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LETTERS TO THE EDITORTurk J Hematol 2021;38:155-174as the primary cause of renal impairment [6,8]. After exclusionof other causes, kidney biopsy should be performed to confirmthe diagnosis. Significant improvement in renal function wasreported after CLL treatment in a majority of patients [8,9]. Ourcase shows that LI of the kidneys can cause AKI as the initialmanifestation of CLL and physicians should be aware of theatypical presentations of the disease.Keywords: Acute kidney injury, Chronic lymphocytic leukemia,Leukemic infiltrationAnahtar Sözcükler: Akut böbrek yetmezliği, Kronik lenfositiklösemi, Lösemik infiltrasyonEthicsInformed Consent: Informed consent was obtained from thepatient included in the study.Authorship ContributionsMedical Practices: G.K.Ş., H.E.K., S.K.; Concept: G.K.Ş., O.İ., K.K.;Design: G.K.Ş., O.İ., K.K.; Data Collection or Processing: G.K.Ş.,H.E.K., S.K.; Analysis or Interpretation: G.K.Ş., K.K.; LiteratureSearch: G.K.Ş.; Writing: G.K.Ş.Conflict of Interest: No conflict of interest was declared by theauthors.Financial Disclosure: The authors declare that this studyreceived no financial support.References1. Barcos M, Lane W, Gomez GA, Han T, Freeman A, Preisler H, Henderson E. Anautopsy study of 1206 acute and chronic leukemias (1958 to 1982). Cancer1987;60:827-837.2. Schwartz J, Shamsuddin A. The effects of leukemic infiltrates in variousorgans in chronic lymphocytic leukemia. Hum Pathol 1981;12:432-440.3. Da’as N, Polliack A, Cohen Y, Amir G, Darmon D, Kleinman Y, GoldfarbAW, Ben-Yehuda D. Kidney involvement and renal manifestations in non-Hodgkin’s lymphoma and lymphocytic leukemia: a retrospective study in700 patients. Eur J Haematol 2001;67:158-164.4. Shanafelt TD, Rabe KG, Hanson CA, Call TG, Schwager S, Parikh SA, Nasr H,Leung N. Renal disease in patients with chronic lymphocytic leukemia (CLL).Blood 2013;122:5302 (abstract).5. Wanchoo R, Ramirez C, Barrientos J, Jhaveri K. Renal involvement in chroniclymphocytic leukemia. Clin Kidney J 2018;11:670-680.6. Kowalewska J, Nicosia RF, Smith KD, Kats A, Alpers CE. Patterns of glomerularinjury in kidneys infiltrated by lymphoplasmacytic neoplasms. Hum Pathol2011;42:896-903.7. Poitou-Verkinder AL, Francois A, Drieux F, Lepretre S, Legallicier B, MoulinB, Godin M, Guerrot D. The spectrum of kidney pathology in B-cell chroniclymphocytic leukemia / small lymphocytic lymphoma: a 25-year multicenterexperience. PLoS One 2015;10:e0119156.8. Strati P, Nasr SH, Leung N, Hanson CA, Chaffee KG, Schwager SM, AchenbachSJ, Call TG, Parikh SA, Ding W, Kay NE, Shanafelt TD. Renal complicationsin chronic lymphocytic leukemia and monoclonal B-cell lymphocytosis: theMayo Clinic experience. Haematologica 2015;100:1180-1188.9. Uprety D, Peterson A, Shah BK. Renal failure secondary to leukemicinfiltration of kidneys in CLL - A case report and review of literature. AnnHematol 2013;92:271-273.©Copyright 2021 by Turkish Society of HematologyTurkish Journal of Hematology, Published by Galenos Publishing HouseAddress for Correspondence/Yazışma Adresi: Gizem Kumru Şahin, M.D., Ankara University Faculty ofMedicine, Department of Nephrology, Ankara, TurkeyPhone : +90 507 428 91 11E-mail : gizemkumru@gmail.com ORCID: orcid.org/0000-0001-7529-3010Received/Geliş tarihi: September 30, 2020Accepted/Kabul tarihi: November 4, 2020DOI: 10.4274/tjh.galenos.2020.2020.0595168
Turk J Hematol 2021;38:155-174LETTERS TO THE EDITORGastric Cancer or Plasmacytoma in a Seemingly Well-ControlledMultiple Myeloma Patient?Görünüşte İyi Kontrol Edilen Bir Multipl Myelom Hastasında Mide Kanseri VeyaPlazmasitomWanlu Ma 1 , Boju Pan 2 , Lu Zhang 31Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Endocrinology,Beijing, China2Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Department of Pathology,Beijing, China3Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College,Department of Hematology,Beijing, ChinaTo the Editor,An 89-year-old man complained of hip joint pain accompaniedby fatigue, anorexia, nausea, and vomiting for 1 year. Labassessments showed anemia with hemoglobin (Hgb) of 68 g/L.Liver and renal functions and serum calcium were normal.Computed tomography (CT) and positron emission-computertomography exhibited multiple osteolytic lesions throughoutthe whole body. Serum protein electrophoresis showedelevated M protein (31.4 g/L). Serum and urine immunofixationelectrophoresis revealed strong positive immunoglobin G λ.Urine light chain (24 hours) was negative (below the lowerlimit of detection). A bone marrow smear showed myelomacells at a rate of 12.5%. Fluorescence in situ chromosomehybridization did not detect 1q21+, 17p-, t(14;16), t(4;14), ort(11;14). Multiple myeloma (MM) (DS IIIA, ISS II, R-ISS II) wasdiagnosed with albumin of 22 g/L, serum β2-microglobulin of5.05 mg/L, and lactate dehydrogenase of 308 U/L (normal range:97-270). An LD regimen (lenalidomide at 25 mg per day for21 days, dexamethasone at 10 mg per week) was administeredfor 8 months. His condition improved with normal Hgb(120 g/L). Serum M protein gradually decreased to 0.3 g/L for7 months before he suffered from hematemesis and melena.Thoracoabdominal CT showed irregularly thickened gastricwall of the sinuses and greater curvature of the body of thestomach. Gastroscopy showed a giant tumor extending fromthe fundus to the stomach horn and anterior wall of the gastricantrum, which resembled gastric cancer (Figures 1a and 1b).However, to our surprise, pathology revealed plasmacytoma(plasmoblast type), which suggested disease progression despitewell-controlled serum M protein (2.2 g/L) (Figures 1c and 1d).Urine light chain also reached 476 mg/24 h despite a negativeurine light chain level at baseline. The patient progressed rapidlyand his general condition worsened as he suffered from not onlygastric hemorrhage but also pulmonary infection. Bortezomibwas intended to be given but, considering his older age,extremely poor condition, and the wishes of the patient and hisfamily, palliative care was given. Unfortunately, the patient diedof pulmonary infection 10 days later.MM is a neoplastic proliferation of monoclonal plasma cells[1,2]. Gastrointestinal (GI) involvement is not common and GIhemorrhage is rarely reported [3]. Here we have presented acase of MM and a giant gastric tumor. We did not expect thetumor to be a plasmacytoma before pathology, mainly due tothree reasons. First, involvement of the GI system is rare in MM[1]. Previous series suggested little or no GI involvement inautopsied MM patients [2]. A systematic review of 2584 MMpatients identified only 24 cases (0.93%) with involvement ofFigure 1. a, b) Gastroscopy showed a giant tumor in the stomachcavity, extending from the fundus and stomach to the stomachhorn and anterior wall of the gastric antrum, with ulcers on thesurface, covered with moss-like growth and bloody scab. c, d)Pathology of the body of the stomach confirmed plasmacytoma(plasmoblast type). c) Hematoxylin and eosin staining magnified100 times. d) CD138 immunohistochemical staining magnified100 times.169
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