The utility of B-cell receptor gene rearrangement studies in diagnosing diffuse large B-cell lymphoma with plasmacytic differentiation

• Published in: Annals of clinical and laboratory science Vol. 45; no. 1; pp. 79 - 82
• Main Authors: Alapat, Daisy V, Ramos, Jeanette M, Anderson, Julia, Post, Ginell R
• Format: Journal Article
• Language: English
• Published: United States 2015
• Subjects: Cell Differentiation; Gene Rearrangement, B-Lymphocyte; Humans; Lymph Nodes - pathology; Lymphoma, Large B-Cell, Diffuse - diagnosis; Lymphoma, Large B-Cell, Diffuse - genetics; Male; Middle Aged; Plasma Cells - pathology; Polymerase Chain Reaction; Receptors, Antigen, B-Cell - genetics; V(D)J Recombination - genetics; plasmacytic differentiation; Diffuse large B cell lymphoma; B cell receptor gene rearrangement
• ISSN: 1550-8080

We present the case of a 50-year-old man with nodal diffuse large B-cell lymphoma characterized by CD10, BCL-6, and BCL-2 expression and a complex karyotype, including t(14;18)(q32;q21) and del6q, suggesting transformation from an antecedent follicular lymphoma. Following rituximab-based chemotherapy, residual nodal disease was characterized by a proliferation of plasmacytoid cells positive for CD138, MUM-1, and cytoplasmic kappa light chain. Immunoglobulin heavy chain and kappa light chain gene rearrangement studies detected the same clone in the diagnostic and post-therapy lymph node specimens. This case illustrates the diagnostic utility of B-cell receptor gene rearrangement studies in detecting a clonal relationship in lymphoma cases with extensive morphologic and immunophenotypic variation following chemotherapy.