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Combined plasmacytoma and squamous cell carcinoma.

A 63-year-old man was admitted to the Cardiothoracic Department of Glasgow Royal Infirmary for surgical treatment of a left suprahilar opacity. A left pneumonectomy was required to deal with an extensive upper lobe tumor. Histopathological examination, in addition to a moderately well-differentiated squamous cell carcinoma, revealed the presence of a band-like infiltrate of plasma cells and lymphoplasmacytoid cells at the main bronchial resection margin. Immunohistochemical studies confirmed this to be an extramedullary plasmacytoma by showing IgA and kappa positive monotypic cells. No paraprotein was detected in the serum. The value of immunohistochemistry in the differential diagnosis has been emphasized.

Bronchial Neoplasms↗

[Primary pulmonary plasmacytoma. Case report of a rare lung tumor].

HISTORY AND CLINICAL FINDINGS: A 45-year old man, suffering from dry cough without haemoptysis, was admitted for evaluation of pulmonary changes of uncertain aetiology. A chest radiograph and computed tomography (CT) had shown a large space-occupying lesion in the left hilus. His general condition was poor and he had resting dyspnoea and stridor. On auscultation of the lung there were decreased breath sounds and dry rales over the left and vesicular breathing over the right lung. INVESTIGATIONS: CT revealed a 7.0 x 6.0 cm space-occupying lesion in the left hilus and ipsilaterally a tumour in the dorsolateral lower lobe surrounding the left lower lobe bronchus. Initial bronchoscopy showed this bronchus to be involved in the tumour process. Biopsy demonstrated monomorphic proliferating plasma cells which on immunochemical testing showed selective staining to lambda-light chains and immunoglobulin G. The first serum electrophoresis was unremarkable, but a later repeat discovered a small amount of paraprotein for IgG-lambda type. Bence-Jones protein was demonstrated in the urine. On the basis of these findings an extramedullary plasmacytoma of the lung (PPP) was diagnosed. TREATMENT AND COURSE: At first the patient was given i.v. chemotherapy, and to prevent a threatening bronchial occlusion oral dexamethasone was given. Pericardial effusion and recurrent retention pneumonia developed. 6 month after onset of symptoms radiotherapy was begun and the tumour became markedly smaller. CONCLUSION: PPP should be included in the differential diagnosis of pulmonary space-occupying lesions even when initial serum protein electrophoresis is negative for monoclonal paraproteinaemia. Pericardial effusion may be caused by pulmonary involvement of the plasma cell tumours.

Biopsy↗

[Plasmacytoma of the orbit].

Report on a 69-year-old woman with exophatalmos in the left eye caused by a plasma-cell tumor. The differential diagnosis of this tumor includes myelomatosis, solitary myeloma of bone and extramedullary plasmacytoma. The clinical features suggest an orbital involvement of myelomatosis. The results of physical examination and findings in axial computer tomography and ultrasonography are discussed.

Aged↗

Radiographic findings for solitary plasmacytoma of the bone in the anterior wall of the maxillary sinus: A case report.

Radiographic findings for a solitary plasmacytoma of the anterior wall of the maxillary sinus are reported. The diagnostic evaluation for this disease is discussed through use of plain images, computed tomography, and magnetic resonance imaging. The treatment selected was radiation therapy combined with chemotherapy. Computed tomography and magnetic resonance imaging revealed bone destruction, though this was not apparent on plain images. T(1)-weighted magnetic resonance images showed similar or high signal intensity relative to muscle; T(2)-weighted images showed hyperintensity.

Aged↗

IL-6 transgenic mouse model for extraosseous plasmacytoma.

Plasma cell neoplasms in humans comprise plasma cell myeloma, otherwise known as multiple myeloma, Ig deposition and heavy chain diseases, and plasmacytoma (PCT). A subset of PCT, designated extramedullary PCT, is distinguished from multiple myeloma and solitary PCT of bone by its distribution among various tissue sites but not the bone marrow. Extramedullary (extraosseus) PCT are rare spontaneous neoplasms of mice but are readily induced in a susceptible strain, BALB/c, by treatment with pristane. The tumors develop in peritoneal granulomas and are characterized by Myc-activating T(12;15) chromosomal translocations and, most frequently, by secretion of IgA. A uniting feature of human and mouse plasma cell neoplasms is the critical role played by IL-6, a B cell growth, differentiation, and survival factor. To directly test the contribution of IL-6 to PCT development, we generated BALB/c mice carrying a widely expressed IL-6 transgene. All mice exhibited lymphoproliferation and plasmacytosis. By 18 months of age, over half developed readily transplantable PCT in lymph nodes, Peyer's patches, and sometimes spleen. These neoplasms also had T(12;15) translocations, but remarkably, none expressed IgA. Unexpectedly, approximately 30% of the mice developed follicular and diffuse large cell B cell lymphomas that often coexisted with PCT. These findings provide a unique model of extramedullary PCT for studies on pathogenesis and treatment and suggest a previously unappreciated role for IL-6 in the genesis of germinal center-derived lymphomas.

Animals↗

Multiple genetic loci modify susceptibility to plasmacytoma-related morbidity in E(mu)-v-abl transgenic mice.

There is a great difference in susceptibility to v-abl transgene-induced plasmacytoma between the BALB/cAn and the relatively resistant C57BL/6J mouse strains. We have used the Mapmaker/SURVIVOR algorithm to analyze genome-wide scans on over 800 transgenic F2 hybrid mice, and have mapped at least six loci on chromosomes 2, 4, 11, 17, and 18 that modify tumor-related morbidity. As in human multiple myeloma, males were found to be more prone to plasmacytomagenesis. Different loci influence tumor susceptibility in male and female mice. Survival in females may be largely controlled by a pair of interacting loci on chromosomes 2 and 17.

Algorithms↗

Frap, FKBP12 rapamycin-associated protein, is a candidate gene for the plasmacytoma resistance locus Pctr2 and can act as a tumor suppressor gene.

Susceptibility to mouse plasmacytomagenesis is a complex genetic trait controlled by several Pctr loci (Pctr1, Pctr2, etc). Congenic strain analysis narrowed the genetic interval surrounding the Pctr2 locus, and genes identified in the interval were sequenced from susceptible BALB/c and resistant DBA/2 mice. Frap (FKBP12 rapamycin-associated protein, mTOR, RAFT) was the only gene differing in amino acid sequence between alleles that correlated with strain sensitivity to tumor development. The in vitro kinase activity of the BALB/c FRAP allele was lower than the DBA/2 allele; phosphorylation of p53 and PHAS1/4EBP1 (properties of heat and acid stability/eukaryotic initiation factor 4E-binding protein) and autophosphorylation of FRAP were less efficient with the BALB/c allele. FRAP also suppressed transformation of NIH 3T3 cells by ras, with DBA/2 FRAP being more efficient than BALB/c FRAP. Rapamycin, a specific inhibitor of FRAP, did not inhibit growth of plasmacytoma cell lines. These studies identify Frap as a candidate tumor suppressor gene, in contrast to many reports that have focused on its prooncogenic properties. Frap may be similar to Tgfb and E2f in exerting both positive and negative growth-regulatory signals, depending on the timing, pathway, or tumor system involved. The failure of rapamycin to inhibit plasma cell tumor growth suggests that FRAP antagonists may not be appropriate for the treatment of plasma cell tumors. Pctr2 joins Pctr1 in possessing alleles that modify susceptibility to plasmacytomagenesis by encoding differences in efficiency of function (efficiency alleles), rather than all-or-none, gain-of-function, or loss-of-function alleles. By analogy, human cancer may also result from the combined effects of several inefficient alleles.

Alleles↗

Endogenous RNA tumor viruses are activated during chemical induction of murine plasmacytomas.

Plasmacytomas are induced in BALB/c mice by the intraperitoneal injection of pristane (2,6,10,14-tetra-methylpentadecane) after a latent period of six months and more [Anderson, P. N. & Potter, M. (1969) Nature 222, 994-995]. Spleen cells mesenteric lymph node cells, thoracic lymph node cells, and peritoneal exudate cells were prepared from pristane-treated and control uninjected BALB/c mice during the course of a 10-month period, and these cell suspensions were tested for the release of infectious murine leukemia viruses. Endogenous ecotropic and xenotropic murine leukemia viruses were expressed in pristane-treated mice during the latter part of the tumor induction period, in those cell populations in which transformed plasma cells appear, namely, peritoneal exudate cells and thoracic lymph node cells. The significance of preferential expression of both ecotropic and xenotropic murine leukemia virus in target cell populations following the administration of a carcinogen is discussed in terms of the possible formation of an oncogenic variant virus.

Animals↗

Comparison of mRNA precursors in plasmacytomas producing closely related kappa chains.

To help elucidate the mechanisms of formation and expression of active immunoglobulin genes, we have made a systematic study of the processing patterns of the mRNAs that code for a closely related family of kappa chains. Among the members of this family, represented by the V(kappa)21 group of plasmacytomas, are examples in which six different germ-line V genes are joined to four different J segments in various combinations. The mRNA precursors were identified by hybridizing a cloned kappa-cDNA probe to poly(A)-containing nuclear RNAs that were size fractionated on methylmercury-agarose gels and transferred to diazotized paper. Based on the length of the segment excised in the last detectable processing step, which presumably represents the removal of the J-C intron, the precursor patterns were classified into four primary categories that correlated well with the type of J segment being expressed. The J segments were thus located at distances ranging from 2.4 to 4.8 kilobases from the constant-region gene. Different V genes joined to the same J segment exhibited similar precursor patterns, suggesting that the size of the translocated V segment may be relatively uniform among members of the V(kappa)21 group. A large (9.1 kilobases) component, which is likely to represent a primary transcription product, was observed in all processing categories, regardless of which J segment was being utilized. This surprising observation leads to some interesting predictions about the mechanism of V-J translocation.

Animals↗

Plasmacytomas with more than one immunoglobulin kappa mRNA: implications for allelic exclusion.

Although only one allele of an immunoglobulin gene is thought to be expressed as a polypeptide by a given lymphocyte ("allelic exclusion"), three murine plasmacytomas were found to contain more than one kappa light chain mRNA species, as evidenced by the sequences of distinct kappa cDNA clones. Two different kappa cDNA sequences were cloned from BFPC 61 microsomal mRNA, two from MOPC 173, and three from S107. One cDNA sequence from each tumor matches the known secreted polypeptide, while the variant sequences differ in the variable (V) region. Hence fusion of a V kappa gene to a joining (J kappa) gene has occurred independently on separate homologous chromosomes and each allele is transcriptionally competent. The BFPC 61 variant sequence contained a normal V kappa sequence linked out of phase to J kappa 2; hence allelic exclusion in this line is accounted for by an error in DNA rearrangement. One S107 variant cDNA has an untranslatable sequence linked to J kappa--C kappa and may derive from a non-V kappa or pseudo-V kappa gene fused to J kappa. Another S107 variant cDNA, however, has a proper V kappa linked in phase to J kappa (albeit missing the first two germ-line J kappa codons) and the MOPC 173 variant sequence also contains a proper V kappa--J kappa join, although it does not encode a tryptophan residue common to all immunoglobulin chains. The presence of two potentially expressible kappa mRNAs in both S107 and MOPC 173 suggests that allelic exclusion does not hold in all lymphocytes, or that it sometimes reflects events subsequent to mRNA production, such as inability of certain kappa chains to assemble properly with the heavy chain. These observations are compatible with a stochastic model for allelic exclusion in which productive and nonproductive V--J recombination events occur at a certain frequency for each allele.

Alleles↗

Activation of the c-mos oncogene in a mouse plasmacytoma by insertion of an endogenous intracisternal A-particle genome.

The activation of the cellular oncogene c-mos in mouse plasmacytoma XRPC24 was found to result from the insertion of a 4.7-kilobase-pair cellular DNA element, within the c-mos coding region. The element terminates on both sides with a direct repeat of around 335 nucleotides. The repeat as well as internal sequences of the element show strong homology to endogenous intracisternal A-particle (IAP) genes. The IAP genome integrated within c-mos in a head-to-head (5' to 5') configuration. This juxtapositioned the IAP 5' long terminal repeat next to the bulk of the oncogene's coding region and shifted c-mos 5' coding and flanking sequences to a position further upstream. The significance of several aspects of this activation and transposition event is discussed.

Animals↗

Illegitimate recombination generates a class switch from C mu to C delta in an IgD-secreting plasmacytoma.

We present here the sequence characterization of a C mu----C delta immunoglobulin (Ig) heavy chain class switch. In the murine IgD-secreting plasmacytoma TEPC 1017, deletion of most of the mu switch recombination region (S mu) and the entire C mu gene occurred in the absence of switch region sequences 5' to C delta. This unique rearrangement resulted from an illegitimate recombination of sequences with only patchy homology to each other. The infrequent and variable nature of illegitimate recombination may explain the low frequency of IgD-secreting plasma cells in normal mouse tissues.

Alleles↗

Products of a reciprocal chromosome translocation involving the c-myc gene in a murine plasmacytoma.

The structures of the rearranged c-myc gene products derived from a rcp T(12;15) have been investigated in the MPC-11 (IgG2b kappa) plasmacytoma. The rcp T(12;15) in MPC-11 is a reciprocal exchange between the c-myc gene on chromosome 15 and the immunoglobulin gamma 2a switch region (S gamma 2a) on chromosome 12. The c-myc gene is broken within a 5'-nontranslated exon, thereby separating the promoter region of the normal c-myc gene from its protein coding sequences. This reciprocal rearrangement results in the loss of 11 base pairs of c-myc sequence and 300 base pairs of S gamma 2a sequence at the point of recombination. Sequences that represent the promoter region of the normal c-myc gene are present in the 5'-myc reciprocal fragment. A comparison of the nucleotide sequences at the recombination site of a number of c-myc rearrangements reveals a common feature that may have mechanistic importance for these translocation events.

Animals↗

Cdkn2a, the cyclin-dependent kinase inhibitor encoding p16INK4a and p19ARF, is a candidate for the plasmacytoma susceptibility locus, Pctr1.

Plasma cell tumor induction in mice by pristane is under multigenic control. BALB/c mice are susceptible to tumor development; whereas DBA/2 mice are resistant. Restriction fragment length polymorphisms between BALB/c and DBA/2 for Cdkn2a(p16) and Cdkn2b(p15), and between BALB/c and Mus spretus for Cdkn2c(p18(INK4c)) were used to position these loci with respect to the Pctr1 locus. These cyclin-dependent kinase (CDK) inhibitors mapped to a 6 cM interval of chromosome 4 between Ifna and Tal1. C.D2-Chr 4 congenic strains harboring DBA/2 alleles associated with the Pctr1 locus contained DBA/2 "resistant" alleles of the CDK4/CDK6 inhibitors p16 and p15. On sequencing p16 and p18 cDNAs, two different allelic variants within ankyrin repeat regions of p16 were found between BALB/c and DBA/2 mice. By using an assay involving PCR amplification and restriction enzyme digestion, allelic variants were typed among several inbred strains of mice. One of the variants, G232A, was specific to two inbred strains, BALB/cAn and ABP/Le, of mice and occurred in a highly conserved amino acid in both human and rat p16. When tested with wild-type (DBA/2) p16, both A134C and G232A BALB/c-specific variants of p16 were inefficient in their ability to inhibit the activity of cyclin D2/CDK4 in kinase assays with retinoblastoma protein, suggesting this defective, inherited allele plays an important role in the genetic susceptibility of BALB/c mice for plasmacytoma induction and that p16(INK4a) is a strong candidate for the Pctr1 locus.

Amino Acid Sequence↗

The mutant plasmacytoma cell line S107 allows the identification of distinct pathways leading to NF-kappaB activation.

Studies on the mechanisms of inducible and constitutive activity of NF-kappaB transcription factors have been hampered by the lack of appropriate mutant cell lines. We have analyzed the defect in the murine S107 plasmacytoma cell line, which was previously found to lack both constitutive and inducible NF-kappaB activity. Our analysis shows that these cells bear a specific defect that interferes with NF-kappaB induction by many diverse stimuli, such as lipopolysaccharide, phorbol 12-myristate 13-acetate, UV light, x-rays, and H2O2. This does not however represent a general signal transduction defect, because AP-1 transcription factors are readily induced by the same stimuli. Phosphatase inhibitors such as okadaic acid as well as calyculin A can efficiently induce NF-kappaB in S107 cells via a pathway apparently insensitive to the radical scavenger pyrrolidine dithiocarbamate. Furthermore, MEKK1 a protein kinase supposedly induced by some of the above stimuli, is also capable of activating NF-kappaB. Interestingly, both the potent physiological inducer of NF-kappaB TNFalpha as well as endoplasmic reticulum overload can induce NF-kappaB via a PDTC sensitive pathway. In all cases, DNA-binding NF-kappaB complexes are comprised predominantly of p50-RelA heterodimers, and NF-kappaB activation results in the induction of transiently transfected or resident reporter genes. In summary, these results suggest that the pathways for many NF-kappaB-inducing stimuli converge at a specific junction, and this pivotal step is mutated in the S107 cell line. Yet there are alternative routes bypassing this critical step that also lead to NF-kappaB induction. These routes utilized by tumor necrosis factor alpha and endoplasmic reticulum overload are still intact in this cell line.

Animals↗

A case of extramedullary plasmacytoma of the larynx.

An 84-year-old male with a complaint of hoarseness was examined. A mass lesion was recognized in the false vocal fold. The tumor was excised and found to consist of atypical plasmacytes. Immunopathological examination revealed that leukocyte common antigen (CD45), UCHLI (CD45RO), CD3 and L26 (CD20) were negative and that CD79 and Vs38C were positive. Neither uric Bence-Jones protein nor serum M-protein were observed. No other bony abnormalities were recognized on X-ray examinations including both bone and Ga scintigraphy. No atypical plasmacyte infiltration was observed in bone marrow. Our final diagnosis was extramedullary plasmacytoma of the larynx. Radiotherapy was performed following surgery. The tumor did not progress to multiple myeloma and no recurrence has been observed after 2 years.

Aged↗

Extramedullary plasmacytoma of the maxillary sinus.

Extramedullary plasmacytomas (EMPs) are localized plasma cell neoplasms that occur within the soft tissues; by definition they cannot occur within bone. They account for 1-2% of all plasma cell growths and have a great predilection for the upper respiratory tract, without specific manifestations. Males are more frequently affected during the fifth and sixth decades of life. At initial presentation, multiple myeloma should be excluded. We report herein the case of a 63-year-old man with an EMP arising in the right maxillary sinus who was referred for surgical excision and postoperative radiotherapy and briefly review the clinical implications and management of this pathology.

Humans↗

Case report. Plasmacytoma presenting as unilateral proptosis.

A 49-year-old man presented with proptosis of the right eye. An x-ray film of the skull showed a lytic lesion in the right frontal bone. No other skeletal lesions were found. Immunoelectrophoretic analysis showed a monoclonal elevation of IgG level. A soft orbital tumor near the foramen of the optic nerve was removed and found to be a plasmacytoma. The patient was given local irradiation. When IgG level increased about four months after surgery, he was treated with chemotherapy. IgG level decreased and no further skeletal lesions were found.

Diagnosis, Differential↗