{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T05:09:06Z","timestamp":1779167346250,"version":"3.51.4"},"reference-count":12,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Oncol."],"abstract":"<jats:p>Cryoglobulinemia comprises heterogeneous disorders caused by immunoglobulins that precipitate at low temperatures, leading to vascular occlusion and immune\u2013mediated tissue injury. Type I disease is typically linked to monoclonal gammopathies, whereas mixed forms (Type II or III) are characterized by immune complex-mediated vasculitis, rheumatoid factor activity, and renal involvement. The immune complexes are generally composed of IgM rheumatoid factor and IgG. We describe a 67\u2013year\u2013old woman with marginal zone lymphoma who developed an unusual cryoglobulinemia phenotype combining monoclonal IgM\u2013\u03ba cryoglobulins with clinical features characteristic of mixed disease, including purpura, transient rheumatoid factor positivity, and renal impairment. Diagnosis was delayed due to initial false\u2013negative cryoglobulin testing and atypical presentation. Despite rituximab therapy, subsequent R\u2013CVP, and intensive plasmapheresis, the patient\u2019s condition progressed, ultimately requiring bendamustine\u2013rituximab, after which she deteriorated and died shortly after discharge. The exceptional nature of this case lies the concomitant clinical manifestation of Type I and Type II cryoglobulinemia, which complicated the diagnostic process and therapeutic management. This case underscores a significant diagnostic challenge in hematology.<\/jats:p>","DOI":"10.3389\/fonc.2026.1838107","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T04:23:03Z","timestamp":1779164583000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Borderline type I\/II cryoglobulinemia associated with marginal zone lymphoma: a diagnostic challenge"],"prefix":"10.3389","volume":"16","author":[{"given":"Fabiana","family":"Crispo","sequence":"first","affiliation":[{"name":"Laboratory of Pre-Clinical and Translational Research, IRCCS-CROB Referral Cancer Center of Basilicata","place":["Rionero in Vulture, PZ, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanna","family":"Mansueto","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplantation Unit, IRCCS-CROB Referral Cancer Center of Basilicata","place":["Rionero in Vulture, PZ, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Francesca Pia","family":"Scioscia","sequence":"additional","affiliation":[{"name":"Unit of Clinical Pathology, IRCCS-CROB Referral Cancer Center of Basilicata","place":["Rionero in Vulture, PZ, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Massimo Dante","family":"Di Somma","sequence":"additional","affiliation":[{"name":"Anatomical Pathology Department, IRCCS-CROB Referral Cancer Center of Basilicata","place":["Rionero in Vulture, PZ, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Diego","family":"Petrilli","sequence":"additional","affiliation":[{"name":"Hematology and Stem Cell Transplantation Unit, IRCCS-CROB Referral Cancer Center of Basilicata","place":["Rionero in Vulture, PZ, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Biagina","family":"Campisi","sequence":"additional","affiliation":[{"name":"Unit of Clinical Pathology, IRCCS-CROB Referral Cancer Center of Basilicata","place":["Rionero in Vulture, PZ, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiorella","family":"D\u2019Auria","sequence":"additional","affiliation":[{"name":"Unit of Clinical Pathology, IRCCS-CROB Referral Cancer Center of Basilicata","place":["Rionero in Vulture, PZ, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giulia Anna Carmen","family":"Vita","sequence":"additional","affiliation":[{"name":"Anatomical Pathology Department, IRCCS-CROB Referral Cancer Center of Basilicata","place":["Rionero in Vulture, PZ, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"D\u2019Arena","sequence":"additional","affiliation":[{"name":"Unit of Immunohematology and Transfusional Medicine, \u201cSan Luca\u201d Hospital, ASL Salerno","place":["Vallo della Lucania, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gabriella","family":"Bianchino","sequence":"additional","affiliation":[{"name":"Unit of Clinical Pathology, IRCCS-CROB Referral Cancer Center of Basilicata","place":["Rionero in Vulture, PZ, Italy"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","DOI":"10.1007\/978-3-031-23488-0_25","article-title":"Cryoglobulinemia - 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