Simultaneous Presentation of Lymphomatoid Granulomatosis and Multiple myeloma in an Immunodeficient Patient with Rheumatoid Arthritis

SummaryA study of the removal of I131-labeled Congo red from the blood of amyloid, non-amyloid, multiple myeloma, rheumatoid arthritis and other patients is presented. The percentage removal of the labeled dye shows the same variation reported by many other workers using Bennhold’s test and its modifications.However, there seems to be a positive correlation between the percentage removal of the labeled dye and the presence of amyloid as revealed by biopsy and autopsy. The half-time of disappearance is also correlated with the amyloidosis.The availability of the I131-labeled dye permits the use of very small weights of the dye thereby drastically reducing the possibility of toxic and sometimes fatal reactions encountered with the unlabeled dye. The I131 present permits easy quantitation of the dye in the blood without separation of plasma and obviates the need of fasting. It also permits external counting and scanning of deposits in the organs containing the dye.The availability and use of the labeled dye may stimulate more comparative studies of the removal of the dye from the blood correlated with biopsy and autopsy findings.

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Grade 3 Lymphomatoid Granulomatosis in a Patient Receiving Methotrexate Therapy for Rheumatoid Arthritis

Internal Medicine ◽

10.2169/internalmedicine.53.2593 ◽

2014 ◽

Vol 53 (16) ◽

pp. 1873-1875 ◽

Cited By ~ 13

Author(s):

Hiroshi Oiwa ◽

Keichiro Mihara ◽

Takanobu Kan ◽

Maiko Tanaka ◽

Hajime Shindo ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Methotrexate Therapy ◽

Lymphomatoid Granulomatosis ◽

Grade 3

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Simultaneous Presentation of Waldenstr^|^ouml;m Macroglobulinemia and Multiple Myeloma: Multidisciplinary Diagnosis, Treatment and 30-Month Follow-up

Journal of Clinical and Experimental Hematopathology ◽

10.3960/jslrt.53.29 ◽

2013 ◽

Vol 53 (1) ◽

pp. 29-36 ◽

Cited By ~ 3

Author(s):

Giovanni Carulli ◽

Eugenio M Ciancia ◽

Antonio Azzar^|^agrave; ◽

Virginia Ottaviano ◽

Susanna Grassi ◽

...

Keyword(s):

Multiple Myeloma ◽

Simultaneous Presentation

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Simultaneous Presentation of Leukemic Non-Nodal Mantle Cell Lymphoma and Gamma-Delta T-Large Granular Lymphocytic Leukemia in a Patient with Rheumatoid Arthritis

Cancer Management and Research ◽

10.2147/cmar.s261910 ◽

2020 ◽

Vol Volume 12 ◽

pp. 9449-9457

Author(s):

Vadim R Gorodetskiy ◽

Natalya Probatova ◽

Natalia A Kupryshina ◽

Svetlana G Palshina ◽

Tatiana N Obukhova ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Mantle Cell Lymphoma ◽

Cell Lymphoma ◽

Simultaneous Presentation ◽

Lymphocytic Leukemia ◽

Gamma Delta ◽

Large Granular Lymphocytic Leukemia ◽

Mantle Cell

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Chronic Inflammation May Predispose to the Development of Plasma Cell Dyscrasias.

Blood ◽

10.1182/blood.v104.11.3650.3650 ◽

2004 ◽

Vol 104 (11) ◽

pp. 3650-3650

Author(s):

Elizabeth M. Blanchard ◽

Elizabeth Lawler ◽

Mary Brophy ◽

Louis Fiore ◽

Nikhil C. Munshi

Keyword(s):

Rheumatoid Arthritis ◽

Multiple Myeloma ◽

Hepatitis C ◽

Hepatitis B ◽

Plasma Cell ◽

Agent Orange ◽

Source Population ◽

Chronic Infections ◽

Inflammatory Conditions ◽

Plasma Cell Dyscrasias

Abstract Background: It has been hypothesized that chronic antigenic stimulation in response to chronic inflammation or infection may predispose to the development of plasma cell dyscrasias (PCD) including multiple myeloma (MM) and monoclonal gammopathy of undetermined significance (MGUS). Using Department of Veterans Affairs (VA) administrative databases we explored associations between PCD and chronic inflammatory diseases (CID) including rheumatoid arthritis (RA), inflammatory bowel diseases (IBD), psoriasis, asthma, the chronic infections hepatitis C (HEPC) and hepatitis B (HEPB), as well as history of agent orange exposure (AO). Methods: To identify a source population of veterans who are regular users of the VA system for medical care, we gathered data on patients seen in the inpatient or outpatient setting with a diagnosis of hypertension (HTN), diabetes (DM) or coronary artery disease (CAD) between Oct 1, 1996 and Sept 30, 2003. This source population represents more than 70% of all users of the VA healthcare system. Within this population, we identified from ICD-9 codes all prevalent cases of PCD inclusive of MM and MGUS and also current diagnoses of RA, HEPB, HEPC, IBD, psoriasis and asthma. Agent Orange (AO) exposure was ascertained through administrative records. Crude and age-adjusted prevalence odds ratios for associations with PCD are reported. Results: The source population consisted of 4,050,741 veterans who visited the VA Healthcare System nationwide during this time period. Of these patients, 12,936 (0.32%) carried a diagnosis of PCD, including either multiple myeloma or MGUS or both. Odds ratios are presented in Table I. Table I: Associations of Plasma Cell Dyscrasias and Inflammatory Conditions Chronic Condition # of cases Crude OR (95% CI) Age-adjusted OR (95% CI) RA 92511 2.20 (2.03,2.39) 2.15 (1.98,2.32) Hepatitis B 22958 2.03 (1.72,2.38) 3.07 (2.60,3.61) Hepatitis C 116615 1.40 (1.28,1.53) 2.326 (2.12,2.55) IBD 2675 2.83 (1.89,4.23) 3.26 (2.18,4.87) Asthma 183753 1.19 (1.10,1.29) 1.30 (1.20,1.40) Psoriasis 76697 1.43 (1.29,1.59) 1.42 (1.28,1.58) BPH 989271 1.81 (1.75,1.88) 1.53 (1.47,1.58) Agent Orange 69710 1.62 (1.45,1.80) 2.37 (2.07,2.58) Conclusions: We have identified strong associations (OR > 2) between plasma cell dyscrasias and inflammatory conditions including rheumatoid arthritis, IBD and the chronic infections hepatitis B and C. Agent Orange exposure (already known to be associated with plasma cell dyscrasias) served as the positive control and had an age adjusted OR of 2.37. We suspect that residual confounding may be responsible for what appears to be a weak association with benign prostatic hypertrophy (BPH). Asthma and psoriasis do not appear to have a strong association with the development of plasma cell dyscrasias. A detailed ethnic and age adjusted analysis that includes other inflammatory and non-inflammatory conditions is underway in an effort to identify other associations. This study provides a basis for future research efforts focused on identifying cytokine pathways that may link these disorders and subsequently serve as targets for novel interventions to prevent the development or progression of plasma cell dyscrasias.

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Crosstalk Between the Bone and Immune Systems: Osteoclasts Function as Antigen-Presenting Cells and Activate CD4+ and CD8+ T Cells.

Blood ◽

10.1182/blood.v114.22.918.918 ◽

2009 ◽

Vol 114 (22) ◽

pp. 918-918

Author(s):

Haiyan Li ◽

Sungyoul Hong ◽

Jianfei Qian ◽

Jing Yang ◽

Liang Zhang ◽

...

Keyword(s):

Rheumatoid Arthritis ◽

Multiple Myeloma ◽

T Cells ◽

Immune System ◽

Mhc Class I ◽

Cd8 T Cells ◽

Immune Systems ◽

Alloreactive T Cells ◽

Antigen Presenting ◽

Stimulation Of

Abstract Abstract 918 Bone is a dynamic tissue that is constantly being remodeled by bone-resorbing osteoclasts (OCs) and bone-forming osteoblasts (OB). Bone destruction, observed in patients with autoimmune disease rheumatoid arthritis and malignancies such as multiple myeloma, is believed to be caused by hyperactivation of OCs. OCs differentiate from hematopoietic monocytic precursors under stimulation by the cytokines RANKL (receptor activator of nuclear factor κB ligand) and M-CSF (macrophage colony-stimulating factor), which are produced primarily by bone marrow stromal cells, OBs, and activated T cells. As OCs are derived from monocytes/macrophages lineage similar to dendritic cells (DCs), we hypothesized that OCs could serve as antigen-presenting cells (APCs) to activate T cells. In this study, OCs were generated from human monocytes with the stimulation of RANKL and M-CSF in vitro. DCs derived from monocytes with the stimulation of GM-CSF and IL-4 were used as positive controls. First, we examined the phenotype of OCs by flow cytometry, and OCs were detached by non-enzymatic cell dissociation solution. Results showed that OCs expressed MHC class I and II molecules and costimulatory molecules important for APCs such as CD80, CD86 and CD40. The expression of these molecules could be upregulated by LPS and IFN-γ. Second, we showed by PCR that OCs expressed IL-10, TGF-β, IL-6 and TNF-α, but not IL-12p35 and p40. Third, we examined the ability of OCs to present alloantigens and activate alloreactive T cells in a mixed lymphocyte reaction assay. OCs could present allogeneic antigens and activate both CD4+ and CD8+ alloreactive T cells to proliferate as detected by [3H]thymidine incorporation and CFSE dilution assay. The activation was restricted by MHC class I and II molecules. Finally, we recruited tetanus toxoid (TT)-immunized healthy donors to test whether OCs could uptake exogenous soluble antigens and present them to CD4+ T cells. OCs pulsed with TT could activate autologous specific CD4+ T cells, which was MHC II molecule restricted. These findings indicate that OCs could function as APCs and activate both CD4+ and CD8+ T cells. Thus, our study provides new insight to the effect of OCs on the immune system especially T cells. This is not only important for a better understanding of the crosstalk between the bone and immune system but also may help develop novel strategies for treating diseases such as rheumatoid arthritis and multiple myeloma, which affect both the bone and immune systems. Disclosures: No relevant conflicts of interest to declare.

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Concurrent Presentation of Hodgkin Lymphoma and Multiple Myeloma

Case Reports in Hematology ◽

10.1155/2013/398769 ◽

2013 ◽

Vol 2013 ◽

pp. 1-3

Author(s):

Rekha Chandran ◽

Miklos Simon ◽

Stephen E. Spurgeon

Keyword(s):

Multiple Myeloma ◽

Hodgkin Lymphoma ◽

Complete Resolution ◽

Simultaneous Presentation ◽

Axillary Node ◽

Prior Chemotherapy ◽

Nodular Sclerosing ◽

Abvd Chemotherapy ◽

Skeletal Lesions

The simultaneous presentation of the Hodgkin lymphoma and multiple myeloma in the absence of prior chemotherapy or radiation is very rare. Here, we discuss a 72-year-old patient who initially presented with generalized pruritis. Workup led to a diagnosis of multiple myeloma which progressed and required treatment. As part of his pretreatment workup, an MRI was performed to evaluate skeletal lesions. This revealed diffuse and bulky adenopathy which was confirmed by PET. A biopsy of an axillary node was consistent with the nodular sclerosing type Hodgkin lymphoma. He was treated with adriamycin, bleomycin, vinblastine, and dacarbazine (ABVD) chemotherapy × 6 resulting in complete resolution of his adenopathy and pruritis as well as improvement in his myeloma.

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