Waldenström's macroglobulinaemia

Case contributed by Dr Jan Frank Gerstenmaier

Presentation

This patient has been suffering from mild malaise and lethargy for some time. There has also been a history of slow weight loss.

Patient Data

Age: 65
Gender: Male
CT

CT abdomen and pelvis

There is abnormal soft tissue attenuation material in a right paramedian presacral position, extending into sacral foramina and surrounding the iliac arteries. Further abnormal soft tissue is seen anterior to the right kidney within the perinephric space. No splenomegaly.

CT

CT-guided biopsy

The bones adjaced to the presacral mass are normal in appearance. 

Biopsy result.

Markers demonstrate a clonal proliferation of B cells which are  SMIg Kappa+ Light Chain Restricted, SMIg M+, CD19+, CD20+, CD22+,  CD24+, CD5-, CD43-, CD10-, CD38-, CD23-, FMC7-ve, TDT-ve.    

These cells total 71% of NEC.                                                                                                                         
In conclusion: Marker results are consistent with a B cell Non Hodgkin's Lymphoma.

MRI

MRI prostate

This study was performed several months after the CT above.

(Ignoring the prostate findings)

There is an 8cm x 6cm soft tissue mass in the posterior right pelvis, incompletely imaged on some of the axial sequences carried out for the prostate. The lesion abuts the sacrum and extends into the right first and second sacral foramina. It also abuts the right commom iliac vessels and encases the right internal iliac vessels. 

Comparing with prior CT, the mass has not changed significantly in the interim.

Case Discussion

The presacral mass seen on CT has not changed significantly in size in a several month interval, despite the fact that the patient was not on any treatment (and was largely asymptomatic). This case illustrates the indolent nature of Waldenström's macroglobulinaemia.

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Case information

rID: 21830
Case created: 20th Feb 2013
Last edited: 24th Jan 2016
System: Haematology
Inclusion in quiz mode: Included

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