Abstract
Three patients, two with typical primary Sjögren's syndrome (SS) and the third with several features of SS, including abnormal sialography and reduced tear secretion, developed B cell non-Hodgkin's lymphoma (NHL) of parotid or lung, or both. Isoelectric focusing of concentrated urine specimens in agarose, followed by immunofixation, demonstrated the presence in each patient's urine of monoclonal free light chains of the same class as that shown on the tumour cells. In one patient the level of urinary free light chains was monitored and found to correlate with disease activity. Similar techniques showed no monoclonal light chains in the urine from a further 26 cases of SS with no clinical evidence of lymphoma. The detection of monoclonal urinary free light chains may provide an early diagnostic clue to the development of lymphoma in patients with SS and be a means of tumour monitoring.
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- Banerjee D., Ahmad D. Malignant lymphoma complicating lymphocytic interstitial pneumonia: a monoclonal B-cell neoplasm arising in a polyclonal lymphoproliferative disorder. Hum Pathol. 1982 Aug;13(8):780–782. doi: 10.1016/s0046-8177(82)80308-0. [DOI] [PubMed] [Google Scholar]
- Beverley P. C., Callard R. E. Distinctive functional characteristics of human "T" lymphocytes defined by E rosetting or a monoclonal anti-T cell antibody. Eur J Immunol. 1981 Apr;11(4):329–334. doi: 10.1002/eji.1830110412. [DOI] [PubMed] [Google Scholar]
- Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 13-1980. N Engl J Med. 1980 Apr 3;302(14):795–803. doi: 10.1056/NEJM198004033021408. [DOI] [PubMed] [Google Scholar]
- Colby T. V., Carrington C. B. Lymphoreticular tumors and infiltrates of the lung. Pathol Annu. 1983;18(Pt 1):27–70. [PubMed] [Google Scholar]
- DeCoteau W. E., Katakkar S. B., Skinnider L., Hayton R. C., Somerville E. A. Sjögren's syndrome terminating as a myeloproliferative disorder. J Rheumatol. 1975 Sep;2(3):331–335. [PubMed] [Google Scholar]
- Díaz-Jouanen E., Ruíz-Argüelles G. J., Vega-Ortíz J. M., Villareal G., Alarcón-Segovia D. From benign polyclonal to malignant monoclonal lymphoproliferation in a patient with primary Sjögren's syndrome. Arthritis Rheum. 1981 Jun;24(6):850–853. doi: 10.1002/art.1780240613. [DOI] [PubMed] [Google Scholar]
- Faguet G. B., Webb H. H., Agee J. F., Ricks W. B., Sharbaugh A. H. Immunologically diagnosed malignancy in Sjögren's pseudolymphoma. Am J Med. 1978 Sep;65(3):424–429. doi: 10.1016/0002-9343(78)90768-4. [DOI] [PubMed] [Google Scholar]
- GODWIN J. T. Benign lymphoepithelial lesion of the parotid gland adenolymphoma, chronic inflammation, lymphoepithelioma, lymphocytic tumor, Mikulicz disease. Cancer. 1952 Nov;5(6):1089–1103. doi: 10.1002/1097-0142(195211)5:6<1089::aid-cncr2820050604>3.0.co;2-m. [DOI] [PubMed] [Google Scholar]
- Gordon J., Howlett A. R., Smith J. L. Free light chain synthesis by neoplastic cells in chronic lymphocytic leukaemia and non-Hodgkin's lymphoma. Immunology. 1978 Mar;34(3):397–404. [PMC free article] [PubMed] [Google Scholar]
- Gregg E. O., Al-Saffar N., Jones D. B., Wright D. H., Stevenson F. K., Smith J. L. Immunoglobulin negative follicle centre cell lymphoma. Br J Cancer. 1984 Dec;50(6):735–744. doi: 10.1038/bjc.1984.250. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Halprin G. M., Ramirez J., Pratt P. C. Lymphoid interstitial pneumonia. Chest. 1972 Oct;62(4):418–423. doi: 10.1378/chest.62.4.418. [DOI] [PubMed] [Google Scholar]
- Herbert A., Walters M. T., Cawley M. I., Godfrey R. C. Lymphocytic interstitial pneumonia identified as lymphoma of mucosa associated lymphoid tissue. J Pathol. 1985 Jun;146(2):129–138. doi: 10.1002/path.1711460208. [DOI] [PubMed] [Google Scholar]
- Herbert A., Wright D. H., Isaacson P. G., Smith J. L. Primary malignant lymphoma of the lung: histopathologic and immunologic evaluation of nine cases. Hum Pathol. 1984 May;15(5):415–422. doi: 10.1016/s0046-8177(84)80074-x. [DOI] [PubMed] [Google Scholar]
- Kassan S. S., Thomas T. L., Moutsopoulos H. M., Hoover R., Kimberly R. P., Budman D. R., Costa J., Decker J. L., Chused T. M. Increased risk of lymphoma in sicca syndrome. Ann Intern Med. 1978 Dec;89(6):888–892. doi: 10.7326/0003-4819-89-6-888. [DOI] [PubMed] [Google Scholar]
- Kradin R. L., Mark E. J. Benign lymphoid disorders of the lung, with a theory regarding their development. Hum Pathol. 1983 Oct;14(10):857–867. doi: 10.1016/s0046-8177(83)80161-0. [DOI] [PubMed] [Google Scholar]
- Mepham B. L., Frater W., Mitchell B. S. The use of proteolytic enzymes to improve immunoglobulin staining by the PAP technique. Histochem J. 1979 May;11(3):345–357. doi: 10.1007/BF01005033. [DOI] [PubMed] [Google Scholar]
- Moutsopoulos H. M., Chused T. M., Mann D. L., Klippel J. H., Fauci A. S., Frank M. M., Lawley T. J., Hamburger M. I. Sjögren's syndrome (Sicca syndrome): current issues. Ann Intern Med. 1980 Feb;92(2 Pt 1):212–226. doi: 10.7326/0003-4819-92-2-212. [DOI] [PubMed] [Google Scholar]
- Moutsopoulos H. M., Costello R., Drosos A. A., Mavridis A. K., Papadopoulos N. M. Demonstration and identification of monoclonal proteins in the urine of patients with Sjögren's syndrome. Ann Rheum Dis. 1985 Feb;44(2):109–112. doi: 10.1136/ard.44.2.109. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Moutsopoulos H. M., Steinberg A. D., Fauci A. S., Lane H. C., Papadopoulos N. M. High incidence of free monoclonal lambda light chains in the sera of patients with Sjogren's syndrome. J Immunol. 1983 Jun;130(6):2663–2665. [PubMed] [Google Scholar]
- Pagani J. J., Collins J. D., Reza M. J. Sjogren syndrome presenting as pulmonary pseudolymphoma: report of a case. J Natl Med Assoc. 1979 Jul;71(7):677–678. [PMC free article] [PubMed] [Google Scholar]
- Payne S. V., Smith J. L., Jones D. B., Wright D. H. Lymphocyte markers in non-Hodgkin's lymphomas. Br J Cancer. 1977 Jul;36(1):57–64. doi: 10.1038/bjc.1977.154. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Pierson J., Darley T., Stevenson G. T., Virji M. Monoclonal immunoglobulin light chains in urine of patients with lymphoma. Br J Cancer. 1980 May;41(5):681–688. doi: 10.1038/bjc.1980.129. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Ryan G. P., James R. A., Milazzo S. C. Malignant lymphoma complicating Sjögren's syndrome. Aust N Z J Med. 1974 Jun;4(3):287–291. doi: 10.1111/j.1445-5994.1974.tb03191.x. [DOI] [PubMed] [Google Scholar]
- Schmid U., Helbron D., Lennert K. Development of malignant lymphoma in myoepithelial sialadenitis (Sjögren's syndrome). Virchows Arch A Pathol Anat Histol. 1982;395(1):11–43. doi: 10.1007/BF00443482. [DOI] [PubMed] [Google Scholar]
- Shearn M. A., Moutsopoulos H. M., Sawada S., Gak C. Letter: Sjögren's syndrome with light chain myeloma. West J Med. 1975 Dec;123(6):496–497. [PMC free article] [PubMed] [Google Scholar]
- Stephen K. W., Speirs C. F. Methods for collecting individual components of mixed saliva: the relevance to clinical pharmacology. Br J Clin Pharmacol. 1976 Apr;3(2):315–319. doi: 10.1111/j.1365-2125.1976.tb00609.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Stevenson F. K., Spellerberg M., Smith J. L. Monoclonal immunoglobulin light chain in urine of patients with B lymphocytic disease: its source and use as a diagnostic aid. Br J Cancer. 1983 May;47(5):607–612. doi: 10.1038/bjc.1983.98. [DOI] [PMC free article] [PubMed] [Google Scholar]
- Strand V., Talal N. Advances in the diagnosis and concept of Sjögren's syndrome (autoimmune exocrinopathy). Bull Rheum Dis. 1979;30(9):1046–1052. [PubMed] [Google Scholar]
- Strimlan C. V., Rosenow E. C., 3rd, Divertie M. B., Harrison E. G., Jr Pulmonary manifestations of Sjögren's syndrome. Chest. 1976 Sep;70(03):354–361. doi: 10.1378/chest.70.3.354. [DOI] [PubMed] [Google Scholar]
- Tutt A. L., Stevenson F. K., Smith J. L., Stevenson G. T. Antibodies against urinary light chain idiotypes as agents for detection and destruction of human neoplastic B lymphocytes. J Immunol. 1983 Dec;131(6):3058–3063. [PubMed] [Google Scholar]
- Verbi W., Greaves M. F., Schneider C., Koubek K., Janossy G., Stein H., Kung P., Goldstein G. Monoclonal antibodies OKT 11 and OKT 11A have pan-T reactivity and block sheep erythrocyte "receptors". Eur J Immunol. 1982 Jan;12(1):81–86. doi: 10.1002/eji.1830120115. [DOI] [PubMed] [Google Scholar]
- Whaley K., Williamson J., Chisholm D. M., Webb J., Mason D. K., Buchanan W. W. Sjogren's syndrome. I. Sicca components. Q J Med. 1973 Apr;42(166):279–304. [PubMed] [Google Scholar]
- Zulman J., Jaffe R., Talal N. Evidence that the malignant lymphoma of Sjögren's syndrome is a monoclonal B-cell neoplasm. N Engl J Med. 1978 Nov 30;299(22):1215–1220. doi: 10.1056/NEJM197811302992204. [DOI] [PubMed] [Google Scholar]