PMC6545763_01
Plasma cells infiltration of pancreas allograft on indication biopsy due to elevation of amylase and lipase. (a-c) Extensive diffuse infiltration and pancreatic tissue replacement with plasma cells observed on H&E ((a): X40; (b): x200; (c): x400). (d) Extensive immunostaining for IgG-kappa chains, x100; (e) absence of lambda staining, x100; (f) immunohistochemical staining were positive for CD79 plasma cells, x100; (g) negative for CD20, x100; and (h) extensively positive for CD138, x100; (i) and (j) Ki67 proliferation index was under 3%.
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IgG-kappa positive, with a cell proliferation index (Ki-67) under 3% (Figure 1). In situ hybridization for EBV (EBER) was negative.
PET/CT scan (a) and (b): diffuse uptake of FDG and enlargement of pancreas allograft (arrow), without focal lesions. Normal captions of bone marrow, brain, and kidney (arrow heads); (c) serum proteinogram: typical M protein gamma peak; (d) microsatellite analysis (Mentype  Chimera ): DNA from recipient peripheral blood (leukocytes). (e-f) Mixed donor and recipient microsatellite analysis was observed in the DNA extracted from the paraffin block obtained from selected areas with a high infiltration of plasma cells.
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Serum M protein had increased up to 34 g/L (Figure 2(c)), serum kappa/lambda ratio was 8.2, urinary protein excretion was normal, and 7% plasma cells were with abnormal phenotype identified on a bone marrow aspirate. Positron emission tomography (PET) scan revealed a fludeoxyglucose (FDG) uptake limited to pancreas allograft (Figures 2(a) and 2(b)). HLA phenotyping revealed a mixed chimerism (Figures 2(d)-2(f)).