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Primary pulmonary lymphoma. Diagnosis by immunoglobulin gene rearrangement study using a novel polymerase chain
D Subramanian1, S Albrecht, J M Gonzalez
1Department of Medicine, Baylor College of Medicine, Houston, Texas.
Insights
Polymerase chain reaction (PCR) successfully identified monoclonal or biclonal plasma cells in a patient with pulmonary infiltrates, aiding in the diagnosis of plasmacytoid pulmonary lymphoma. This novel PCR application for lung lymphoid infiltrates offers diagnostic advantages.
Area of Science:
- Pulmonary Medicine
- Hematology
- Molecular Diagnostics
Background:
- A 63-year-old woman presented with pulmonary infiltrates and macroglobulinemia.
- Standard immunocytochemical staining for kappa and lambda light chains was inconclusive for determining plasma cell clonality.
Observation:
- Open lung biopsy revealed an interstitial plasma cell infiltrate.
- Traditional methods for detecting gene rearrangements, such as Southern blotting, were not employed in this initial diagnostic workup.
Findings:
- Polymerase chain reaction (PCR) amplification of the immunoglobulin heavy chain gene's CDR-III region indicated the plasma cells were monoclonal or biclonal.
- This finding suggested a diagnosis of plasmacytoid pulmonary lymphoma.
Implications:
- This case represents the first reported use of PCR for detecting gene rearrangements to determine lymphoid infiltrate clonality in the lung.
- The PCR technique offers advantages over traditional methods and can be applied to various sample types, including bronchoalveolar lavage, needle biopsies, and pleural effusions.
Abstract:
A 63-yr-old-woman presented with pulmonary infiltrates and macroglobinemia. Open lung biopsy revealed an interstitial plasma cell infiltrate. Immunocytochemical staining to determine clonality of the infiltrate was negative for both kappa and lambda light chains and therefore was not helpful. Polymerase chain reaction (PCR) amplification of the CDR-III region of the immunoglobulin heavy chain gene revealed that the plasma cells were either monoclonal or biclonal, thus suggesting the diagnosis of a plasmacytoid pulmonary lymphoma. The advantages and limitations of the PCR technique over the traditional method of detecting gene rearrangements, i.e., restriction-digestion of DNA and Southern blotting, are discussed. To our knowledge this patient represents the first reported application of the PCR technique for detecting gene rearrangements to determine the clonality of a lymphoid infiltrate in the lung. This technique can also be applied to determine the clonality of lymphocytes obtained by bronchoalveolar lavage or needle biopsy, or from a pleural effusion.
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