Korean J Lab Med.  2011 Jan;31(1):18-21. 10.3343/kjlm.2011.31.1.18.

A Case of Monoclonal Gammopathy in Extranodal Marginal Zone B-cell Lymphoma of the Small Intestine

• Kim DY
• Kim YS
• Huh HJ
• Choi JS
• Yeo JS
• Kwak BS
• Chae SL

• KMID: 1096655
• DOI: http://doi.org/10.3343/kjlm.2011.31.1.18

Abstract

Monoclonal gammopathy occurs in one-third of the patients with mucosa-associated lymphoid tissue lymphoma (MALT lymphoma). However, monoclonal gammopathy has been rarely reported in Korea. Paraprotenemia accompanying MALT lymphoma is strongly correlated with involvement of the bone marrow, and this involvement leads to the progression of the disease. Here, we present a case of a 66-yr-old man diagnosed with IgM monoclonal gammopathy and stage IV extranodal marginal zone lymphoma of the small intestine, with the involvement of the bone marrow.

Keyword

Marginal zone B-cell lymphoma; Monoclonal gammopathy; Bone marrow

MeSH Terms

Aged
Antineoplastic Agents/therapeutic use
Bone Marrow/pathology
Drug Therapy, Combination
Electrophoresis, Polyacrylamide Gel
Humans
Immunoglobulin M/analysis
Intestinal Neoplasms/complications/drug therapy/*pathology
Lymphatic Metastasis
Lymphoma, B-Cell, Marginal Zone/complications/drug therapy/*pathology
Male
Neoplasm Staging
Paraproteinemias/blood/complications/*pathology
Positron-Emission Tomography
Tomography, X-Ray Computed

Figure

• 

  Fig. 1 Serum immunofixation electrophoresis showed a dense abnormal zone of restriction in the IgM lane and in the lambda light chain lane.

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  Fig. 2 Microscopic features of the small intestinal mucosa-associated lymphoid tissue lymphoma. (A) The tumor cells of the marginal zone surround the reactive follicles and diffusely infiltrate the mucosa (hematoxylin and eosin stain, ×100). (B) A lymphoepithelial lesion showing destruction of the intestinal crypts by tumor cells (arrows) (hematoxylin and eosin stain, ×400). (C) Plasma cells with eccentric nuclei are admixed with small lymphocytes (hematoxylin and eosin stain, ×400). (D) Plasma cells are highlighted (brown) by immunohistochemical staining for CD38 (Immunohistochemistry, ×400).

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  Fig. 3 Findings of peripheral blood smear and bone marrow study. (A) The peripheral blood smear shows a plasmacytoid lymphocyte (Wright stain, ×1,000). (B) The bone marrow aspirate contains 2.1% plasma cells (Wright stain, ×1,000). (C) Bone marrow biopsy showing interstitial infiltration of mature lymphocytes (hematoxylin and eosin stain, ×400).

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