kappa-Immunoglobulin corneal deposits associated with monoclonal gammopathy. Immunohistochemical and electron microscopic findings.
A 62-year-old man had a 1-year history of bilaterally decreased visual acuity associated with irregular, patchy, grayish-white stromal infiltrates involving both corneas. As visualized by light microscopy, the keratectomy specimen showed numerous homogeneous, eosinophilic deposits located mostly within keratocytes in the posterior one-third of the stroma. The deposits stained reddish-brown with Masson's trichrome but were periodic acid/Schiff-negative. As visualized by electron microscopy, the intracytoplasmic deposits were located within dilated cisternae of rough-surfaced endoplasmic reticulum of keratocytes and disclosed a 10-nm periodicity with a distinct lattice pattern. Immunoperoxidase strains confirmed that the deposits contained immunoglobulin (IgG-kappa). At 2 weeks following a histopathologic examination of the keratectomy specimen, serum protein analysis and immunoelectrophoresis with quantitation of immunoglobulins demonstrated an IgG-kappa monoclonal gammopathy. The abnormal corneal deposits may be the first clinical sign of a malignant lymphoproliferative process that may be associated with a monoclonal gammopathy.
Graichen
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DF
Department of Ophthalmology, Cullen Eye Institute, Baylor College of Medicine, Houston, TX 77030.
Perez
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E
Jones
D B
DB
Font
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RL
D003316:Corneal Diseases / Q000378:metabolism* / Q000473:pathology; D003319:Corneal Stroma / Q000378:metabolism* / Q000648:ultrastructure*; D006801:Humans; D007122:Immunoelectrophoresis; D007124:Immunoenzyme Techniques; D007074:Immunoglobulin G / Q000378:metabolism*; D007145:Immunoglobulin kappa-Chains / Q000378:metabolism*; D015948:Keratoplasty, Penetrating; D008297:Male; D008875:Middle Aged; D010265:Paraproteinemias / Q000378:metabolism* / Q000473:pathology
D007074:Immunoglobulin G; D007145:Immunoglobulin kappa-Chains