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PRIMARY PLASMACYTOMA of the CERVICAL LYMPH NODE: (A Case Report) Servikal Lenf Nodunun Primer Plazmasitomu: (Olgu Sunumu)

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PRIMARY PLASMACYTOMA of the CERVICAL LYMPH NODE: (A Case Report) Servikal Lenf Nodunun Primer Plazmasitomu: (Olgu Sunumu) OLGU SUNUMLARI (Case Report~) PRIMARY PLASMACYTOMA OF THE CERVICAL LYMPH NODE: (A Case Report) Servikal lenf nodunun primer plazmasitomu: (Olgu sunumu) 3 Kısmet BİLDİRİCİ 1, Emine DÜNDAR2, Abdülvahap ASLAN Abstract: Primaıy extramedullary plasmacytomas are Özet: Primer ekstramedüller plazmasitomlar nadir rare disorders, and the majority arise in the upper hastalıklardır, çoğunluğu üst solunum sisteminden köken respiratory system. Primaıy· plasmacytoma of the lymph alır. Lenf nodunun prim er plazmasitomlan çok nadirdir nodes is extremely rare, and there are fewer than 20 ve literatürde 20 'den az olgu bildirilmiştir. Bıı olgu reported cases in medical literature. in this case report, sunumu nda, servikal lenf nodunda primer plazmasitom we present a case of primary plasmacytoma of the saptanan bir olgu sunduk. cervical lymph node. Key Words: Lymph node, Primaıy plasmacytoma Anahtar Kelimeler: Lerif nodu, Primer plazmasitom Plasmacytoma is an immunoproliferative, Case Report monoclonal disease of the B-cell !ine and is A 41-year-old male patient was admitted for a classified as non-Hodgkin lymphoma. It originates painless swelling in his right cervica l region. The from a clone of malignant transformed plasma cells. swelling had been present for the last five years and The different types of plasma celi tumors are: 1) had grown more rapidly in the last year. The blood Extramedullary plasmacytoma (EMP): a) primary formula showed 6.0xl0 9 /L white blood cells, with a (true) plasmacytoma of the mucosa, normal differential count. The hemoglobin level was unifocal/multifocal, with/without affected lymph 15 g/dL and platelet count 150x10 9/L. Total serum nodes; and b) extramedullary manifestations of protein was 7.0 g/L. Bence Jones protein in the urine multiple myeloma (MM); 2) solitary plasmacytoma was negative. Serum concentrations of lgG, IgA and ofthe bone; 3) the multifocal form of MM; 4) MM; IgM were 993 , 200 and 161 mg/d l, respectivel y. 5) plasmablastic sarcoma (modified classifıcation of Bone marrow aspiration and biopsy showed norma l Bartl and Deicher, 1995) (3). Primary hemopoiesis and no exces s of plasma cells. A chest extramedullary plasmacytomas consist of X-ray .was normal. On physica l examinat ion there proliferation of monoclonal plasma cell foci located was a fırın, easily movable lymph node swelling outside the bone marrow. it is a rare disorder and the measuring 4 cm in diameter at the right cervical majority arise in the upper respiratory system region. A right cervical lymph node biopsy was (6,9,14). Primary plasmacytoma ofthe lymph nodes carried out. Roentgenographic examinat ion (PPLN) is very rare, and there are fewer than 20 displayed no lytic shadows in the bones. No other reported cases in the medical literature (1, 11, 13). site of plasmacytoma was detected. Chemotherapy We report a case of primary plasmacytoma or radiotherapy could not be applied as the patient apparently confıned to a single servical lymph node did not give consent . For the past two years , the patie nt has remained free of disease, with no evidence of loca! recurrence in the biops y site. OsmangaziÜniversitesi Tıp FakültesiESKİŞEHiR The surgical specimen was fixed with 10% buffered 1 2 3 Patoloji. Öğr.Gör.Dr. , YDoç.Dr. Hematoloji.YDoç.D r. formaldehyde and embedded in paraffın. Sections (4 µ thick) were stained with haematoxylin & eosin and Geliş tarihi: 9 Nisan 2001 Congo-red. Immunohistochemical analysis was Bildirici, Dündar, Aslan performed using the avidin-biotin peroxidase (ABC) method. Primary antibodies against the following antigens were used: CD20 ( Neomarkers, 1:50 dilution), CD45 (Neomarkers, 1:50 dilution), kappa light chain (Zymed), lambda light chain (Zymed), immunoglobulin (Ig) E heavy chain (Dako, 1:25 dilution), IgM heavy chain (Zymed), IgA heavy chain (Biogenex) and IgG heavy chain (Zymed) . The specimen consisted of an encapsulated firm mass, which measured 6.Sx3.5x3 cm in diameter , with a smooth greyish surface. The cut surface was uniform and grey-white in colour. Figure 2. High-power view of the plasma celi infıl trates . (H&E stain, x 800) Microscopic examination revealed diffuse infıltration of atypical plasma cells in both cortex and medulla (Fig. l and 2). Kappa light chain was evaluated as intensely positive (Fig. 3). Lambda light chain, CD45, CD20, and lg heavy chains lgG, IgA, lgM, IgE were negative. The Congo-red staining performed for evaluation of amyloid was negative . Histopathological and immunohistochemical examination revealed a kappa plasmacytoma. Figure 3. Plasmacytoma with positiv e immunog lobulin kappa light chain ([mmunoper oxidase technique, kappa, X 800). DISCUSSION Extramedullary plasmacytomas, tike multiple myeloma, consist ofa proliferation of plasma cells showing varying degrees of differentiation . ln order to diagnose PPLN, the fırst criterion is the establishment of the malignant nature of the tumor. Second, it must be proven that this is . not a metastasis of myeloma or plasmacytoma of another organ. Plasmacytoma of the lymph . node i~ Figure 1. Sections of lymph node showing residual occasionally seen in the course of multiple myeloma lymphoid tissuee and sheets of plasma celi infıltrate s or metastasis from other sites of plasmacytoma , (H&E stain, x 50) (9,11,14). Therefore, the absence of bone marrow Primaıy p lasmacytoma of the lymph node infıltration of plasma cells and another primary cells are usually accompanied by many neopla stic plasmacytoma is an important factor in the diagnosis small lymphocytes (1,7, 11). The immunop eroxydase of PPLN. Histological and immunological findings staining technique is the most usefu l meth od to are additional important factors in the diagnosis achieve this goal (12). (13). Wiltshaw stressed tha t solitar y extramedu llary EMPs make up 4% of all plasma celi tumors and plasmacytoına has a natura ! histo ry distin ct from occur most commonly in the upper aerodigestive multiple myeloma and soli tary mye lom a of bone, tract , and regional lymph nodes are sometimes with a more favora ble progno sis (6, 18). The re invo lved (6,8, 10, 15). However, EMP has also been appears to be a small number ofp atient s in whom the described in a wide array of locations including tumor is confıned to a solitary node or grou p of palatine tonsil, breast, lung, thyroid gland lymph nodes. in this group , loca! tre atm ent is (2,8,14,15,17), gastrointestinal tract and skin . adequate and the prognosi s is simil ar to tha t for Prirnary plasmacytoma of the lymph nodes is very cases of solitary pla smacytoma in other sites (1) . rare, and there are fewer than 20 reported cases in Most cases respond well to excis ion with or without medical literature (6, 1 1). The mean patient age in adjuvant chemotherapy or rad iation thera py with no the previously reported cases is 50.6 years. recurrence or progression ( 11). Our patient did not permit the applica tion of che ınoth era p y or The immunophenotype of the primary nodal radiotherapy , and showed no rec urrenc e or plasmacytomas is characteristic. According to Lin progression in the two year s period of follo w-up . and Weiss, 7 of the 7 cases had light chain restriction, 4 of the 7 cases expressed monoclonal REFERENCES heavy chain (three with lgG and one with IgM), 1 of the 7 cases had nodal monoclonal IgG and serum 1. Addis BJ, Isaacson P, Billings JA. monoclonal IgA elevation. None of the cases had Plasmacytoma of lymph nodes. Cancer / 980; CD20 or CD43 antigen expression, and 6 of the 46: 340-346. cases expressed CD79a (11). in the report by 2. Amin R. Extrame dulfary p lasmacytoma of the Menke et al, 17 of 20 cases had light chain lung. Cancer 1985; 56: 152-156. restriction, 16 of 20 cases expressed ınonoclonal 3. Bartl R, Deich er H. Das Mu/tip le Myelom , heavy chain (1 O lgG, 4 lgM, 2 lgA) , and 3 of 20 Onkologie Forum International pmi . Frank/ ur! cases had CD20 exp re ssion (16). These results am Main: Verlagsgruppe GmbH, 5(1), 1995. indicate that primary nodal plasmacytoma is an 4. Beguin Y, Bon iver J, Bury J, et af. unequivocal monoclonal neoplastic proliferation. in Plasmacytoma of the thyroid: A case report, a our case immunohistochemical staining for kappa study with use of the immunoperoxydase light chain was positive in the cytoplasm of tumor technique , and a review of the f i te ra t ıı re . cells. Lambda light chain, lgG, IgA, JgM and IgE Surgery 1987; /Ol : 496-500. heavy chain, CD20, CD45 were negative. 5. Chen KTK, Bauer V, Bauer F. Locafized thyroid plasmacytoma . J. Surg. Oncol. 1986; 32: 220- ln lymph nodes, a true plasmacytoma must be 222. differentiated from nonneoplastic conditions in 6. Christoph A, Reinhardt JK, Hermann D, et al. which larger nuınbers of plasma cells are found , Extrameduffary p lasmacytoma Cancer 1999; such as the lymphadenopathy associated with 85: 2305-2314. rheumatoid disease and the plasına celi variant of 7. Cousin eau S, Beauchamp G, Boileaıı J. giant lymph node hyperplasia, and neoplastic Extraınedullary p lasmacyt oma associated with condition such as the plasmacytoid variant of angiofofficular lymph node hyperpl asia. Arch. ınalignant lymphoma. in these cases , the plasma Pathol. lab. Med 1986; 1/0 : 157-158. Bildirici, Dündar, Aslan 8. Hanna EYN, Lavertıı P, Tucker HM, Tubbs RP. 14. Mayr NA, Wen BC, Hussey DH, et al. The role Bilateral extraınedullary plasmacytomas of the of radiation therapy in the treatment ofsolitary palat ine tonsils: A case report. Otolaryngol. plasmacytomas. Radioth er Oncol 1990; 17: Head NeckSurg. /990; 103: /024-1027 293-303. 9. Kayroıız T, Jose B, Chıı AM, Scott RM. Solilary 15. Möll U, Knöbber D, Vogl T, Switalla R. Das plasmacytoma. J Sur. Oncol.
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