Reactions 1680, p286 - 2 Dec 2017 residual disease. One year following completion of pentostatin therapy, colon biopsies were negative for disease. Author comment: "We present an indolent pancolonic MALT lymphoma occurring in a 39-year-old female". "It is Extranodal marginal zone lymphoma of mucosa- unclear if and to what extent potential risk factors including associated lymphoid tissue: case report autoimmune hepatitis requiring liver transplant, inflammatory A woman in her 30’s [specific age at the time of reaction bowel disease, and chronic immunosuppressive therapy may onset not stated] developed extranodal marginal zone have contributed to the development of her hematologic lymphoma of mucosa-associated lymphoid tissue (MALT malignancy. Following reduction in her immunosuppression lymphoma) during treatment with prednisone and tacrolimus and 6 cycles of pentostatin she reached a complete [routes and time to reaction onset not stated]. remission." In 2015, the woman reported for a surveillance colonoscopy. Her medical history included an autoimmune Chaffin JM, et al. Persistent indolent pancolonic marginal zone lymphoma of hepatitis treated with a liver transplant in 1997, prolonged iron MALT-type with plasmacytic differentiation - A rare post-transplant lymphoma?. Human Pathology: Case Reports 10: 74-78, Nov 2017. Available from: URL: http:/ deficiency anaemia and ulcerative colitis diagnosed in 2004. /doi.org/10.1016/j.ehpc.2017.06.006 - USA 803285550 Her daily medications included prednisone 5mg/day and tacrolimus 5mg twice a day for anti-rejection immunosuppression, which coincidentally also controlled her ulcerative colitis. The surveillance colonoscopy was performed, which revealed mild erythema and friability in the rectum. Multiple random biopsies were procured. A dense, monomorphic, predominantly plasmacytoid infiltrate, causing expansion of lamina propria with some crypt architectural distortion, but without marked crypt infiltration, destruction or branching was observed on haematoxylin and eosin-stained sections of the descending, transverse and ascending colonic biopsies. The plasmacytoid cells had relatively pale cytoplasm but were without marked nuclear mitosis or atypia. An immunohistochemical staining of the biopsied tissue showed that the cells were positive for CD79a and CD138, and an immunohistochemical analysis revealed that the cells had overt lambda restriction with only rare kappa positive cells. Prior colorectal biopsies were reviewed retrospectively, and a similar infiltrate was identified in all colonic biopsies procured in 2010 and 2012. DNA was extracted from the representative formalin-fixed paraffin-embedded tissue blocks from the biopsies from 2010 and 2015. PCR amplification was performed for the detection of immunoglobulin gene (IGH and IG loci) rearrangement. For the IG locus, two peaks with ¸ k ¸ k increased intensity were detected in both blocks from 2010 and 2015, consistent with notable clonal rearrangements. For the IGH locus, an intense peak was detected only in the 2015 sample. The indolent clinical behaviour, overall morphologic features and the absence of EBV were considered as most indicative of an extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue. Thereafter, she underwent an evaluation for the staging of MALT lymphoma. A M-protein of 0.97 g/dL was identified along with IgG-lambda. A right inguinal lymph node at normal upper limits was identified and an excisional biopsy performed. A pathologic analysis of the right inguinal lymph node showed several plasma cells with abundant pale, eosinophilic cytoplasm in a sheet-like infiltrate resulting in complete effacement of the normal nodal architecture, that extended out into the attached adipose tissue. The right inguinal lymph node infiltrate revealed similar immunohistochemical findings to the gastrointestinal biopsies with overt lambda restriction. In addition, a distinct subpopulation of CD20 positive plasma cells were also identified. Subsequently, she also underwent a bone marrow biopsy for the purposes of staging. Increased plasma cells were noted, consisting at least 15–20% of the cellularity with some atypical morphology and lambda restriction. Thereafter, a diagnosis of stage IV extranodal marginal zone lymphoma of mucosa-associated lymphoid tissue with lymph, gastrointestinal and bone marrow involvement. The woman’s tacrolimus dose was decreased to 0.5mg twice a day because of a differential diagnosis of post- transplant lymphoproliferative disorder, considered previously while her prednisone 5mg daily dose was continued. Thereafter, she was treated with pentostatin due to lack of CD20 expression. Following six cycles of pentostatin, colon biopsies showed morphologic remission with mild chronic active colitis only. Five months following the completion of treatment, bone marrow biopsies demonstrated no evident 0114-9954/17/1680-0001/$14.95 Adis © 2017 Springer International Publishing AG. All rights reserved Reactions 2 Dec 2017 No. 1680
Reactions Weekly – Springer Journals
Published: Dec 2, 2017
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