eISSN: 1896-9151
ISSN: 1734-1922
Archives of Medical Science
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vol. 13
Letter to the Editor

Marginal zone B-cell lymphoma mimicking extramedullary plasmacytoma and the clinical outcome after treatment

Man Fai Law
Hay Nun Chan
Charlotte Leung
Cheuk Kei Wong
Ho Kei Lai
Chung Yin Ha
Celia Ng
Yiu Ming Yeung
Sze Fai Yip

Arch Med Sci 2017; 13, 3: 698–701
Online publish date: 2017/04/20
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Marginal zone B-cell lymphoma is occasionally associated with prominent plasma cell differentiation, suggesting a possible histogenic relationship [1]. Primary lymph node plasmacytoma is a rare disorder [2, 3]. It has been suggested to represent an extreme form of plasmacytic differentiation of nodal marginal zone B-cell lymphoma. We report a case of marginal zone B-cell lymphoma with focal plasmacytic differentiation presenting with lymphadenopathy. The lymph node biopsy was initially interpreted as plasmacytoma, and the patient was treated with chemotherapy for plasma cell neoplasm. He had disease progression and then lymph node biopsy was repeated and finally revealed marginal zone B-cell lymphoma. He was treated with chemoimmunotherapy for lymphoma and had a good clinical response.
A 58-year-old man with an unremarkable medical history, except for appendicitis with appendectomy, presented with an enlarged left supraclavicular lymph node of 4 cm in diameter. He had no fever, weight loss or bone pain. There was no hepatosplenomegaly on physical examination. Complete blood count, liver and renal function tests were unremarkable. Incisional biopsy of the lymph node showed effacement of nodal architecture by a diffuse infiltrate of plasmacytoid cells and immature cells with prominent nucleoli (Figure 1). On immunohistochemical staining, these cells were positive for plasma cell marker CD138 and negative for CD3, CD5, CD20, and CD79a. Kappa light chain restriction was demonstrated. The biopsy result was interpreted as plasmacytoma.
There was an incidental finding of second degree heart block, and a pacemaker was inserted. Echocardiogram showed a large soft tissue mass in the right atrium attached to the atrial septum. Computed tomography (CT) scan of the thorax revealed a large lobulated soft tissue mass occupying the right and left atria with the largest transaxial dimension measuring 7.6 cm. There were mediastinal and left hilar masses representing lymph nodes deposits. The patient was reluctant to undergo biopsy of the intracardiac mass. Bone marrow examination showed active marrow without plasmacytosis. The patient’s immunoglobulin G level was 19.7 g/l, and there was no immunoparesis. The 2-microglobulin level was 1.85 ng/ml. Skeletal survey did not show any lytic lesions.
The patient received treatment for extramedullary plasmacytoma. He was given bortezomib (Velcade), thalidomide and dexamethasone (VTD) chemotherapy. The...

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