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Jones TE, De Frances MC, Aggarwal N. Educational Case: Orbital B-Cell Lymphoma With Amyloid Deposition. Acad Pathol 2020; 7:2374289520934089. [PMID: 32671198 PMCID: PMC7338727 DOI: 10.1177/2374289520934089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 01/26/2020] [Accepted: 05/09/2020] [Indexed: 12/22/2022] Open
Abstract
The following fictional case is intended as a learning tool
within the Pathology Competencies for Medical Education (PCME),
a set of national standards for teaching pathology. These are
divided into three basic competencies: Disease Mechanisms and
Processes, Organ System Pathology, and Diagnostic Medicine and
Therapeutic Pathology. For additional information, and a full
list of learning objectives for all three competencies,
seehttp://journals.sagepub.com/doi/10.1177/2374289517715040.1
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Affiliation(s)
- Terrell E Jones
- Department of Pathology, University of Pittsburgh Medical Center, PA, USA
| | - Marie C De Frances
- Department of Pathology, University of Pittsburgh Medical Center, PA, USA
| | - Nidhi Aggarwal
- Department of Hematopathology, University of Pittsburgh Medical Center, PA, USA
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Ponzoni M, Govi S, Licata G, Mappa S, Giordano Resti A, Politi LS, Spagnuolo L, Di Cairano E, Doglioni C, Ferreri AJM. A reappraisal of the diagnostic and therapeutic management of uncommon histologies of primary ocular adnexal lymphoma. Oncologist 2013; 18:876-84. [PMID: 23814042 DOI: 10.1634/theoncologist.2012-0425] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Lymphoma is the most common malignancy arising in the ocular adnexa, which includes conjunctiva, lachrymal gland, lachrymal sac, eyelids, orbit soft tissue, and extraocular muscles. Ocular adnexal lymphoma (OAL) accounts for 1%-2% of non-Hodgkin lymphoma and 5%-15% of extranodal lymphoma. Histology, stage, and primary localizations are the most important variables influencing the natural history and therapeutic outcome of these malignancies. Among the various lymphoma variants that could arise in the ocular adnexa, marginal zone B-cell lymphoma (OA-MZL) is the most common one. Other types of lymphoma arise much more rarely in these anatomical sites; follicular lymphoma is the second most frequent histology, followed by diffuse large B-cell lymphoma and mantle cell lymphoma. Additional lymphoma entities, like T-cell/natural killer cell lymphomas and Burkitt lymphoma, only occasionally involve orbital structures. Because they are so rare, related literature mostly consists of anecdotal cases included within series focused on OA-MZL and sporadic case reports. This bias hampers a global approach to clinical and molecular properties of these types of lymphoma, with a low level of evidence supporting therapeutic options. This review covers the prevalence, clinical presentation, behavior, and histological and molecular features of uncommon forms of primary OAL and provides practical recommendations for therapeutic management.
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Affiliation(s)
- Maurilio Ponzoni
- Unit of Lymphoid Malignancies, Department of Onco-Hematology, San Raffaele Scientific Institute, Milan, Italy.
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Abstract
Lymphomas of the ocular adnexa are a heterogeneous group of malignancies, composing approximately 1% to 2% of non-Hodgkin lymphomas (NHLs) and 8% of extranodal lymphomas. The most common subtype, accounting for up to 80% of cases of primary ocular adnexal lymphoma, is marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT) type. In the recent past, there have been significant advances in our understanding of the clinical characteristics, morphology and phenotype, etiology, pathogenesis, diagnosis, natural history, treatment approaches, outcome, and prognostic factors of this disease entity. Novel immunologic and molecular techniques have aided in the distinction between MALT lymphoma and other lymphoproliferative disorders and led to the identification of tissue markers of prognostic significance. Modern imaging modalities provide invaluable tools for accurate staging and treatment planning. Besides radiotherapy and chemotherapy, a variety of new treatment options have emerged in the management of patients with ocular adnexal MALT lymphoma, especially monoclonal antibody therapy and antibiotic therapy against Chlamydia psittaci, which has been associated with the pathogenesis of ocular adnexal lymphomas in some parts of the world. In this review, we present a state-of-the-art summary of ocular adnexal MALT lymphomas.
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Lagoo AS, Haggerty C, Kim Y, Hammons M, Neufeld K, Redher C, Woodward J, Klintworth GK. Morphologic Features of 115 Lymphomas of the Orbit and Ocular Adnexa Categorized According to the World Health Organization Classification: Are Marginal Zone Lymphomas in the Orbit Mucosa-Associated Lymphoid Tissue–Type Lymphomas? Arch Pathol Lab Med 2008; 132:1405-16. [DOI: 10.5858/2008-132-1405-mfolot] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/14/2008] [Indexed: 11/06/2022]
Abstract
Abstract
Context.—Marginal zone lymphomas (MZLs) are the most common lymphomas encountered in the orbit and ocular adnexa. The accurate categorization of these lymphomas is critical to avoid undertreatment or overtreatment.
Objective.—To identify features of orbital MZLs that distinguish them from other lymphomas and reactive lymphoid infiltrates and support the categorization of orbital MZL as mucosa-associated lymphoid tissue (MALT)–type MZLs.
Design.—Biopsies from 149 patients with lymphoid lesions of ocular adnexa were examined. Additional immunohistochemical stains and fluorescence in situ hybridization study for the MALT1 locus were performed in selected cases, and patient charts were reviewed.
Results.—A total of 115 lymphomas and 34 reactive infiltrates were identified, of which B-cell lymphomas constituted 92% and MZLs constituted 54% of all lymphomas. Certain clinical features (young age, race, bilaterality) favored a reactive infiltrate, but none were diagnostic. Histologic features, such as infiltrative lesions, reactive B-cell follicles, and lymphoepithelial lesions, overlapped between reactive infiltrates and conjunctival MZL. In contrast to conjuctival MZL, orbital MZL infrequently showed reactive follicles, rarely showed epithelial tissue, and did not show lymphoepithelial lesions. Cytogenetic abnormality involving the MALT1 locus was demonstrated in only 15% of ocular adnexal MZLs.
Conclusion.—Many MZLs of orbital soft tissue lack key features associated with MALT-type MZL, and the designation MALT lymphoma should be avoided in their diagnosis.
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Affiliation(s)
- Anand S. Lagoo
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Christopher Haggerty
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Young Kim
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Matthew Hammons
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Kenneth Neufeld
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Catherine Redher
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Julie Woodward
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
| | - Gordon K. Klintworth
- From the Department of Pathology (Drs Lagoo, Kim, Redher, and Klintworth) and the Duke Eye Center (Drs Haggerty, Hammons, Neufeld, Woodward, and Klintworth), Duke University Medical Center, Durham, NC
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Hsieh PP, Olsen RJ, O'Malley DP, Konoplev SN, Hussong JW, Dunphy CH, Perkins SL, Cheng L, Lin P, Chang CC. The role of Janus Kinase 2 V617F mutation in extramedullary hematopoiesis of the spleen in neoplastic myeloid disorders. Mod Pathol 2007; 20:929-35. [PMID: 17643100 DOI: 10.1038/modpathol.3800826] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Extramedullary hematopoiesis (EMH) in the spleen is a characteristic feature of the chronic myeloproliferative disorders (CMPDs) and various other neoplastic or reactive myeloid conditions. However, the origin of these hematopoietic precursor cells and the molecular mechanisms underlying their development in the spleen is uncertain. The V617F mutation in the Janus Kinase 2 gene (JAK2(V617F)) was recently shown to be frequently and preferentially present in the peripheral blood and bone marrow cells of CMPD patients, and the resulting dysregulation of its downstream targets is important to CMPD pathogenesis. To determine the occurrence and potential role of JAK2(V617F) in splenic EMH cells, we studied splenectomy specimens from 47 patients with significant EMH. JAK2(V617F) was detected by real-time PCR melting curve analysis in 22 specimens, including 11/17 chronic idiopathic myelofibrosis, 7/7 polycythemia vera, 1/1 essential thrombocythemia, 1/3 CMPD unclassifiable, 1/5 chronic myelomonocytic leukemia, 0/5 chronic myelogenous leukemia, 1/3 myelodysplastic syndrome and 0/6 acute myeloblastic leukemia cases, whereas only the JAK2 wild-type allele was detected in the other 25. Nineteen of 20 cases with adequate bone marrow samples available for molecular examination demonstrated concordant JAK2 genotypes. Laser-capture microdissection was then used to enrich the EMH and non-EMH splenic cell fractions, confirming that the mutant alleles specifically originated from the EMH cells. Furthermore, megakaryocytes in the JAK2(V617F)-positive splenectomy specimens expressed higher levels of Bcl-xL, an antiapoptotic protein and downstream target of the JAK2/STAT5 pathway. Thus, JAK2(V617F) is frequently present in splenic EMH cells associated with CMPD, but it is rarely identified in splenic EMH cells associated with other myeloid disorders. Our results indicate that the precursor cells leading to extramedullary hematopoietic expansion in CMPD most likely originate from the transformed bone marrow clone. Also, dysregulation of downstream pathways such as Bcl-xL may be important to CMPD disease pathogenesis in the spleen.
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MESH Headings
- Bone Marrow Cells/chemistry
- Bone Marrow Cells/enzymology
- Chronic Disease
- Hematopoiesis, Extramedullary/genetics
- Humans
- Immunohistochemistry
- Janus Kinase 2/genetics
- Janus Kinase 2/metabolism
- Lasers
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/blood
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/enzymology
- Leukemia, Myelogenous, Chronic, BCR-ABL Positive/genetics
- Leukemia, Myeloid, Acute/blood
- Leukemia, Myeloid, Acute/enzymology
- Leukemia, Myeloid, Acute/genetics
- Leukemia, Myelomonocytic, Chronic/blood
- Leukemia, Myelomonocytic, Chronic/enzymology
- Leukemia, Myelomonocytic, Chronic/genetics
- Megakaryocytes/chemistry
- Megakaryocytes/enzymology
- Microdissection/methods
- Mutation
- Myelodysplastic Syndromes/blood
- Myelodysplastic Syndromes/enzymology
- Myelodysplastic Syndromes/genetics
- Myeloproliferative Disorders/blood
- Myeloproliferative Disorders/enzymology
- Myeloproliferative Disorders/genetics
- Myeloproliferative Disorders/metabolism
- Polycythemia Vera/blood
- Polycythemia Vera/enzymology
- Polycythemia Vera/genetics
- Polymerase Chain Reaction
- Primary Myelofibrosis/blood
- Primary Myelofibrosis/enzymology
- Primary Myelofibrosis/genetics
- Retrospective Studies
- Spleen/chemistry
- Spleen/enzymology
- Thrombocythemia, Essential/blood
- Thrombocythemia, Essential/enzymology
- Thrombocythemia, Essential/genetics
- United States
- bcl-X Protein/analysis
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Affiliation(s)
- Pin-Pen Hsieh
- Department of Pathology and Laboratory Medicine, The Methodist Hospital and the Methodist Hospital Research Institute, Houston, TX 77030, USA
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Sagaert X, De Wolf-Peeters C, Noels H, Baens M. The pathogenesis of MALT lymphomas: where do we stand? Leukemia 2007; 21:389-96. [PMID: 17230229 DOI: 10.1038/sj.leu.2404517] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Mucosa-associated lymphoid tissue (MALT) lymphoma is a heterogeneous form of a B-cell non-Hodgkin's lymphoma with extranodal location. The gastrointestinal tract is the most common site of disease, but involvement of multiple other organ systems has been documented. Four translocations, t(11;18)(q21;q21), t(1;14)(p22;q32), t(14;18)(q32;q21) and t(3;14)(p13;q32), are specifically associated with MALT lymphoma. Remarkably, the genes targeted by at least three of these translocations are involved in one and the same pathway, leading to the activation of nuclear factor-kappaB (NF-kappaB). This review presents MALT lymphoma as a model of how sustained inflammation increases the risk of genotoxic insults and how these genetic events initiate oncogenesis.
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MESH Headings
- Animals
- Antigens, Bacterial/immunology
- Autoantigens/immunology
- B-Lymphocyte Subsets/immunology
- Caspases/genetics
- Caspases/physiology
- Chromosomes, Human, Pair 1/genetics
- Chromosomes, Human, Pair 1/ultrastructure
- Chromosomes, Human, Pair 11/genetics
- Chromosomes, Human, Pair 11/ultrastructure
- Chromosomes, Human, Pair 14/genetics
- Chromosomes, Human, Pair 14/ultrastructure
- Chromosomes, Human, Pair 18/genetics
- Chromosomes, Human, Pair 18/ultrastructure
- Chronic Disease
- Gastritis/complications
- Gastritis/drug therapy
- Gastritis/immunology
- Gastritis/microbiology
- Gastrointestinal Neoplasms/etiology
- Gastrointestinal Neoplasms/genetics
- Gastrointestinal Neoplasms/microbiology
- Gene Expression Regulation, Neoplastic
- Genes, Immunoglobulin
- Helicobacter Infections/complications
- Helicobacter Infections/drug therapy
- Helicobacter Infections/immunology
- Helicobacter pylori/immunology
- Humans
- Immunoglobulin Heavy Chains/genetics
- Inflammation/complications
- Lymphoma, B-Cell, Marginal Zone/drug therapy
- Lymphoma, B-Cell, Marginal Zone/etiology
- Lymphoma, B-Cell, Marginal Zone/genetics
- Lymphoma, B-Cell, Marginal Zone/immunology
- Lymphoma, B-Cell, Marginal Zone/microbiology
- Mice
- Mice, Transgenic
- Mucosa-Associated Lymphoid Tissue Lymphoma Translocation 1 Protein
- NF-kappa B/physiology
- Neoplasm Proteins/genetics
- Neoplasm Proteins/physiology
- Oncogene Proteins, Fusion/genetics
- Oncogene Proteins, Fusion/physiology
- Translocation, Genetic
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Affiliation(s)
- X Sagaert
- Department of Morphology and Molecular Pathology, University of Leuven, Leuven, Belgium.
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