Concurrent Chronic Lymphocytic Leukemia and Plasma Cell Myeloma in the Bone Marrow: A Retrospective Review of Six Cases
CL Alley, EL Boswell, AS Lagoo, E Wang. Duke University Medical Center, Durham, NC
Background: The finding of chronic lymphocytic leukemia (CLL) and plasma cell myeloma in the same individual is an uncommon finding which is currently limited to only single case reports in the published literature.
Design: A ten-year retrospective electronic search of the pathology case database was performed to identify cases of concurrent occurance of chronic lymphocytic leukemia and plasma cell myeloma. The morphologic, cytogenetic, and immunophenotypic features were evaluated to confirm the simultaneous presence of two B-cell malignancies and to rule out the possibility of lymphoplasmacytic lymphoma and marginal zone lymphoma with marked plasma cell differentiation.
Results: Six bone marrow core biopsy specimens involved by concurrent chronic lymphocytic leukemia and plasma cell myeloma were identified. The patient population ranged from 64 to 85 (median 77.5), and male patients constituted 5 of the 6 cases (83%). Three cases (50%) showed discordant light chain restriction in the abnormal plasma cells and CLL B-lymphocytes by immunohistochemistry and flow cytometry, respectively. Confirmatory cytogenetic and/or FISH testing was performed in all cases. Three cases (50%) showed abnormal findings with two of these cases demonstrating discordant light chain restriction and one case showing the same light chain restriction. Abnormalities involving chromosome 13, which can be seen in both chronic lymphocytic leukemia and plasma cell myeloma, were the commonest finding (100% of cytogenetically abnormal cases). Multiple cytogenetic abnormalities were observed in only one case (17%). The abnormal plasma cells showed nuclear staining for cyclin D1 in 4 cases (67%), but none of the clonal B-cells stained positive. Interestingly, no evidence of the t(11;14) translocation commonly associated with Cyclin D1 over-expression was seen in any of our cases.
Conclusions: Concurrent chronic lymphocytic leukemia and plasma cell myeloma within the same bone marrow is an uncommon observation that is found primarily in older men. Discordant light chain restriction occurs in half of the cases, which confirms the distinct clonal origins of the two B-cell neoplasms. Cytogenetic abnormalities of chromosome 13 are seen in about half of the cases when these two neoplasms are found concurrently. While cyclin D1 staining is seen in two-thirds of myeloma cells in these cases, it is not associated with t(11;14).
Monday, March 22, 2010 9:30 AM
Poster Session I Stowell-Orbison/Surgical Pathology/Autopsy Awards Poster Session # 174, Monday Morning