IgA multiple myeloma coexistent with atypical adult T-cell leukemia

IgG-kappa-type plasmacytoma secreting salivary-type amylase in adult T-cell leukemia

A IgG-kappa-type plasmacytoma secreting salivary-type amylase ectopically is reported in a patient with smouldering adult T-cell leukemia(ATL). The patient had plasmacytomas in the distal region of the right femur, the proximal region of left tibia, and the left paranasal sinus. Both his serum and urine contained high levels of amylase. The presence of IgG-kappa and S-type amylase in the plasmacytoma cells was confirmed immunocytochemically. In addition, he was also positive for the antibody against the human T-cell leukemia virus type I (HTLV-I), and had abnormal lymphocytes with convoluted nuclei (ATL cells) in the peripheral blood. The monoclonal integration of HTLV-I proviral DNA was demonstrated in the leukemic cells of the peripheral blood, but not in the plasmacytoma cells. Our case suggested that not only can HTLV-I infection play a role in the development of ATL, but may also induce a B-cell malignancy in an indirect manner, and even an ectopic amylase producing plasmacytoma.

Epstein-Barr virus (EBV) genome carrying monoclonal B-cell lymphoma in a patient with adult T-cell leukemia-lymphoma

A Japanese patient with adult T-cell leukemia-lymphoma (ATL) showed a disease progression from the smoldering type to the chronic type and finally to the acute type. The patient was variously treated, including 2'-deoxycoformycin, with some beneficial effects. During the chronic type he developed a composite lymphoma consisting of T-cell lymphoma (ATL) of medium-sized cells and B-cell lymphoma of diffuse large cell type. At that time, he also suffered from miliary tuberculosis and adenovirus type 11-induced hemorrhagic cystitis, indicating that he was in a marked immunodeficient state. Southern-blot analysis revealed that the two malignancies have distinct clonal origin on the basis of the following results: (1) clonally rearranged T-cell receptor beta-chain gene (TcR-beta gene) and germline configuration of immunoglobulin heavy chain gene (IgH gene) in ATL leukemic cells, (2) clonal rearrangement of IgH gene in lymphoma cells, indicating a monoclonal B-cell lymphoma, (3) monoclonal integration of HTLV-I provirus in ATL leukemic cells, (4) definite presence and monoclonal origin of EBV genome in lymphoma cells. This is the first report of secondary EBV genome carrying monoclonal B-cell lymphoma in an ATL patient. It is suggested that the immunodeficient state in the patient with ATL allows the emergence of EBV-related B-cell lymphoma.

Peripheral blood and bone marrow lymphocyte subsets in patients with multiple myeloma

A panel of monoclonal antibodies (McAb) from the Wu series was used to characterize lymphocyte subsets of peripheral blood (PB) from 9 patients with multiple myeloma (MM) by means of indirect immunofluorescence assay. In 7 of these patients bone marrow (BM) cells were also studied. Abnormal distribution of T lymphocyte subsets was observed in these patients, and the alterations were quite similar in both PB and BM. A significant increase in the proportion of WUT8+ cells (P less than 0.001) and a reduced WuT4/WuT8 ratio (P less than 0.001) were found in patient group. In both PB and BM of patients, WuT10+ cell counts were significantly higher than normal (P less than 0.001). There was a good correlation between BM WuT10+ cells and BM myeloma cells (r = 0.76, P less than 0.05), whereas no correlation was found between PB WuT10+ cells and BM myeloma cells. The significance of abnormal T-cell subset distribution and elevated WuT10+ cells in MM is discussed.