Korean Journal of Clinical Laboratory Science (대한임상검사과학회지)

Korean Society for Clinical Laboratory Science (대한임상검사과학회)
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Angioimmunoblastic T-Cell Lymphoma with Polyclonal Proliferation of Plasma Cells: A Cautionary Note for Flow Cytometry Interpretations

유세포 분석의 주의사항: 혈관면역모세포성 T세포 림프종에서 관찰된 다클론성 형질세포

  • Shin, Woo Yong (Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital) ;
  • Bang, Hae In (Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital) ;
  • Kim, Jung-Ah (Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital) ;
  • Kim, Jieun (Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital) ;
  • Park, Rojin (Department of Laboratory Medicine, Soonchunhyang University Seoul Hospital)
  • 신우용 (순천향대학교 부속 서울병원 진단검사의학과) ;
  • 방해인 (순천향대학교 부속 서울병원 진단검사의학과) ;
  • 김정아 (순천향대학교 부속 서울병원 진단검사의학과) ;
  • 김지은 (순천향대학교 부속 서울병원 진단검사의학과) ;
  • 박노진 (순천향대학교 부속 서울병원 진단검사의학과)
  • Received : 2021.12.23
  • Accepted : 2022.02.14
  • Published : 2022.03.31
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Abstract

Angioimmunoblastic T-cell lymphoma (AITL) is a lymphoproliferative disorder of mature T follicular helper cells. Atypical lymphoid cells were observed in the bone marrow of an 80-year-old woman, and the flow cytometric determined immunophenotypes of B-cells were unusual, that is, CD19+, CD20-, and CD22- with lambda light chain restriction. Initially, we suspected BM involvement of B-cell lymphoma based on the presence of abnormal B-cells. However, the patient was diagnosed with AITL involving BM. A re-analysis of flow cytometric immunophenotyping revealed a minor, aberrant T-cell population, and the lambda light chain restriction observed by surface staining was considered non-specific binding. This case demonstrates B-cells in patients with EBV-positive T-cell lymphoma may exhibit immunophenotypes resembling those of plasma cells, and that proliferation of abnormal B-cells or plasma cells could also potentially mask underlying T-cell lymphoma. A more integrated approach is required for accurate diagnosis.

혈관면역모세포성 T세포 림프종(AITL)은 성숙 T follicular helper cells의 림프증식성 질환이다. 80세 여성의 골수에서 비정형 림프구가 관찰되었고 B세포에 대한 유세포검사에서 CD19+, CD20-, CD22- 및 lambda 경쇄 restriction과 같은 비정상 표현형이 관찰되었다. 처음에는 유세포검사에서 관찰된 비정상 B세포에 대해 B세포 림프종을 의심하였다. 그러나 환자는 골수를 침범한 AITL로 진단되었다. 유세포검사의 재분석에서 소수의 비정상 T세포 군집을 발견했다. 표면 lambda 경쇄 restriction은 비특이적 결합으로 생각되었다. EBV 양성 T세포 림프종 환자에서 형질세포와 유사한 면역표현형을 가진 B세포가 관찰될 수 있다. 이러한 비정상 B세포 혹은 형질세포의 증식이 기저에 존재하는 T세포 림프종을 가릴 수 있다. 정확한 진단을 위해서는 통합적인 접근이 필요할 것이다.

Keywords

Acknowledgement

This work was supported by the Soonchunhyang University Research Fund.

References

  1. Swerdlow SH, Campo E, Harris NL, Jaffe ES, Pileri SA, Stein H, et al. Mature T- and NK-cell neoplasms. In: WHO classification of tumours of haematopoietic and lymphoid tissues. Revised 4th ed. Lyon: IARC; 2017;407-408.
  2. Hashimoto A, Asai S, Tanaka Y, Shinzato I. Epstein-Barr virus-positive adrenal diffuse large B-cell lymphoma after treatment for angioimmunoblastic T-cell lymphoma. Eur J Case Rep Intern Med. 2021;8:002533. https://doi.org/10.12890/2021_002533
  3. Yang QX, Pei XJ, Tian XY, Li Y, Li Z. Secondary cutaneous Epstein-Barr virus-associated diffuse large B-cell lymphoma in a patient with angioimmunoblastic T-cell lymphoma: a case report and review of literature. Diagn Pathol. 2012;7:7. https://doi.org/10.1186/1746-1596-7-7
  4. Lee T, Park BG, You E, Cho YU, Jang S, Lee SM, et al. Bone marrow involvement of Epstein-Barr virus-positive large B-cell lymphoma in a patient with angioimmunoblastic T-cell lymphoma. Ann Lab Medicine. 2018;38:172-175. https://doi.org/10.3343/alm.2018.38.2.172
  5. Grogg KL, Morice WG, Macon WR. Spectrum of bone marrow findings in patients with angioimmunoblastic T-cell lymphoma. Br J Haematol. 2007;137:416-422. https://doi.org/10.1111/j.1365-2141.2007.06577.x
  6. Hulspas R, O'Gorman MR, Wood BL, Gratama JW, Sutherland DR. Considerations for the control of background fluorescence in clinical flow cytometry. Cytometry B Clin Cyto. 2009;76:355-364. https://doi.org/10.1002/cyto.b.20485
  7. Van Der Meer W, Van Gelder W, de Keijzer R, Willems H. The divergent morphological classification of variant lymphocytes in blood smears. J Clin Pathol. 2007;60:838-839. https://doi.org/10.1136/jcp.2005.033787
  8. Hudnall SD, Patel J, Schwab H, Martinez J. Comparative immunophenotypic features of EBV-positive and EBV-negative atypical lymphocytosis. Cytometry B Clin Cytom. 2003;55:22-28. https://doi.org/10.1002/cyto.b.10043
  9. Nakatsuka SI, Yutani C, Kurashige M, Kohara M, Nagano T, Goto T, et al. An unusual case of Epstein-Barr virus-positive large B-cell lymphoma lacking various B-cell markers. Diagn Pathol. 2017;12:1-6. https://doi.org/10.1186/s13000-017-0606-7
  10. Kaleem Z, Hassan A, Pathan MH, White G. Flow cytometric evaluation of posttransplant B-cell lymphoproliferative disorders. Arch Pathol Lab Med. 2004;128:181-186. https://doi.org/10.5858/2004-128-181-FCEOPB
  11. Cobaleda C, Schebesta A, Delogu A, Busslinger M. Pax5: the guardian of B cell identity and function. Nat Immunol. 2007;8:463-470. https://doi.org/10.1038/ni1454
  12. Lee N, Yario TA, Gao JS, Steitz JA. EBV noncoding RNA EBER2 interacts with host RNA-binding proteins to regulate viral gene expression. Proc Natl Acad Sci USA. 2016;113:3221-3226. https://doi.org/10.1073/pnas.1601773113