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Published on: October 23, 2019
Intracytoplasmic immunoglobulin crystals in follicular lymphoma
Ryuichi Wada1, Yoshihito Ebina, Hidekachi Kurotaki
1Department of Pathology, Hirosaki University School of Medicine, Hirosaki, Japan.
Insights
This study details a rare follicular lymphoma case with crystals inside cancer cells, not in other cells. These unique crystal inclusions in lymphoma cells suggest a favorable prognosis.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Follicular lymphoma is a common indolent non-Hodgkin's lymphoma.
- Crystal inclusions in neoplastic cells are exceptionally rare findings.
Observation:
- A 53-year-old Japanese woman presented with left neck lymphadenopathy.
- Biopsy revealed follicular lymphoma composed of atypical centroblastic and centrocytic cells.
- Intracytoplasmic crystalline inclusions were observed exclusively within the lymphoma cells.
Findings:
- Immunohistochemistry showed lambda light chain restriction in lymphoma cells.
- In situ hybridization confirmed monoclonal lambda light chain mRNA expression.
- Crystals exhibited a periodic linear substructure (approx. 5 nm intervals) and weak positivity for immunoglobulin light chains.
- No paraproteinemia or crystal-storing histiocytosis was detected.
Implications:
- This case adds to the limited literature on non-Hodgkin's lymphoma with intracellular crystals.
- The confinement of crystals to neoplastic cells and absence of paraproteinemia may indicate a favorable clinical course.
- Further research into the nature and origin of these crystals could offer new diagnostic or therapeutic insights.
Abstract:
We report a case of follicular lymphoma with crystal inclusions. Swollen lymph nodes taken from the left neck of a 53- year-old Japanese woman were replaced by follicular proliferation of atypical centroblastic and centrocytic cells with intracytoplasmic crystal inclusions. The crystals were confined to lymphoma cells and were not found in histiocytes. Lymphoma cells were positively immunostained with lambda light chain and mu heavy chain, but the crystals were only weakly so. In situ hybridization of light chains disclosed a monoclonal expression of lambda light chain mRNA in lymphoma cells. The crystals had a periodic linear substructure with about 5-nm intervals. The worldwide literature reports 8 cases, including the current case of non-Hodgkin's lymphoma with crystals confined to the neoplastic cells. The cases did not accompany paraproteinemia and crystal-storing histiocytosis and appear to follow a favorable clinical outcome.
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