Lymphoplasmacytic lymphoma involving bone marrow:a clinicopathological analysis of 51 cases
Objective To investigate the clinical pathological characteristics,immunophenotype,diagnosis,and differential diagnosis of lymphoplasmacytic lymphoma involving bone marrow.Methods A retrospective analysis was conducted on the result of bone marrow biopsy,immunohistochemistry,flow cytometry,immunofixation electrophoresis,and Ig gene rearrangement tests in 51 patients with lymphoplasmacytic lymphoma,and a review of relevant literature was conducted.Results There were 31 males and 20 females.The proportion of abnormal cells involved in bone marrow in lymphoplasmacytic lymphoma ranged from 0.5％to 95％.The proliferative pattern of tumor induced lymphocytes was mainly nodular,with a small amount of plasma cell proliferation commonly around and between lymphocytes,more mast cells,and hemosiderin containing particles were more commonly detected.62.7％(32/51)were nodular bone marrow infiltration,29.4％(15/51)were diffuse bone marrow infiltration,and 7.8％(4/51)were interstitial bone marrow infiltration.51 cases underwent immunohistochemistry,with 100％(51/51)expressing B cell related antigens(CD20,CD19,PAX-5)and 21％(11/51)expressing CD23.The proportion of plasma cell components was low,ranging from 0.5％to 10％,with restricted expression of Ig light chains and 70.6％(36/51)expressing cytoplasmic monoclonal Ig light chain Kappa;29.4％(15/51)expressed cytoplasmic monoclonal Ig light chain Lambda,with Ki-67 proliferation index ranging from 5％to 10％.Flow cytometry in 51 patients showed monoclonal small B lymphocytes and a small amount of monoclonal plasma cells.Among them,23 cases underwent immunofixation electrophoresis,17 cases were IgM-KAP type M protein,and 6 cases were IgM-LAM type M protein.11 cases underwent Ig gene rearrangement analysis,10 cases were detected IGHV and IGK gene clonal rearrangement,and 1 case detected IGK gene clonal rearrangement.Conclusion Lymphoplasmacytic lymphoma often involves bone marrow with nodular infiltration,and the proportion of plasma cells can be very low.The diagnosis needs to be combined with clinical manifestations,bone marrow biopsy,immunohistochemistry,flow cytometry,immunofixation electrophoresis,and Ig gene rearrangement detection for comprehensive diagnosis.
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