Abstract
We described a rare case of follicular lymphoma producing IgG λ type M-protein and Bence Jones protein.
A 64 year old male patient was admitted to the hospital of NIRS in Chiba because of leukocytosis and abdominal tumor. Diagnosis of follicular lymphoma medium sized cell type was made on his large tumorous mesenteric lymph node by laparotomy biopsy.
On admission peripheral blood examination showed WBC 18,600/μl with 36.5% leukemic lymphoma cells. Bone marrow aspiration yielded normal cellularity containing 54.6% lymphoma cells. The PAP method observations of lymph node and peripheral leukemic cells showed that the lymphoma cells were positive with anti-IgG and anti-λ sera. Immunoelectron microscopic observation revealed that the positive reaction for IgG and λ was demonstrated in the nuclear envelope, rough endoplasmic reticulum and on the surface of these lymphoma cells, clearly indicating that these cells were producing IgG. In accordance with these findings the laboratory data showed IgG λ type M-proteinemia and Bence Jones proteinuria.
As lymphoma cells were proved to invade to the liver and to the bone marrow, chemotherapy with adriamycin, cyclophosphamide, vincristine and prednisolone was started, but these drugs were ineffective. Next, melphalan was used alone successfully. Nearly complete remission with a little amount of residual leukemic cells in the bone marrow, was achieved after additional radiotherapy against tumor and swollen lymph nodes.
