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

Q4 Medicine

IJU Case Reports Pub Date : 2025-04-09 DOI:10.1002/iju5.70022

Shingo Morinaga, Shigeyuki Aoki, Motoi Tobiume, Genya Nishikawa, Fusako Higuchi, Yuusuke Ikenohata, Manabu Honda, Hiroe Kubo, Tomoko Sawada, Yoshiaki Yamada

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Abstract

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.

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Waldenström右肾周肿瘤超声引导活检诊断巨球蛋白血症

Waldenström巨球蛋白血症是一种以骨髓淋巴浆细胞性淋巴瘤浸润和免疫球蛋白M （IgM）蛋白为特征的低级别b细胞淋巴瘤。一例80岁男性患者以体重减轻、全身乏力为主诉来我院就诊。计算机断层扫描（CT）显示肾脏周围均质肿瘤，可溶性白介素-2受体、血清IgM和β2微球蛋白水平升高。超声引导下活检组织病理分析显示淋巴细胞密集增生，浆细胞样分化，荷兰小体，CD20、CD138、IgM阳性，CD3、CD5阴性，与淋巴浆细胞性淋巴瘤一致。骨髓活检显示淋巴浆细胞性淋巴瘤浸润。患者接受硼替佐米、环磷酰胺和地塞米松治疗以及地塞米松、利妥昔单抗和环磷酰胺治疗4个疗程。治疗12个月后，CT显示腹主动脉旁淋巴结轻微增大。结论恶性淋巴瘤在肾周病变中是一种较为罕见的疾病；然而，超声引导下的活检可以获得明确的诊断，允许早期开始。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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