Case Report
Copyright ©The Author(s) 2020. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 6, 2020; 8(11): 2305-2311
Published online Jun 6, 2020. doi: 10.12998/wjcc.v8.i11.2305
Extensive multifocal and pleomorphic pulmonary lesions in Waldenström macroglobulinemia: A case report
De-Feng Zhao, Hao-Yong Ning, Jian Cen, Yi Liu, Li-Ren Qian, Zhi-Hai Han, Jian-Liang Shen
De-Feng Zhao, Department of Hematology, Beijing Boren Hospital, Beijing 100070, China
Hao-Yong Ning, Department of Pathology, Navy General Hospital of PLA, Beijing 100048, China
Jian Cen, Yi Liu, Li-Ren Qian, Jian-Liang Shen, Department of Hematology, Navy General Hospital of PLA, Beijing 100048, China
Zhi-Hai Han, Department of Respiratory Care, Navy General Hospital of PLA, Beijing 100048, China
Author contributions: Zhao DF, Ning HY, Cen J, Liu Y, Qian LR, and Han ZH participated in collecting the data; Zhao DF and Shen JL helped draft the manuscript; all authors read and approved the final manuscript.
Informed consent statement: Informed written consent was obtained from the patient for publication of this report and any accompanying images.
Conflict-of-interest statement: The authors declare that they have no conflict of interest.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Jian-Liang Shen, MD, Doctor, Department of Hematology, Navy General Hospital of PLA, No. 6, Fucheng Road, Haidian District, Beijing 100048, China. nghxyk@163.com
Received: December 24, 2019
Peer-review started: December 24, 2019
First decision: January 13, 2020
Revised: March 13, 2020
Accepted: May 13, 2020
Article in press: May 13, 2020
Published online: June 6, 2020
Processing time: 166 Days and 23.8 Hours
Abstract
BACKGROUND

Waldenström 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.

Keywords: Waldenström macroglobulinemia; Lung; Amyloidosis; Computed tomography; Case report

Core tip: Waldenström macroglobulinemia is a type of small lymphocytic lymphoma that mainly affects the bone marrow, spleen, and lymph nodes. Amyloidosis of the lower respiratory tract associated with Waldenström macroglobulinemia occurs very rarely. Here we report a patient who exhibited prominent pulmonary involvement. Chest computed tomography showed extensive multifocal and pleomorphic lesions in the patient's lungs. A computed tomography-guided percutaneous pulmonary biopsy confirmed the amyloid deposition.