Waldenstrom’s Macroglobulinemia Presenting in A Hypertensive Patient
Diagnostic Approach with Brief Review of Literature
Keywords:
Bone marrow, hyperviscosisty, lymphoplasmacytoid cells, M band, waldenstrom’s macroglobulinemia
Abstract
Waldenstrom’s macroglobulinemia (WM) is a rare lymphoplasmacytic lymphoma. It is characterized by a wide range of clinical presentations related to direct tumor infiltration and the production of IgM. Usually it presents with constitutional symptoms, organomegaly, cytopenias and hyperviscosity syndrome. We report a case of WM in a 75-year-old male who initially presented with only epistaxis and unconsciousness. The patient had no lymphadenopathy or any organomegaly. The diagnosis of WM was made after morphological and immunohistochemical examination of bone marrow of the patient along with an elevated serum IgM level. The patient responded well to chemotherapy. This case report discusses wide variety of clinical presentations of WM along with various other lymphoid lesions as differential diagnosis.References
1. Hunter Z.R., Yang G, Xu L, Liu X, Castillo J.J, et al. “Genomics, signaling, and treatment of Waldenstrom macroglobulinemia. Journal of Clinical Oncology 2017;35(9):994–1001.
2. Leblond V, Kastritis E, Advani R. Treatment recommendations from the Eighth International Workshop on Waldenstrom’s macroglobulinemia. Blood 2016;128(10):1321–28.
3. Alexander P, Flanagan D, Rege K, Foss A, Hingorani M, et al. Bilateral simultaneous central retinal vein occlusion secondary to hyperviscosity in Waldenstrom’s macroglobulinaemia, Eye 2008;22(8):1089–92.
4. Chanana B, Gupta N, Azad R.V. Bilateral simultaneous central retinal vein occlusion in Waldenstrom’s macroglobulinemia. Optometry 2009:80(7):350–3.
5. Vos J.M, Gustine J, Rennke H.G. Renal disease related to Waldenstrom macroglobulinaemia: incidence, pathology and clinical outcomes. British Journal of Haematology 2016;175(4):623–30.
6. Gertz M.A. Waldenstrom macroglobulinemia: 2017 update on diagnosis, risk stratification and management. American Journal of Hematology 2017;92(2) 209–17.
7. Castillo J.J, Garcia-Sanz R., Hatjiharissi E. Recommendations for the diagnosis and initial evaluation of patients with Waldenstrom macroglobulinaemia: a task force from the 8th International Workshop on Waldenstrom macroglobulinaemia. British Journal of Haematology 2016;175(1)77–86.
8. Morice W.G, Chen D, Kurtin P.J., Hanson C.A., McPhail E.D, et al Novel immunophenotypic features of marrow lymphoplasmacytic lymphoma and correlation with Waldenstrom’s macroglobulinemia. Modern Pathology 2009;22(6):807–16.
9. Merlini G, Baldini L, Broglia C. Prognostic factors in symptomatic Waldenstrom’s macroglobulinemia, Seminars in Oncology 2003;30(2):211–15.
10. Menke M.N, Feke G.T, McMeel, J.W, Treon S.P. Effect of plasmapheresis on hyperviscosity-related retinopathy and retinal hemodynamics in patients with Waldenstrom’s macroglobulinemia. Investigative Ophthalmology & Visual Science 2008;49(3):1157-60.
11. Chauvet S., Bridoux F, Ecoti`ere L. Kidney diseases associated with monoclonal immunoglobulin M-secreting B-cell lymphoproliferative disorders: a case series of 35 patients. American Journal of Kidney Diseases 2015;66(5):756–67.
12. Kyle R.A, Treon S.P, Alexanian R. Prognostic markers and criteria to initiate therapy in Waldenstrom’s macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstrom’s Macroglobulinemia. Seminars in Oncology 2003;30(2):116–120.
13. Nayak HK, Kar P, Bagchi A, Kapoor N, Kapahtia S et al. Waldenstrom Macroglobulinemia Presenting with Pancreatic Mass: A Case Report and Review of Literature. J Pancreas 2013;14(1):92-5.
14. Dimopoulos M.A, Kastritis E., Roussou M. Rituximab-based treatments in Waldenstrom’s macroglobulinemia. Clinical Lymphoma and Myeloma, 2009;9(1):59–61.
15. Laszlo D, Andreola G, Rigacci L. Rituximab and subcutaneous 2-chloro-2′-deoxyadenosine combination treatment for patients with Waldenstrom macroglobulinemia: clinical and biologic results of a phase II multicenter study. Journal of Clinical Oncology 2010;28(13):2233–38.
2. Leblond V, Kastritis E, Advani R. Treatment recommendations from the Eighth International Workshop on Waldenstrom’s macroglobulinemia. Blood 2016;128(10):1321–28.
3. Alexander P, Flanagan D, Rege K, Foss A, Hingorani M, et al. Bilateral simultaneous central retinal vein occlusion secondary to hyperviscosity in Waldenstrom’s macroglobulinaemia, Eye 2008;22(8):1089–92.
4. Chanana B, Gupta N, Azad R.V. Bilateral simultaneous central retinal vein occlusion in Waldenstrom’s macroglobulinemia. Optometry 2009:80(7):350–3.
5. Vos J.M, Gustine J, Rennke H.G. Renal disease related to Waldenstrom macroglobulinaemia: incidence, pathology and clinical outcomes. British Journal of Haematology 2016;175(4):623–30.
6. Gertz M.A. Waldenstrom macroglobulinemia: 2017 update on diagnosis, risk stratification and management. American Journal of Hematology 2017;92(2) 209–17.
7. Castillo J.J, Garcia-Sanz R., Hatjiharissi E. Recommendations for the diagnosis and initial evaluation of patients with Waldenstrom macroglobulinaemia: a task force from the 8th International Workshop on Waldenstrom macroglobulinaemia. British Journal of Haematology 2016;175(1)77–86.
8. Morice W.G, Chen D, Kurtin P.J., Hanson C.A., McPhail E.D, et al Novel immunophenotypic features of marrow lymphoplasmacytic lymphoma and correlation with Waldenstrom’s macroglobulinemia. Modern Pathology 2009;22(6):807–16.
9. Merlini G, Baldini L, Broglia C. Prognostic factors in symptomatic Waldenstrom’s macroglobulinemia, Seminars in Oncology 2003;30(2):211–15.
10. Menke M.N, Feke G.T, McMeel, J.W, Treon S.P. Effect of plasmapheresis on hyperviscosity-related retinopathy and retinal hemodynamics in patients with Waldenstrom’s macroglobulinemia. Investigative Ophthalmology & Visual Science 2008;49(3):1157-60.
11. Chauvet S., Bridoux F, Ecoti`ere L. Kidney diseases associated with monoclonal immunoglobulin M-secreting B-cell lymphoproliferative disorders: a case series of 35 patients. American Journal of Kidney Diseases 2015;66(5):756–67.
12. Kyle R.A, Treon S.P, Alexanian R. Prognostic markers and criteria to initiate therapy in Waldenstrom’s macroglobulinemia: consensus panel recommendations from the Second International Workshop on Waldenstrom’s Macroglobulinemia. Seminars in Oncology 2003;30(2):116–120.
13. Nayak HK, Kar P, Bagchi A, Kapoor N, Kapahtia S et al. Waldenstrom Macroglobulinemia Presenting with Pancreatic Mass: A Case Report and Review of Literature. J Pancreas 2013;14(1):92-5.
14. Dimopoulos M.A, Kastritis E., Roussou M. Rituximab-based treatments in Waldenstrom’s macroglobulinemia. Clinical Lymphoma and Myeloma, 2009;9(1):59–61.
15. Laszlo D, Andreola G, Rigacci L. Rituximab and subcutaneous 2-chloro-2′-deoxyadenosine combination treatment for patients with Waldenstrom macroglobulinemia: clinical and biologic results of a phase II multicenter study. Journal of Clinical Oncology 2010;28(13):2233–38.
Published
2018-07-18
Issue
Section
Case Report
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