Abstract
A case of primary macrogrobulinemia (Waldenström) with systemic, especially intramuscular dissemination of immunoglobulin-bearing cells is reported.
The patient was a 82-year-old female who had been admitted to the hospital in Oct. 1982 because of anemia and anorexia. Physical examinations revealed anemia and hoarseness, but no lymphadenopathy or hepatosplenomegaly. Peripheral blood smear showed increment of atypical lymphocytes and rouleaux formation of red cells. Serum IgM level was elevated (1.6 g/dl) and immunoelectrophoresis of serum indicated monoclonal increment of immunoglobulin (IgM, K). Despite of chemotherapy, serum IgM level increased and tumors appeared in the left elbow. In Dec. 1983, she died of respiratory failure.
At autopsy, she showed extranodular type of malignant lymphoma (diffuse, lymphoplasmacytoid type), involving the muscles in the elbows and anterior thorax, the larynx, pharynx, trachea, esophagus, lung, spleen, kidney and heart. Peroxidase-anti-peroxidase staining of the specimens of the muscles revealed monoclonal lymphoma cells bearing IgM, K type immunoglobulin.
It is very rare to see intramuscular lymphoma cells bearing immunoglobulin without lymphadenopathy and hepatosplenomegaly in primary macroglobulinemia.
