Monoclonal macroglobulinemia with osteolytic lesions: a case report and review of the literature.

A patient with monoclonal macroglobulinemia and osteolytic lesions was studied and 24 previously reported closely related cases were reviewed. Cases studied by ultracentrifugation without an immunoelectrophoresis were not considered. Patients presenting with a primary increase in monoclonal IgM molecules may be divided into three groups: typical Waldenstrom's macroglobulinemia, macroglobulinemia with osteolytic lesions resembling multiple myeloma, and a group displaying features of both diseases. At present, cell morphology is not helpful in separating these groups, and a bone survey is recommended. The authors underscore the clinical importance of the early recognition of these entities since procedures such as plasmapheresis for the management of hyperviscosity syndrome, mobilization and local radiotherapy to symptomatic lytic lesions may be necessary for optimal management.