Nodular localized cutaneous amyloidosis: detection of monoclonality of infiltrating plasma cells by polymerase chain reaction

Abstract

We report nodular localized cutaneous amyloidosis arising in a 74-year-old woman as a single nodule at the left angle of the mouth. Histological examination revealed eosinophilic material deposited in the dermis, identified as amyloid by staining with Dylon stain, and antiamyloid P component, and by electron microscopy. The amyloid material was further determined immunohistochemically to be of AL fibril protein type derived from lambda light chains. Infiltrating plasma cells, around blood vessels in the dermis, stained monotypically with anti-lambda antibody, suggesting plasma cell monoclonality. Semi-nested polymerase chain reaction (PCR), for rearrangement of immunoglobulin heavy chain gene using paraffin-embedded sections, yielded two distinct amplified bands, indicating monoclonality of the infiltrating plasma cells. These findings support the hypothesis that primary localized nodular amyloidosis involves local accumulation of monoclonal plasma cells and their secreted products. The two amplified bands observed on PCR may, in the present case, reflect abnormal secretion of immunoglobulin light chains.

Cutaneous Amyloidosis: A Concept Review

“…Some studies have demonstrated monoclonality of this infiltrate in most cases but not in all. [213][214][215] In these patients, however, a systemic involvement must strictly be excluded due to its bad prognosis. 215 In this respect, gene rearrangement studies could be useful in the early detection of systemic AL amyloidosis which presents as cutaneous involvement as its first manifestation.…”

Monoclonality of infiltrating plasma cells in primary pulmonary nodular amyloidosis: detection with polymerase chain reaction

“…7 8 Furthermore, we suggested that clonal expansion of plasma cells in nodular localised cutaneous amyloidosis occurs locally, because plasma cells in a skin lesion showed monotypic staining with anti-antibody, while the adjacent normal skin contained plasma cells stained with both anti-and antiantibodies. 7 Laeng et al have reported similar results for nervous system amyloidomas. 17 In the present study, we obtained the results by two diVerent methods-immunohistochemistry and PCR: plasma cells with monotypic staining for immunoglobulin light chains were observed adjacent to amyloid deposits, while those showing either staining were located peripherally; and there was a distinct band on a polyclonal smear.…”

Nodular localized cutaneous amyloidosis: further demonstration of monoclonality of infiltrating plasma cells in four additional Japanese patients

“…Semi-nested PCR amplification for the rearranged VDJ region of the immunoglobulin heavy chain gene was performed as previously described with slight modifications. 3,[8][9][10][11] Briefly, DNA was extracted from paraffin-embedded sections and used as a template in the first round of PCR amplification (30 cycles) with consensus primers, forward primer FR3A and outer reverse primer LJH. [8][9][10] Using the resulting PCR products, the second round of PCR (30 cycles) with FR3A and inner reverse primer VLJH was performed.…”

“…2 We recently described a case of NLCA and demonstrated monoclonality of infiltrating plasma cells by semi-nested polymerase chain reaction (PCR). 3 In this study we analyse further paraffin-embedded sections.…”