Lymphoplasmacytic lymphoma with IgA hypergammaglobulinemia and liver involvement.
BACKGROUND
Lymphoplasmacytic lymphoma (LPL) is a low grade lymphoma. Most cases are Waldenstorm macroglobulinemia which has IgM hypergammaglobulinemia. Lymphoplasmacytic lymphoma with IgA hypergammaglobulinemia is less than 5%. Liver involvement was reported in 20%. However this disease has been found to be mostly presented with lymphadenopathy and hypergammaglobulinemia.


METHODS
We present a forty-year-old woman with anemia, renal insufficiency and abnormal liver function test. Liver biopsy showed atypical clonal B-cell lymphoproliferation, small cells with prominent plasmacytic differentiation. Serum protein electrophoresis showed monoclonal gammopathy which was IgA. Rituximab, fludarabine and cyclophosphamide were given and resulting in partial response.


CONCLUSIONS
The presentation of LPL can mimic multiple myeloma (anemia, renal failure and monoclonal gammopathy). Definite histological and immunological technique should be done to confirm the diagnosis.
Polprasert
Chantana
C
Division of Hematology, Department of Medicine, Srinakarinwirot University, Bangkok, Thailand. jeedchantana@gmail.com
Wongchitrat
Chatchawan
C
Assanasen
Thamathorn
T
Prayongratana
Kannadit
K
D000328:Adult; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents / Q000627:therapeutic use; D018501:Antirheumatic Agents / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006942:Hypergammaglobulinemia / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*; D007070:Immunoglobulin A; D007155:Immunologic Factors / Q000627:therapeutic use; D008107:Liver Diseases / Q000175:diagnosis / Q000276:immunology / Q000503:physiopathology*; D000069283:Rituximab; D013785:Thailand; D014740:Vidarabine / Q000031:analogs & derivatives / Q000627:therapeutic use; D008258:Waldenstrom Macroglobulinemia / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology / Q000503:physiopathology*
D000911:Antibodies, Monoclonal; D058846:Antibodies, Monoclonal, Murine-Derived; D000970:Antineoplastic Agents; D018501:Antirheumatic Agents; D007070:Immunoglobulin A; D007155:Immunologic Factors; D000069283:Rituximab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine