Waldenström's Macroglobulinemia Accompanying Systemic Amyloidosis: The Usefulness of Endobronchial Ultrasound-guided Transbronchial Needle Aspiration for Detecting Amyloid Deposits

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A 75-year-old man with a history of dyspnea lasting for three years presented to our hospital. Chest computed tomography showed bilateral pulmonary nodules, some of which were calcified, in addition to mediastinal/hilar lymphadenopathy and bilateral pleural effusions. Endobronchial ultrasound-guided (EBUS) transbronchial needle aspiration (TBNA) of the subcarinal lymph nodes showed amorphous acellular material compatible with λ-light chain amyloid deposits. Sternal bone marrow aspiration demonstrated increased small lymphocytes admixed with plasma cells and plasmacytoid lymphocytes. Serum immunoglobulin values were decreased with the exception of immunoglobulin M monoclonal peak. We subsequently diagnosed the patient as having Waldenström's macroglobulinemia accompanying AL-type amyloidosis. In this case, EBUS-TBNA was useful for detecting AL-type amyloidosis.