title: Waldenström macroglobulinemia transforming from t (11;18) (q21;q21) -negative gastric MALT lymphoma after systemic dissemination.
abstract: OBJECTIVE
  We here describe the clinical course of a 70-year-old male patient with Waldenström macroglobulinemia (WM) putatively transformed from refractory mucosa-associated lymphoid tissue lymphoma (MALTL).
  
  
  METHODS
  Immunological staining was performed on formalin-fixed, paraffin-embedded tissue sections, and M-protein and cryoglobulin were identified by immunofixation electrophoresis and the cold precipitation method. Chromosome translocation was analyzed by the G-banded karyotype, and API2/MALT1 fusion gene underwent fluorescent in situ hybridization. Multiplex polymerase chain reaction was performed to analyze the VH-JH or DH-JH rearrangements of the IGH gene.
  
  
  RESULTS
  At diagnosis, the WM patient had monoclonal IgM with cryoglobulinemia and hyperviscosity syndrome. Eight years before developing WM, the patient experienced the onset of typical gastric MALT-L with H. pylori infection, but in spite of negative for chromosome translocation, t (11;18) and the successful eradication of H. pylori, the MALT-L relapsed repeatedly, and finally led to systemic metastasis. The lymphoma cells also infiltrated the large intestine and spleen. Immunoglobulin gene analyses of cellular clonality revealed that the same clone had been present in the stomach, bone marrow (BM) at the onset of MALT L, and in the BM at the diagnosis of WM.
  
  
  CONCLUSIONS
  In this case, lymphoma developed as H. pylori-associated gastric MALT-L with negative for t (11;18), and might be transformed into MW during the systemic metastasis.
authors.affiliation: Department of Laboratory Medicine, Shinshu University Hospital.
authors.forename: Masako
authors.initials: M
authors.lastname: Hirota-Kawadobora
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Matsuda
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Yamauchi
authors.forename: Takeshi
authors.initials: T
authors.lastname: Uehara
authors.forename: Naoko
authors.initials: N
authors.lastname: Asano
authors.forename: Hiroyoshi
authors.initials: H
authors.lastname: Ota
authors.forename: Hideaki
authors.initials: H
authors.lastname: Hamano
authors.forename: Taiji
authors.initials: T
authors.lastname: Akamatsu
authors.forename: Takayuki
authors.initials: T
authors.lastname: Honda
authors.forename: Nobuo
authors.initials: N
authors.lastname: Okumura
mesh_terms: D000368:Aged; D002880:Chromosomes, Human, Pair 11 / Q000235:genetics*; D002887:Chromosomes, Human, Pair 18 / Q000235:genetics*; D003449:Cryoglobulinemia / Q000209:etiology; D005756:Gastritis / Q000150:complications / Q000382:microbiology; D016481:Helicobacter Infections; D016480:Helicobacter pylori; D006801:Humans; D007075:Immunoglobulin M; D018442:Lymphoma, B-Cell, Marginal Zone / Q000150:complications* / Q000235:genetics*; D008297:Male; D013274:Stomach Neoplasms / Q000150:complications* / Q000235:genetics*; D014178:Translocation, Genetic / Q000235:genetics*; D008258:Waldenstrom Macroglobulinemia / Q000175:diagnosis / Q000209:etiology*
chemical_list: D007075:Immunoglobulin M