title: Hematogones With Lambda Light Chain Restriction in a 4-Year-Old Boy With Burkitt Lymphoma: A Potential Diagnostic Pitfall.
abstract: Hematogones are immature normal B cell precursors with a characteristic immunophenotype profile on flow cytometry that typically do not express surface immunoglobulin light chains. In this report, we describe a case in which the hematogones exhibit light chain restriction. Our patient was a 4-year-old boy with a complicated medical history involving treatment for a presumed bilateral Wilms tumor of the kidney that on later resection was diagnosed as Burkitt lymphoma. Flow cytometry analysis of his bone marrow revealed a small distinct population of cells expressing dim cluster of differentiation (CD)10, CD19, CD22, CD38, dim CD58, human leukocyte antigen-D related (HLA-DR), and dim CD45, which are characteristic of hematogones. These cells, however, demonstrated dim surface immunoglobulin lambda light-chain restriction. Molecular study results for immunoglobulin heavy and kappa light-chain gene rearrangements were negative. We present this case to raise awareness of the potential pitfalls of working up bone marrow for involvement by B cell lymphoproliferative disorder.
authors.affiliation: Department of Pathology, Emory University, Atlanta, GA.
authors.forename: Tesha
authors.initials: T
authors.lastname: Guillory
authors.affiliation: Department of Pathology, Emory University, Atlanta, GA.
authors.forename: Shiyong
authors.initials: S
authors.lastname: Li
authors.affiliation: Division of Hematology/Oncology, Department of Pediatrics, AFLAC Cancer and Blood Disorder Center, Emory University, Atlanta, GA.
authors.forename: Daniel J
authors.initials: DJ
authors.lastname: Bergsagel
authors.affiliation: Department of Pathology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Weinzierl
authors.affiliation: Department of Pathology, Children's Healthcare of Atlanta, Emory University School of Medicine, Atlanta, GA silvia.bunting@choa.org.
authors.forename: Silvia T
authors.initials: ST
authors.lastname: Bunting
mesh_terms: D015703:Antigens, CD / Q000378:metabolism; D001402:B-Lymphocytes / Q000502:physiology*; D002051:Burkitt Lymphoma / Q000175:diagnosis*; D002469:Cell Separation; D002675:Child, Preschool; D003951:Diagnostic Errors / Q000517:prevention & control; D005434:Flow Cytometry; D006801:Humans; D007147:Immunoglobulin Light Chains / Q000235:genetics*; D007146:Immunoglobulin lambda-Chains / Q000235:genetics*; D008297:Male; D054448:Precursor Cells, B-Lymphoid / Q000502:physiology*
chemical_list: D015703:Antigens, CD; D007147:Immunoglobulin Light Chains; D007146:Immunoglobulin lambda-Chains
keywords: Lambda light chain; flow cytometry; hematogones; hematopathology; light-chain restriction; lymphoproliferative disorders