title: [Angioimmunoblastic T-cell lymphoma with marked polyclonal plasmacytosis in peripheral blood and bone marrow mimicking plasma cell leukemia].
abstract: A 70-year-old man was admitted to our hospital with fever, generalized lymphadenopathy and hypoxia in October 2009. Blood examination demonstrated leukocytosis, anemia, thrombocytopenia and hyper γ-globulinemia. Peripheral blood and bone marrow smear showed marked plasma cell proliferation mimicking plasma cell leukemia. However, flow cytometric analysis showed that plasma cells were of polyclonal origin and M-protein was not detected by immunofixation of serum protein. Elevations of soluble interleukin 2 receptor and serum IL-6 were observed. A heavy Epstein-Barr viral load was detected in serum by real-time PCR. Biopsy was obtained from the right inguinal lymph node. The pathological diagnosis was angioimmunoblastic T-cell lymphoma (AITL) and rearrangement of the T-cell receptor Cβ1 gene was detected. The patient was treated with CHOP therapy, and all clinical manifestations, including fever, lymphadenopathy, anemia, thrombocytopenia, hyper γ-globulinemia, plasmacytosis and hypoxia, were improved. Only a few reported cases have demonstrated AITL with marked polyclonal plasmacytosis. Although pathological mechanisms of plasmacytosis in AITL patients have not been fully elucidated, it is suggested that IL-6 and IL-10 were involved in its pathogenesis in the present case.
authors.affiliation: Department of Hematology, Tokyo Women's Medical University.
authors.forename: Kenjiro
authors.initials: K
authors.lastname: Mitsuhashi
authors.forename: Masayuki
authors.initials: M
authors.lastname: Shiseki
authors.forename: Midori
authors.initials: M
authors.lastname: Ishiyama
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kondo
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kazama
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yasunami
authors.forename: Takamitsu
authors.initials: T
authors.lastname: Okamura
authors.forename: Kentaro
authors.initials: K
authors.lastname: Yoshinaga
authors.forename: Naoki
authors.initials: N
authors.lastname: Mori
authors.forename: Masanao
authors.initials: M
authors.lastname: Teramura
authors.forename: Akihiro
authors.initials: A
authors.lastname: Masuda
authors.forename: Toshiko
authors.initials: T
authors.lastname: Motoji
mesh_terms: D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000008:administration & dosage / Q000627:therapeutic use; D001853:Bone Marrow / Q000473:pathology*; D003520:Cyclophosphamide / Q000008:administration & dosage; D004317:Doxorubicin / Q000008:administration & dosage; D006801:Humans; D007119:Immunoblastic Lymphadenopathy / Q000097:blood* / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D016753:Interleukin-10; D015850:Interleukin-6; D007952:Leukemia, Plasma Cell; D016399:Lymphoma, T-Cell / Q000097:blood* / Q000188:drug therapy / Q000209:etiology / Q000473:pathology*; D008297:Male; D010950:Plasma Cells / Q000473:pathology*; D011239:Prednisolone / Q000008:administration & dosage; D016896:Treatment Outcome; D014750:Vincristine / Q000008:administration & dosage
chemical_list: D015850:Interleukin-6; D016753:Interleukin-10; D014750:Vincristine; D004317:Doxorubicin; D003520:Cyclophosphamide; D011239:Prednisolone