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Multiple Myeloma
Published in Pat Price, Karol Sikora, Treatment of Cancer, 2020
A bone marrow examination is an essential diagnostic investigation. A marrow aspirate may be sufficient to confirm the diagnosis, but a trephine biopsy is likely to give a more reliable estimate of plasma cell numbers. Immunohistology or flow cytometry to demonstrate monoclonality is essential where there is only a modest increase in plasma cell numbers. The majority of cases have an abnormal plasma cell phenotype, and although there is no single characteristic phenotype most cases show a reduction in CD19 expression and aberrant expression of CD56, and a minority have aberrant expression of CD117, CD20, and CD28.
The lymphoreticular system and bone marrow
Published in C. Simon Herrington, Muir's Textbook of Pathology, 2020
Reactive lymphoid infiltrates are derived from many different clones, all directed against different antigens. The cells in a lymphoma are genetically identical and represent the progeny of a single cell (monoclonal). In a B-lymphocytic proliferation, the demonstration that the cells produce only one of the two types of immunoglobulin light chain (κ or λ), by either immunocytochemistry or in situ hybridization, effectively establishes the presence of monoclonality and thus of neoplasia. Monoclonality can also be determined by detecting clonal rearrangements of immunoglobulin and T-cell receptor genes in B- and T-cell lymphomas, respectively.
Lymphoid and Myeloid Malignancies
Published in Victor A. Bernstam, Pocket Guide to GENE LEVEL DIAGNOSTICS in Clinical Practice, 2019
Evidence of monoclonality per se does not imply malignancy, because a number of clinically benign conditions may have clonal populations of T and/or B cells, and precise distinction between benignity and malignancy in these conditions is not straightforward.
Tubular basement membrane amyloid deposition: is it an indicator of renal progression in light chain amyloidosis?
Published in Renal Failure, 2023
Csilla Markóth, László Bidiga, László Váróczy, Ibolya File, József Balla, János Mátyus
The medical history of a 61-year-old female patient included osteomyelitis of the right tibia in 1975, splenectomy due to immune thrombocytopenia, hypertension, treatment for type-2 diabetes mellitus since 2012, neoadjuvant chemotherapy for rectal cancer in 2013, followed by a Hartmann’s procedure, colostomy closure, and left knee replacement in 2018. In September 2020, she was referred to a nephrologist because of increasing proteinuria (2 g/day), which began in 2018. She had diabetes that was well controlled with metformin and semiglutide. The kidney size and function were normal, as were routine blood tests and urine sediment. Serum protein electrophoresis (SPEP) confirmed an IgG lambda monoclonal component (6.3 g/l), which was also present in urine (7 mg/l), and the serum free light chain kappa/lambda ratio (sFLCk/l) was 0.13. Bone marrow flow cytometry revealed 0.45% plasma cells, of which 55% were pathological, showing lambda monoclonality.
ClonoSEQ assay for the detection of lymphoid malignancies
Published in Expert Review of Molecular Diagnostics, 2019
Anna Monter, Josep F. Nomdedéu
However, HTS provides a sequence-based compilation of identical rearrangements (clonotypes), which makes it possible: a quantitative consideration of the individual Ig/TCR rearrangements; identify intraclonal diversity and assess the clonal relationship of the amplified rearrangements between lesions. In other words, to interpret the context of clonality assessment: reactive (oligo- and polyclonality) vs malignant lymphoproliferation (monoclonality). NGS-based IG/TR sequence data obtained in the context of clonality assessment will reveal the true extent of repertoire skewing in normal individuals with nonmalignant repertoires, as well as in settings of vaccination, postinfection, autoimmunity, allergy or even immune reconstitution after allogeneic hematopoietic stem cell transplantation or drug-induced lymphocyte depletion [12].
Prognostic value of cryoglobulins, protein electrophoresis, and serum immunoglobulins for lymphoma development in patients with Sjögren’s syndrome. A retrospective cohort study
Published in Acta Clinica Belgica, 2018
Jesse Kimman, Xavier Bossuyt, Daniel Blockmans
The distribution of patients based on protein electrophoresis results are depicted in Table 4. Progressively decreasing gammaglobulins were a significant risk factor for lymphoma development in the overall population (p-value = 0.0137 and OR 13.4 with CI 1.7–105.4). A transient or persistent but steady hypogammaglobulinemia was not significantly correlated with lymphoma (p-values = 0.6422 and 0.2994, respectively). Also a persistent detection of monoclonality was a significant lymphoma predictor in the primary (p-value = 0.0003; OR 14.6 with CI 3.4–62.6) and overall group (p-value < 0.0001; OR 13.9 with CI 3.7–51.9), while a transient detection was not significant (p-value 0.0563 in pSS). No significant correlation between any of the hypergammaglobulinemia, hypobetaglobulinemia, or hyperbetaglobulinemia groups and lymphoma was found.