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Alegría-Landa V, Prieto-Torres L, Santonja C, Córdoba R, Manso R, Requena L, Rodríguez-Pinilla SM. MYD88L265P mutation in cutaneous involvement by Waldenström macroglobulinemia. J Cutan Pathol 2017; 44:625-631. [DOI: 10.1111/cup.12944] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2016] [Revised: 02/23/2017] [Accepted: 03/22/2017] [Indexed: 12/31/2022]
Affiliation(s)
| | - Lucía Prieto-Torres
- Department of Pathology; Hospital Clínico Universitario Lozano Blesa; Zaragoza Spain
| | - Carlos Santonja
- Lymphoma Unit, Oncohealth Institute; Fundación Jiménez Díaz, Universidad Autónoma; Madrid Spain
| | - Raul Córdoba
- Department of Hematology; Fundación Jiménez Díaz, Universidad Autónoma; Madrid Spain
| | - Rebeca Manso
- Lymphoma Unit, Oncohealth Institute; Fundación Jiménez Díaz, Universidad Autónoma; Madrid Spain
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Díaz; Universidad Autónoma; Madrid Spain
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Lipsker D. Monoclonal gammopathy of cutaneous significance: review of a relevant concept. J Eur Acad Dermatol Venereol 2016; 31:45-52. [PMID: 27501129 DOI: 10.1111/jdv.13847] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 06/09/2016] [Indexed: 11/28/2022]
Abstract
Some dermatologic entities are strongly associated with the presence of a monoclonal gammopathy. They should be referred to as monoclonal gammopathy of cutaneous significance (MGCS). A short review of the main entities that fit into the spectrum of MGCS is provided. Amyloidosis, macroglobulinoderma and follicular hyperkeratotic spicules result from extravascular immunoglobulin or immunoglobulin-related protein deposition. Skin findings include papules and plaques, follicular spicules, purpura, haemorrhagic bullae, macroglossia and nail changes. The skin findings in cryoglobulinemia (CG) result from vascular immunoglobulin deposition, either as immune complexes within the vessel walls in mixed CG or within the lumina of small vessels in monoclonal CG. Mixed CG manifests as palpable purpura of leukocytoclastic vasculitis, and monoclonal CG as stellar and/or retiform purpura that can evolve into extensive skin necrosis. In some rare instances, immunoglobulins have a specific biological activity. This is, for example, the case when they bind lipoproteins that precipitate and induce hypocomplementemic xanthomas. Xanthoderma related to antiflavin activity of the monoclonal component or acquired angioedema related to anti-C1INH activity is other example. Abnormal cytokine secretion is the hallmark of some entities. High vascular endothelial growth factor levels correlate with some of the skin manifestations of the Polyneuropathy organomegaly endocrinopathy monoclonal component skin changes syndrome, such as hypertrichosis or the adenopathy and extensive skin patch overlying plasmacytoma syndrome. All the clinical manifestations of the Schnitzler syndrome are IL-1 mediated. In other MGCS, such as scleromyxedema, Clarkson syndrome, TEMPI syndrome, cutis laxa and the neutrophilic dermatoses, the link between the monoclocal component and the entity is clearly established, but not understood so far.
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Affiliation(s)
- D Lipsker
- Faculté de Médecine, Université de Strasbourg et Clinique Dermatologique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
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Xiao LI, Lin F, Xiao R, Hu C, Deng M, Li D, She X, Liu F, Sun L. Multiple myeloma-associated skin light chain amyloidosis: A case of misdiagnosis. Oncol Lett 2016; 11:3617-3620. [PMID: 27284363 PMCID: PMC4887792 DOI: 10.3892/ol.2016.4432] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2015] [Accepted: 03/10/2016] [Indexed: 11/05/2022] Open
Abstract
The present study reports the case of a 42-year-old male with multiple myeloma (MM)-associated skin light chain amyloidosis who presented with skin purpura as the initial symptom, which was misdiagnosis as Henoch-Schönlein purpura nephritis prior to admission to the Second Xiangya Hospital (Changsha, Hunan, China). The patient presented with purpura, papules petechiae and spontaneous ecchymosis, which was located scattered around the neck, chest and limbs, accompanied by a small amount of bleeding in the conjunctival and oral mucosa, and a swollen tongue. Upon laboratory examination, the serum immunological change showed increased serum immunoglobulin G and λ light chain levels, and a urine Bence Jones protein level of >1 g/24 h. This was accompanied with an abnormal result for immunofixation electrophoresis, and positive staining with Congo red showing apple-green birefringence in skin biopsy specimens. Thus, the patient was diagnosed with MM-associated skin amyloidosis with the initial symptom of skin purpura. Following treatment with chemotherapy consisting of prednisone and bortezomib, the skin lesions markedly improved. The present study indicates that the presentation of skin purpura in systemic amyloidosis associated with MM may be an important aid in the diagnosis and direct treatment of this disease in the clinic.
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Affiliation(s)
- L I Xiao
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Fengxia Lin
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Rong Xiao
- Department of Dermatology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Chun Hu
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Mingyang Deng
- Department of Hematology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Daiqiang Li
- Department of Pathology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Xiaoling She
- Department of Pathology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Fuyou Liu
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
| | - Lin Sun
- Department of Nephrology, Second Xiangya Hospital, Central South University, Changsha, Hunan 410011, P.R. China
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Lacoste C, Ingen-Housz-Oro S, Ortonne N. [Dermatological manifestations of monoclonal gammopathies: contribution of cutaneous histopathology]. Ann Pathol 2015; 35:281-93. [PMID: 26188671 DOI: 10.1016/j.annpat.2015.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2014] [Accepted: 05/06/2015] [Indexed: 12/19/2022]
Abstract
Skin manifestations associated with monoclonal gammapathy are common and can present with various clinical and pathological aspects. They can be the first events leading to the diagnosis of monoclonal gammapathy. They may be present either as specific lesions, including lymphoplasmacytic or pure plasma cell neoplastic infiltrates and monoclonal immunoglobulin deposits, or as non-specific dermatitis, such as leukocytoclastic vasculitis, neutrophilic dermatoses, mucinoses or xanthomatosis, giving little clues for the diagnosis of the underlying disease.
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Harel S, Mohr M, Jahn I, Aucouturier F, Galicier L, Asli B, Malphettes M, Szalat R, Brouet JC, Lipsker D, Fermand JP. Clinico-biological characteristics and treatment of type I monoclonal cryoglobulinaemia: a study of 64 cases. Br J Haematol 2014; 168:671-8. [PMID: 25363150 DOI: 10.1111/bjh.13196] [Citation(s) in RCA: 75] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 08/15/2014] [Indexed: 11/27/2022]
Abstract
This retrospective analysis was conducted in 64 patients diagnosed with type I cryoglobulinaemia (CG) followed at two French centres. Median follow-up was 6·75 years. CG was IgG in 60% and IgM in 40% of all cases and was asymptomatic in 16 patients (25%). Cold-triggered ischaemic skin manifestations were observed in 33 patients (51%). Neurological manifestations were observed in 15 patients and renal manifestations in 13. Most of the patients with necrotic purpura (14/16, P = 0·009) and renal manifestations (11/13, P = 0·057) had IgG CG. IgG CG was associated with monoclonal gammopathy of undetermined significance (MGUS), myeloma, chronic lymphocytic leukaemia and lymphoplasmocytic lymphoma in 18, 13, 5 and 2 patients, respectively. IgM CG was associated with MGUS and Waldenström macroglobulinaemia in 8 and 18 cases, respectively. One third of patients did not receive any specific treatment. Various treatments, including rituximab, were administered to 25/31 patients with IgG CG and 6/25 patients with IgM CG due to CG-related symptoms. Rituximab was ineffective in all cases associated with a predominantly plasmacytic proliferation. To conclude, type I CG has specific clinico-biological characteristics compared to type II CG. Furthermore, there are differences in terms of related manifestations between type I IgG and type I IgM CG.
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Affiliation(s)
- Stephanie Harel
- Département d'Immuno-Hématologie, Hôpital Saint-Louis, Paris, France
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Hello M, Barbarot S, Néel A, Connault J, Graveleau J, Durant C, Decaux O, Hamidou M. [Skin manifestations of monoclonal gammopathies]. Rev Med Interne 2014; 35:28-38. [PMID: 24070793 DOI: 10.1016/j.revmed.2013.08.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2013] [Revised: 08/19/2013] [Accepted: 08/21/2013] [Indexed: 01/01/2023]
Abstract
Whatever their aetiology, monoclonal gammopathies can be associated to several clinical features. Mechanisms are various and sometimes unknown. Skin is frequently involved and may represent a challenging diagnosis. Indeed, skin manifestations are either the presenting features and isolated, or at the background of a systemic syndrome. Our objective was to review the various skin manifestations that have been associated with monoclonal gammopathies.
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Peterlin P, Ponge T, Blin N, Moreau P, Hamidou M, Agard C. Paraneoplastic cutaneous leukocytoclastic vasculitis disclosing multiple myeloma: a case report. Clin Lymphoma Myeloma Leuk 2011; 11:373-4. [PMID: 21729687 DOI: 10.1016/j.clml.2011.03.034] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/20/2011] [Revised: 03/01/2011] [Accepted: 03/07/2011] [Indexed: 11/20/2022]
Abstract
Cutaneous lesions are unusual during the course of multiple myeloma. In rare cases, multiple myeloma may be associated to skin involvement secondary to amyloidosis, cryoglobulinemia, and POEMS syndrome. Paraneoplastic skin involvement occurs preferentially during solid neoplasms. We report the case of an uncommon presentation of an IgA lambda multiple myeloma in a 58 year-old woman preceded by vascular purpura with cutaneous leukocytoclastic vasculitis (LV) and intense deposit of IgA and kappa light chains in the dermal vessels. Purpura resolved after specific treatment of multiple myeloma and diagnosis of paraneoplastic purpura was asserted. We propose a brief review of the literature about skin involvement during multiple myeloma. This case highlights the necessity to search for MM when we are facing a LV.
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Phelippeau M, Bonnet D, Laurenty AP, Meyer N, Apoil PA, Selves J, Alric L, Saadoun D. Blanc ou rouge, il fallait choisir…. Rev Med Interne 2011; 32:120-3. [DOI: 10.1016/j.revmed.2010.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2010] [Accepted: 12/02/2010] [Indexed: 11/17/2022]
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