A 51-year-old male was admitted to Nagoya Ekisaikai Hospital with complaints of a high fever, cough, and left chest pain. Physical examination revealed moderate epigastric tenderness, decreased vocal fremitus and flat percussion note on the left side with decreased breath sounds. The liver edge was palpable 2 finger-breadths below the right costal margin. No splenomegaly nor lymphadenopathy was noted. X-ray films of the chest showed left pleural effusion. Immunoelectrophoresis revealed a monoclonal gammopathy in the serum with 8,560 mg/dl of IgM-λ and Bence Jones protein in the urine. The bone marrow picture disclosed 14.5% plasma cells, and osteolytic lesions were found in the cranial bone. Gastric biopsy revealed massive plasma cell infiltration in the lamina propria. By means of immunohistochemical staining, the cytoplasms of the plasma cells were stained by anti-μ and anti-λ antibodies. These results indicated the infiltrating cells were monoclonal.
From these findings the patient was diagnosed as primary macroglobulinemia occurred in the stomach and treated by interferon, antineoplastic agents and plasmapheresis which entirely improved clinical complaints.
