Increased incidence of monoclonal B-cell infiltrate in chronic myeloproliferative disorders

A total of 106 trephine biopsy specimens with clinical, laboratory and pathology findings corresponding to chronic myeloproliferative disorders (CMPD) were analyzed to reveal the nature of the lymphoid infiltrate in the bone marrow. Histological investigation in 31 chronic myeloid leukemia (CML), 29...

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Bibliographic Details
Published in:Modern pathology 2004-12, Vol.17 (12), p.1521-1530
Main Authors: Pajor, László, Lacza, Ágnes, Kereskai, László, Jáksó, Pál, Egyed, Miklós, Iványi, János L, Radványi, Gáspár, Dombi, Péter, Pál, Katalin, Losonczy, Hajna
Format: Article
Language:English
Subjects:
B-Lymphocytes - immunology
B-Lymphocytes - pathology
CD3 Complex - analysis
CD5 Antigens - analysis
Chronic Disease
DNA - analysis
DNA - genetics
DNA - isolation & purification
Flow Cytometry
Fusion Proteins, bcr-abl - genetics
Gene Expression
Gene Rearrangement, B-Lymphocyte, Heavy Chain - genetics
Humans
immunoglobulin gene
Immunoglobulin kappa-Chains - analysis
Immunoglobulin lambda-Chains - analysis
In Situ Hybridization, Fluorescence
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - genetics
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - immunology
Leukemia, Myelogenous, Chronic, BCR-ABL Positive - pathology
lymphoma
myeloproliferation
Myeloproliferative Disorders - genetics
Myeloproliferative Disorders - immunology
Myeloproliferative Disorders - pathology
Neprilysin - analysis
Polycythemia Vera - genetics
Polycythemia Vera - immunology
Polycythemia Vera - pathology
Polymerase Chain Reaction
Receptors, IgE - analysis
Thrombocytosis - genetics
Thrombocytosis - immunology
Thrombocytosis - pathology
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Summary:A total of 106 trephine biopsy specimens with clinical, laboratory and pathology findings corresponding to chronic myeloproliferative disorders (CMPD) were analyzed to reveal the nature of the lymphoid infiltrate in the bone marrow. Histological investigation in 31 chronic myeloid leukemia (CML), 29 CMPDs not otherwise specified (CMPD-NOS), 28 essential thrombocytosis (ET), 15 polycythemia vera (PV) and three chronic eosinophilic leukemia/hypereosinophilic syndrome (CEL/HES) exhibited in 32% various amounts of lymphocytic infiltrate of sparsely to moderately diffuse or nodular types in the bone marrow, but the reactive or coinciding lymphomatous nature could not be revealed by histology alone in the majority of cases. PCR analysis of the immunoglobulin heavy chain (IgH) gene rearrangement was successfully performed in 81 out of the 106 DNA specimens extracted from formol–paraffin blocks. Out of the 81 samples with good-quality DNA, 18 gave a single or double discrete amplification band(s), which was reproducible only in four specimens. Sequencing finally proved monoclonal B-cell population of both pre- and postfollicular origin in all four samples (5%), one CML and three CMPD-NOS. Detailed clinical and pathological investigations indicated overt B-cell malignant lymphoma with clonal relationship to the CMPD in two out of these four patients. We conclude that detailed molecular analysis of IgH gene rearrangement in bone marrow samples of CMPD patients is needed to identify the true monoclonal B-cell infiltration, which—even without overt malignant lymphoma—may occur in this group of disorders.
ISSN:0893-3952
1530-0285
DOI:10.1038/modpathol.3800225