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AL-Amyloidoma of the Skin-A Rare Manifestation of Primary Cutaneous Marginal Zone Lymphoma. Am J Dermatopathol 2019; 41:518-521. [PMID: 30839349 DOI: 10.1097/dad.0000000000001368] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
AL-amyloidoma is considered to be a variant of primary cutaneous marginal zone lymphoma (pcMZL). A 51-year-old white man presented a 2 × 2-cm erythematous to brownish waxy plaque on the back of the scalp. The plaque was first noticed 16 years ago. It was asymptomatic, and the patient was otherwise healthy. The lesion was excised. Histological examination revealed dermal deposits of amyloid and a subtle perivascular infiltrate, predominately consisting of plasma cells. Infiltrating cells expressed CD79a, bcl2, and IgG and were negative for bcl6, CD56, and IgM. A monoclonal light-chain expression of lambda (lambda:kappa = 10:1) was demonstrated by in situ hybridization. The diagnosis of pcMZL, presenting as an AL-amyloidoma, was made because staging procedures excluded systemic manifestation of lymphoma, monoclonal gammopathy, and systemic amyloidosis. Cutaneous amyloid deposits with monoclonal plasma cell proliferation can occur as a result of monoclonal gammopathy/plasmocytoma or as a rare manifestation of pcMZL. Systemic B-cell lymphoma and systemic monoclonal plasma cell proliferations have to be excluded.
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Dangien A, Beylot‐Barry M, Battistella M, Ram‐Wolff C, Talbot A, Rybojad M, Vergier B, Jachiet M, Bouaziz J, Arnulf B, Bagot M, Masson A. Clinical presentation, therapeutic approach and outcome of primary cutaneous marginal zone B‐cell lymphoma presenting as AL amyloidoma of the skin. Br J Dermatol 2019; 181:607-609. [DOI: 10.1111/bjd.17821] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- A. Dangien
- Departments of Dermatology Saint‐Louis Hospital APHP Paris France
| | - M. Beylot‐Barry
- Departments of Dermatology Saint‐André Hospital CHU de Bordeaux INSERM U1053 Université de Bordeaux Bordeaux France
| | - M. Battistella
- Departments of Pathology Saint‐Louis Hospital APHP Paris France
- INSERM U976 Université Paris 7 Paris France
| | - C. Ram‐Wolff
- Departments of Dermatology Saint‐Louis Hospital APHP Paris France
| | - A. Talbot
- Departments of Immuno‐hematology Saint‐Louis Hospital APHP Paris France
| | - M. Rybojad
- Departments of Dermatology Saint‐Louis Hospital APHP Paris France
| | - B. Vergier
- Departments of Pathology Saint‐André Hospital CHU de Bordeaux INSERM U1053 Université de Bordeaux Bordeaux France
| | - M. Jachiet
- Departments of Dermatology Saint‐Louis Hospital APHP Paris France
| | - J.‐D. Bouaziz
- Departments of Dermatology Saint‐Louis Hospital APHP Paris France
- INSERM U976 Université Paris 7 Paris France
| | - B. Arnulf
- Departments of Immuno‐hematology Saint‐Louis Hospital APHP Paris France
| | - M. Bagot
- Departments of Dermatology Saint‐Louis Hospital APHP Paris France
- INSERM U976 Université Paris 7 Paris France
| | - A. Masson
- Departments of Dermatology Saint‐Louis Hospital APHP Paris France
- INSERM U976 Université Paris 7 Paris France
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Alegría-Landa V, Cerroni L, Kutzner H, Requena L. Paraprotein deposits in the skin. J Am Acad Dermatol 2017; 77:1145-1158. [PMID: 28985955 DOI: 10.1016/j.jaad.2017.07.039] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2017] [Revised: 07/19/2017] [Accepted: 07/23/2017] [Indexed: 02/04/2023]
Abstract
Cutaneous manifestations secondary to paraprotein deposits in the skin include a group of different disorders that although rare, may be the first clinical manifestation of the underlying hematologic dyscrasia. In this article we review the clinical manifestations and histopathologic findings of the processes that result from specific deposition of the paraprotein in different structures of the skin. Paraneoplastic processes frequently associated with hematologic malignancies will not be covered in this review. Some of the disorders included here result from deposition of the intact paraprotein in the skin, whereas in other cases the lesions are due to deposition of modified paraproteins in the form of amyloid substance, cryoglobulins, or crystalglobulins. Cutaneous amyloidoma refers to nodular dermal deposits of amyloid derived from immunoglobulin light chains produced by local plasma cells in the absence of systemic amyloidosis. Dermatologists and dermatopathologists should be aware of the clinical and histopathologic features of these rare disorders because sometimes the cutaneous lesions are the first sign of an underlying silent hematologic malignancy with paraproteinemia.
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Affiliation(s)
| | - Lorenzo Cerroni
- Dermatopathology Research Unit, Medical University of Graz, Graz, Austria
| | - Heinz Kutzner
- Dermatopathologie Friedrichschafen, Friedrichschafen, Germany
| | - Luis Requena
- Department of Dermatology, Fundación Jiménez Diaz, Universidad Autónoma, Madrid, Spain.
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AL Amyloidoma of the Skin/Subcutis: Cutaneous Amyloidosis, Plasma Cell Dyscrasia or a Manifestation of Primary Cutaneous Marginal Zone Lymphoma? Am J Surg Pathol 2017; 41:1069-1076. [PMID: 28505007 DOI: 10.1097/pas.0000000000000861] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
It is unclear whether AL amyloidoma of the skin/subcutis represents a distinct entity, an indolent precursor of systemic amyloidosis, or a manifestation of cutaneous marginal zone lymphoma (cMZL). We collected 10 cases of cutaneous AL amyloidoma in order to better characterize the clinicopathologic features of this elusive entity (M:F=4:6; median age: 62.5 y, range: 31 to 82 y). Nine patients had a solitary nodule or plaque on the lower extremity (n=7), upper extremity (n=1), or chin (n=1). One patient had an AL amyloidoma on the right thigh and a second lesion on the right arm showing histopathologic features of cMZL without amyloid deposits. Clinical investigations excluded relevant systemic disease in all cases. Microscopically, dermal/subcutaneous deposits of amyloid were associated with sparse to moderate perivascular infiltrates of lymphocytes and monotypic plasma cells (7 with kappa and 3 with lambda light chain restriction). The plasma cells expressed CD56 in one of 9 studied cases. One case was characterized by a t(14;18)(q32;q21)/IGH-MALT1 translocation. Follow-up was available in 8 cases. All remain systemically well after a median time of 86.5 months (range: 40 to 144 mo). Local recurrence of disease was observed in 3 patients. A fourth patient presented with a cMZL without amyloid deposits 8 years after excision of the cutaneous AL amyloidoma. Although our series is small, careful categorization and follow-up of the cases, together with updated information in the literature, show clinical and biological links between AL amyloidomas of the skin/subcutis and cMZL, suggesting that at least a subset of cutaneous AL amyloidoma may represent an unusual manifestation of cMZL (cutaneous mucosa-associated lymphoid tissue lymphomas).
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Gérard E, Ly S, Cogrel O, Pham-Ledard A, Fauconneau A, Penchet I, Ouhabrache N, Vergier B, Beylot-Barry M. [Primary localized cutaneous nodular amyloidosis: A diagnostic and therapeutic challenge]. Ann Dermatol Venereol 2015; 143:134-8. [PMID: 26724842 DOI: 10.1016/j.annder.2015.10.596] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2015] [Revised: 10/12/2015] [Accepted: 10/29/2015] [Indexed: 11/17/2022]
Abstract
BACKGROUND Nodular primary localized cutaneous amyloidosis (PLCA) is a rare subtype of localized cutaneous amyloidosis in which amyloid protein is derived from immunoglobulin light chains. Follow-up for progression to systemic amyloidosis or autoimmune disease is mandatory. No consensus exists regarding treatment. PATIENTS AND METHODS We report a case of nodular PLCA in a 49-year-old man, presenting as an asymptomatic nodule of the nose. Skin biopsy revealed diffuse deposition of amyloid associated with plasmocyte proliferation. Monotypic kappa light-chain restriction was observed. Extensive systemic evaluation, including bone marrow biopsy and PET scan, was negative. Protein electrophoresis and immunofixation in serum and urine were normal. The nodule was treated with radiotherapy but there was no response. Mohs micrographic surgery (MMS) was performed with no recurrence at 6 months of follow-up. No systemic progression was observed one year after the initial diagnosis. DISCUSSION Since nodular PLCA may have a cutaneous presentation similar to that of primary systemic amyloidosis, evaluation for systemic amyloidosis is necessary. Treatment of amyloidosis is difficult. Radiotherapy appears ineffective in treating this type of primary cutaneous amyloidosis, and surgical treatment, where possible, is a good option, especially with MMS, which allows both controlled excision and minimal margins.
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Affiliation(s)
- E Gérard
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - S Ly
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - O Cogrel
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Pham-Ledard
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - A Fauconneau
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France
| | - I Penchet
- Service d'anatomopathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - N Ouhabrache
- Service de radiothérapie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - B Vergier
- Service d'anatomopathologie, hôpital Haut-Lévêque, CHU de Bordeaux, avenue de Magellan, 33604 Pessac, France
| | - M Beylot-Barry
- Service de dermatologie, hôpital Saint-André, CHU de Bordeaux, rue Jean-Burguet, 33076 Bordeaux, France.
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Cai YX, Li SJ, Zhou Y, Li W, Fan YM. Immunohistochemical study of immunoglobulin light chains and inflammatory cells in a patient with localized primary cutaneous nodular amyloidosis. J Eur Acad Dermatol Venereol 2014; 30:469-70. [PMID: 25399683 DOI: 10.1111/jdv.12849] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Y-X Cai
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - S-J Li
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Y Zhou
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - W Li
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
| | - Y-M Fan
- Department of Dermatology, Affiliated Hospital of Guangdong Medical College, Zhanjiang, Guangdong, China
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Mehta N, Schöder H, Chiu A, Schoolmeester JK, Portlock C. Adnexal mass secondary to extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) with associated amyloid deposition. BMJ Case Rep 2014; 2014:bcr-2014-206699. [PMID: 25398916 DOI: 10.1136/bcr-2014-206699] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Systemic amyloid light chain amyloidosis (AL amyloidosis) is usually seen in association with a plasma cell disorder. Amyloid deposition associated with extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue (MALT lymphoma) is a rare phenomenon that is not typically associated with systemic AL amyloidosis. We describe the unusual case of a patient with an adnexal mass secondary to MALT lymphoma with associated amyloid deposition.
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Affiliation(s)
- Neha Mehta
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
| | - Heiko Schöder
- Department of Radiology, Memorial Sloan Kettering Cancer Center, New York, NY
| | - April Chiu
- Department of Pathology, Memorial Sloan Kettering Cancer Center, New York, NY
| | | | - Carol Portlock
- Department of Medicine, Memorial Sloan Kettering Cancer Center, New York, NY
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Blixt EK, Brewer JD. Chronic lymphocytic leukemia: cutaneous involvement associated with nodular amyloidosis. Int J Dermatol 2014; 54:e230-2. [PMID: 25039892 DOI: 10.1111/ijd.12202] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2012] [Revised: 01/02/2013] [Accepted: 01/19/2013] [Indexed: 11/26/2022]
Affiliation(s)
- Elizabeth K Blixt
- University of North Dakota, School of Medicine and Health Sciences, Grand Forks, ND, USA
| | - Jerry D Brewer
- Division of Dermatologic Surgery, Department of Dermatology, Mayo Clinic/Mayo Clinic College of Medicine, Rochester, MN, USA
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