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Cyclin D1 Protein Overexpression in Extramedullary Plasmacytoma : A Clinicopathologic Study of 11 Cases

2009; Volume: 49; Issue: 1 Linguagem: Inglês

10.3960/jslrt.49.53

1880-9952

Masaru Kojima, Tadashi Motoori, Yoshio Tamaki, Tadahiko Igarashi, Morio Matsumoto, Kazuhiko Shimizu, Akira Ogawa, Hideaki Itoh, Shigeyuki Asano, Nobuhide Masawa, Hiroshi Inagaki,

Chronic Lymphocytic Leukemia Research

To clarify the presence or absence of cyclin D1 overexpression in extramedullary plasmacytomas (EMPs) , we examined 11 cases using an immunohistochemical study. None of the 11 cases showed evidence of underlying multiple myeloma at the diagnosis of EMP. The main clinicopathological findings of the 11 cases are summarized in Table I. Four (Nos. 14) of the 11 cases demonstrated greater than 30% Cyclin D1 tumor cells (Fig. 1a), whereas there were no cyclin D1 tumor cells in the remaining seven cases (Nos. 511). According to WHO classification standards, two of the four cyclin D1 cases were poorly differentiated EMP and the other two samples comprised cases of well differentiated EMP and moderately differentiated EMP. Five of the seven cyclin D1 cases were well differentiated EMP and two were moderately differentiated EMP. Two cases (Nos. 6 and 11) showed prominent amyloid deposition. Immunohistochemistry was performed on paraffin sections using a Ventana automated (BenchMarkTM) stainer. There were no CD5 or CD20 tumor cells in any of the 11 cases. All 11 cases showed monotypic intracytoplasmic immunoglobulins and expressed CD38 and CD138 antigens. The plasma cells exhibited monotypic intracytoplasmic k light chain in five patients (Nos. 1, 2, 4, 8, and 9) and l light chain in six (Nos. 3, 57, 10, and 11). Intracytoplasmic immunoglobulin heavy chains were positive in nine (Nos. 24, and 611) of the 10 lesions tested (Nos. 14, and 611) : of these, four (Nos. 3, 6, 7, and 10) stained positive for IgG, three (Nos. 4, 8, and 9) staind for IgG and IgA, and two (Nos. 2 and 11) stained for IgA alone. IgM were not detected in any of the lesions. There were no CD56 or human-herpes virus type8 tumor cells in any of the 11 cases. A two-color fluoresence in situ hybridization (FISH) assay using commercially available 14q32 and 11q13 probes (Vysis Inc, Downers Grove, IL, USA) disclosed separate BCL1 and IgH signals in the nuclei of tumor cells, which is a pattern seen in non-rearranged cells (Fig. 1b). However, two (Nos. 2 and 3) of the three cases (Nos. 13) were scored as having an 11q13 trisomy or polysomy (Fig. 1c). In the remaining one case (No. 4), there were insufficient materials available for FISH analysis. Among the four cyclin D1 cases, one case (No. 1) showed only partial remission and bone marrow involvement was found 13 months after the onset of disease. Complete remission was obtained in the remaining three cases (Nos. 24). However, all of the three cases were relapsed (bone marrow = 2, duodenum = 1). Three (Nos. 13) of the four cyclin D1 cases died of disease. Complete remission was achieved in all seven cyclin D1 cases. Three cases (Nos. 6, 9, and 11) relapsed. The remaining one (No. 11) died due to ovarian cancer. EMPs are rare, typically solitary tumors lacking any signs of systemic spread, and represent approximately 4% of all