Waldenström Macroglobulinemia Diagnosed by Ultrasonography-Guided Biopsy of the Right Perinephric Tumor.

INTRODUCTION

Waldenström macroglobulinemia is a low-grade B-cell lymphoma characterized by lymphoplasmacytic lymphoma infiltration of the bone marrow and immunoglobulin M (IgM) protein.

CASE PRESENTATION

An 80s-year-old male presented to our hospital with chief complaints of weight loss and general fatigue. Computed tomography (CT) showed homogeneous tumor around the kidney with elevated soluble Interleukin-2 receptor, serum IgM, and β2-microglobulin levels. Histopathological analysis by ultrasonography-guided biopsy revealed dense lymphocytic proliferation, plasmacytoid differentiation, and Dutcher bodies, positive for CD20, CD138, and IgM, but negative for CD3 and CD5, consistent with lymphoplasmacytic lymphoma. Bone marrow biopsy revealed infiltration of the lymphoplasmacytic lymphoma. The patient received four courses of bortezomib, cyclophosphamide, and dexamethasone along with dexamethasone, rituximab, and cyclophosphamide therapy. Twelve months after treatment, CT revealed only slightly enlarged abdominal para-aortic lymph nodes.

CONCLUSION

Malignant lymphoma in perinephric lesions is a relatively rare condition; however, a definitive diagnosis can be obtained by ultrasound-guided biopsy, allowing early initiation.