Anna Linda Zignego, MD, PhD; Clodoveo Ferri, MD; Francesca Giannelli, PhD; Carlo Giannini, PhD; Patrizio Caini, PhD; Monica Monti, PhD; Maria Eugenia Marrocchi, PhD; Elena Di Pietro, MD; Giorgio La Villa, MD; Giacomo Laffi, MD; Paolo Gentilini, MD
Acknowledgments: The authors thank Gianpiero Buzzelli, MD; Antonio Mazzocca, MD, PhD; Roberto Giulio Romanelli, MD, PhD; Stefania Moscarella, MD; and Laura Gragnani, BS, for helpful discussion and expert technical assistance and Ms. Mary Diamond for help in the preparation of the manuscript.
Grant Support: By the Italian Liver Foundation, the Italian Ministero d'struzione, d'niversità e della Ricerca, the Associazione Italiana per la Ricerca sul Cancro, and the Fondazione Istituto di Ricerca Virologica O.B. Corsi.
Requests for Single Reprints: Anna Linda Zignego, MD, PhD, Department of Internal Medicine, University of Florence, Viale Morgagni, 85, 50134 Florence, Italy; e-mail, firstname.lastname@example.org.
Current Author Addresses: Drs. Zignego, Giannelli, Giannini, Caini, Monti, Marrocchi, Di Pietro, La Villa, Laffi, and Gentilini: Department of Internal Medicine, University of Florence, School of Medicine, Viale Morgagni, 85, 50134 Florence, Italy.
Dr. Ferri: Department of Internal Medicine, University of Pisa, School of Medicine, Via Roma, 67, 56100 Pisa, Italy.
Author Contributions: Conception and design: A.L. Zignego, F. Giannelli, C. Giannini, P. Caini, M. Monti.
Analysis and interpretation of the data: A.L. Zignego, C. Ferri, F. Giannelli, C. Giannini, P. Caini, M. Monti, M.E. Marrocchi, E. Di Pietro, G. La Villa, G. Laffi, P. Gentilini.
Drafting of the article: A.L. Zignego, F. Giannelli, C. Giannini, P. Caini, M. Monti, G. La Villa, G. Laffi.
Critical revision of the article for important intellectual content: A.L. Zignego, C. Ferri, F. Giannelli, C. Giannini, P. Caini, M. Monti, M.E. Marrocchi, E. Di Pietro, G. La Villa, G. Laffi, P. Gentilini.
Final approval of the article: A.L. Zignego, C. Ferri, F. Giannelli, C. Giannini, P. Caini, M. Monti, M.E. Marrocchi, E. Di Pietro, G. La Villa, G. Laffi, P. Gentilini.
Provision of study materials or patients: A.L. Zignego, C. Ferri, F. Giannelli, C. Giannini, P. Caini, M. Monti, E. Di Pietro, G. La Villa, G. Laffi, P. Gentilini.
Statistical expertise: C. Ferri, G. La Villa, P. Gentilini.
Obtaining of funding: A.L. Zignego, C. Ferri, F. Giannelli, C. Giannini, P. Caini, M. Monti, M.E. Marrocchi, P. Gentilini.
Administrative, technical, or logistic support: E. Di Pietro, P. Gentilini.
Collection and assembly of data: M.E. Marrocchi, E. Di Pietro.
Zignego A., Ferri C., Giannelli F., Giannini C., Caini P., Monti M., Marrocchi M., Di Pietro E., La Villa G., Laffi G., Gentilini P.; Prevalence of bcl-2 Rearrangement in Patients with Hepatitis C Virus–Related Mixed Cryoglobulinemia with or without B-Cell Lymphomas. Ann Intern Med. 2002;137:571-580. doi: 10.7326/0003-4819-137-7-200210010-00008
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Published: Ann Intern Med. 2002;137(7):571-580.
Mixed cryoglobulinemia is a distinct syndrome clinically characterized by purpura; weakness; arthralgia; and such conditions as membranoproliferative glomerulonephritis, peripheral neuropathy, skin ulcers, and diffuse vasculitis (1, 2). Cryoprecipitable immune complexes, specifically mixed (IgG-IgM) cryoglobulins, are the serologic hallmark of the disease. Immunoglobulin Gs are the autoantigens, and IgMs with rheumatoid factor activity are the autoantibodies. Mixed cryoglobulinemia is classified as type II or type III according to the presence of polyclonal or monoclonal IgMs (3, 4).
Because expansion of rheumatoid factor–producing B cells is the underlying disorder of mixed cryoglobulinemia, this condition is considered a benign B-cell lymphoproliferative disease. Type II and III mixed cryoglobulinemia are similar in terms of organ involvement and clinical course, except that type II disease may evolve into cancer. Type II mixed cryoglobulinemia is often observed in conjunction with bone marrow findings consistent with indolent B-cell lymphoma (5-9) and evolves to frank B-cell malignancy in about 10% of cases (10).
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Gastroenterology/Hepatology, Hematology/Oncology, Infectious Disease, Leukemia/Lymphoma, Viral Hepatitis.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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