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Signet-ring cells in a Waldenström's Macroglobulinaemia
T Molero1, S De La Iglesia, C Santana
1Department of Haematology, Hospital Universitario Ntra. Sra. del Pino, Las Palmas de Gran Canaria, Spain.
Insights
This report details the first known case of Waldenström's Macroglobulinaemia presenting with signet-ring cells in the bone marrow. These neoplastic cells express kappa immunoglobulin light chain, CD45, and CD19, aiding in diagnosis and differentiation from other tumors.
Area of Science:
- Hematology
- Oncology
- Immunopathology
Background:
- Waldenström's Macroglobulinaemia (WM) is a rare lymphoproliferative disorder characterized by malignant B cells producing monoclonal IgM.
- Bone marrow involvement is typical in WM, but specific morphological variants can pose diagnostic challenges.
Observation:
- A unique case of WM is presented with the presence of signet-ring cells within the bone marrow.
- These signet-ring cells exhibited intracytoplasmic inclusions staining positive for kappa immunoglobulin light chain via immunohistochemistry.
Findings:
- The neoplastic cells were confirmed as B-cell in origin, expressing CD45 and CD19.
- Gene rearrangement studies and immunohistochemistry were crucial for diagnosing WM and identifying the signet-ring cell morphology.
Implications:
- This finding expands the known morphological spectrum of Waldenström's Macroglobulinaemia.
- Accurate diagnosis requires specific immunostaining to differentiate these signet-ring cells from non-haemopoietic tumors.
Abstract:
A case of signet-ring cell lymphoma affecting bone marrow is reported. The patient was diagnosed as Waldenström's Macroglobulinaemia on the basis of clinical and laboratory features including morphology, immunohistochemistry and gene rearrangement studies. Light microscopy examination showed cells contained large globular inclusions (signet-ring cells) that stained for kappa immunoglobulin light chain by immunohistochemistry. In addition, the neoplastic cells expressed the common leukocyte antigen CD45 and the B cell marker CD19. This to the best of our knowledge is the first report of a patient with Waldenström's Macroglobulinaemia with the presence of vacuolated signet ring- cells in the bone marrow. Differential diagnosis arises with non-haemopoietic tumours and this needs to be based on specific immunostaining. Tumours and this need to be based on specific immunostaining.