ER -