Abstract
A case of immunoblastic lymphadenopathy which underwent transformation into immunoblastic sarcoma associated with polyclonal hypergammaglobulinemia at later date is reported.
A 52-year-old man hospitalized on March 11, 1980, with anemia and generalized lymphadenopathy. Laboratory findings showed marked anemia, reticulocytosis and positive Coombs' test. Serum gammablobulin level remained slight increase on admission. The lymph node of the neck was examined by biopsy and initially interpreted as showing immunoblastic lymphadenopathy. Therapy with prednisolone was started. However, there was no objective effect on the patient's condition, and the lymph nodes remained large. In addition to prednisolone, cyclophosphamide was administered, but anemia and hepatosplenomegaly aggravated. Two months after admission, histological findings of rebiopsied lymph node of the neck demonstrated monotonous proliferation of immunoblasts and monoclonal staining pattern of heavy chain class Ig G and lambda light chain type in the cytoplasm of these cells using immunoperoxidase method (PAP technique). A diagnosis of immunoblastic sarcoma was made. Serum gammaglobulin level rapidly increased and of interest was the finding that there was diffuse, polyclonal hepergammaglobulinemia on immunoelectrophoresis. The level of serum gammaglobulin reached 4.9 g/dl. Hepatosplenomegaly increased and high fever continued, and thus, combination chemotherapy with VEMP was tried. However, his condition continued to deteriorate with progressive pancytopenia and high fever. He died of sepsis four months after admission.
