Gene/Protein Disease Symptom Drug Enzyme Compound
Pivot Concepts:   Target Concepts:
Query: UMLS:C0038002 (splenomegaly)
 9,873 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Primary bone marrow presentation of diffuse large B-cell lymphoma (DLBCL) is unusual, and appreciation of the diffuse growth pattern may be difficult in cases with low-level involvement. In particular, subtle sinusoidal and interstitial bone marrow involvement and morphologic overlap of the tumor cells with pronormoblasts may result initially in a missed diagnosis. We describe the clinicopathologic features of 13 cases of morphologically subtle DLBCL involving the bone marrow, which were only identified with the aid of immunohistochemistry. The overwhelming majority of cases (12/13, 92%) presented with cytopenias, and 5 of 7 cases, with available information, had splenomegaly. The morphology of the tumor cells in the aspirate smears overlapped with pronormoblasts (immature erythroid precursors) in 12 of 13 cases. Similarly, in histologic sections, the tumor cells in virtually all cases (12/13) demonstrated round nuclear contours and oblong nucleoli, mimicking pronormoblasts. A CD20 immunohistochemical stain was essential in identifying the neoplastic infiltrate in all cases. The majority of cases (73%, 10/13) showed low-level bone marrow involvement by lymphoma, 10% or less. CD20 immunohistochemistry highlighted individually dispersed and small clusters of large lymphoid cells in a sinusoidal and/or interstitial growth pattern. Most of the cases that were assessed showed a non-germinal center phenotype (CD10-, BCL6-/+, IRF4/MUM1+). There was an aggressive disease course with a median overall survival of 6 months. We would recommend performing a CD20 immunostain in patients who present with unexplained cytopenias and/or splenomegaly. Further investigation is warranted to better describe the features of this unique and aggressive variant of DLBCL.
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PMID:Subtle bone marrow involvement by large B-cell lymphoma with pronormoblast-like morphology and prominent but not exclusive sinusoidal distribution. 2276 30

Kaiso was previously described as a methylated DNA-binding protein and a transcription repressor interacting with the corepressor protein complex NCoR. In the current study, we show that generation-3 Kaiso knockout mice show a phenotype of splenomegaly and large diffused germinal centers (GC). In the spleens of Kaiso knockout mice, Bcl6 (a transcriptional repressor that plays a critical role in GC development in spleen) and c-Myc were highly expressed, while the cell cycle arrest genes p27 (CDKN1B), p21 (CDKN1A) and Gadd45a were downregulated. Chromatin immunoprecipitation (ChIP) and transcription assays suggested that Kaiso represses Bcl6 expression, and in Kaiso knockout mice, derepressed Bcl6 increased cell proliferation by suppressing p27 (CDKN1B), p21 (CDKN1A) and Gadd45a, while upregulating the oncogene c-Myc. Further evidence for Kaiso regulation of splenomegaly was provided by B lymphocyte Ramos cells, in which ectopic KAISO repressed BCL6 and c-MYC expression, while concomitantly increasing the expression of the cell cycle arrestors p21, p27 and Gadd45a. In summary, derepressed Bcl6 expression may be responsible for increases in GC cell proliferation and splenomegaly of Kaiso knockout mice.
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PMID:Kaiso is a key regulator of spleen germinal center formation by repressing Bcl6 expression in splenocytes. 2426 70

Intravascular large B-cell lymphoma (IVLBCL) is a rare and clinically distinctive entity characterized by the almost exclusive growth of large cells within the lumen of blood vessels in particular capillaries. Reports of this peculiar disease, do not commonly address the PD-L1 expression on IVLBCL tumor cells. Here, we describe a 51-year-old Japanese woman who presented with rapidly progressive cognitive decline and higher brain dysfunction. CT scan and MRI revealed multiple ischemic foci in the cerebral hemispheres, ground-glass opacity in the lungs, and splenomegaly. Random skin biopsy for IVLBCL diagnosis yielded negative results. The patient experienced a rapidly deteriorating clinical course with no treatment, and died from the disease after 3 months of hospitalization. Post-mortem examination revealed systemic intravascular plugging of lymphoma cells, without mass lesions in the central nervous system or in visceral organs such as the lungs, liver, pituitary gland, ovaries, and uterus. The tumor cells were positive for CD10, CD20, BCL2, BCL6, and MUM1, but not other lineage-specific markers. Notably, the tumor cells showed strong PD-L1 expression. Our case was diagnosed as IVLBCL with neoplastic PD-L1 expression. These findings suggest that PD-L1 is associated with immune evasion of IVLBCL and may play a role in the pathogenesis and peculiar biological behavior of this unique disease. Additionally, PD-L1 may represent a possible therapeutic target for immune check-point inhibitors.
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PMID:Autopsy case report of intravascular large B-cell lymphoma with neoplastic PD-L1 expression. 2941 79