Extensive multifocal and pleomorphic pulmonary lesions in Waldenstrom macroglobulinemia: A case report  

作　　者：De-Feng Zhao Hao-Yong Ning Jian Cen Yi Liu Li-Ren Qian Zhi-Hai Han Jian-Liang Shen 

机构地区：[1]Department of Hematology,Beijing Boren Hospital,Beijing 100070,China [2]Department of Pathology,Navy General Hospital of PLA,Beijing 100048,China [3]Department of Hematology,Navy General Hospital of PLA,Beijing 100048,China [4]Department of Respiratory Care,Navy General Hospital of PLA,Beijing 100048,China

出　　处：《World Journal of Clinical Cases》2020年第11期2305-2311,共7页世界临床病例杂志

摘　　要：BACKGROUND Waldenstrom macroglobulinemia(WM) is a type of small lymphocytic lymphoma that mainly affects the bone marrow, spleen, and lymph nodes. A subset of patients with WM demonstrates extramedullary involvement(4.4%),and the most frequent extramedullary disease site involved is the lungs(30%).CASE SUMMARY A 60-year-old male patient who experienced intermittent breath-holding for 6 mo was admitted on August 14, 2017. Chest computed tomography indicated multiple pulmonary cavities in the upper lobes of both lungs, with pulmonary consolidation, ground-glass opacities, patchy infiltrates, fibrous bands, large bullae, and enlarged lymph nodes in the mediastinum. The patient was a heavy smoker(20 cigarettes/d for 40 years). Diagnostic fiberoptic bronchoscopy revealed normal findings. Serological examination revealed a remarkable increase in serum immunoglobulin M levels(30.24 g/L;normal: 0.4-2.30 g/L). A computed tomography-guided percutaneous pulmonary biopsy was performed in the left lower lobe of the lung with pulmonary consolidation and indicated that the alveolar structure disappeared and that a large amount of amyloid-like deposition was present along with the infiltration of very few lymphocytes and plasma cells. The patient was treated with the combined treatment of dexamethasone + rituximab + lenalidomide over four courses. Serum immunoglobulin M did not normalize, and he received ibrutinib +dexamethasone.CONCLUSION This patient with WM and lung amyloidosis had a wide range of pulmonary lesions and a variety of morphological features, which was a rare case. Yet, some changes might be ascribed to heavy smoking.

关 键 词：Waldenström macroglobulinemia Lung AMYLOIDOSIS Computed tomography Case report 

分 类 号：R553[医药卫生—血液循环系统疾病] R563[医药卫生—内科学]