[An unusual case of localized form of primary macroglobulinemia developing from a nodular primary pulmonary amyloidosis].
The authors reported here a case of primary pulmonary amyloidosis, which developed into a localized form of primary macroglobulinemia (PMG) 10 years later. A nodular shadow was pointed out on routine chest x-ray films of a 61-year-old Japanese male in 1977. In 1981, a diagnosis of nodular primary pulmonary amyloidosis was made by percutaneous lung biopsy. At that time, he suffered from signs and symptoms of chronic cold agglutinin disease (CCAD). Cold agglutinins were IgM-kappa antibodies. In 1986, serum immunoelectrophoresis demonstrated the presence of a small amount of monoclonal IgM-kappa. In 1987, the patient was readmitted because of pleural effusions. In the pleural effusion, the IgM level was 3,341 mg/dl and the titer of cold agglutinin was 32,000. Cytological examinations of pleural effusion showed the proliferation of lymphocytes, lymphoid cells and plasma cells. These cells showed the monoclonality of IgM-kappa by the peroxidase-antiperoxidase method. At post-mortem examination in March 1988, PA and PMG were found, but both lesions were localized only in the thoracic cavity. It is suggested that primary amyloidosis (PA) as well as CCAD and monoclonal gammopathy of undetermined significance may be one of the pre-neoplastic conditions of PMG.
Fujii
H
H
Third Department of Internal Medicine, Kyoto First Red Cross Hospital.
Yashige
H
H
Kanoh
T
T
Urata
Y
Y
D000368:Aged; D000686:Amyloidosis / Q000150:complications* / Q000473:pathology; D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications; D006801:Humans; D008171:Lung Diseases / Q000150:complications* / Q000473:pathology; D008297:Male; D008258:Waldenstrom Macroglobulinemia / Q000209:etiology*