Waldenström's macroglobulinemia revealed by atypical blood lymphoid cells.

A 69-year old man was hospitalized because of weakness and weightless. Physical examination revealed cachexia, hepatomegaly, voluminous splenomegaly and polyadenopathy. The patient was not jaundiced. Blood and biochemistry analysis showed: leukocytes 8.7ϫ10 9 /L, hemoglobin 96 g/L, platelets 95ϫ10 9 /L, alkaline phosphatase: 6N, ␥-glutamyl transferase: 10N), decreased pro-thrombin time (58%), hyperuricemia, increased serum creatinine (109 µmol/L). Serum protein immunoelectrophoresis revealed hypoalbuminemia (26 g/L) with a monoclonal immunoglobulin M ␬ component (52 g/L). LDH were normal. Examination of a smear of peripheral blood revealed 32% of abnormal lymphoid cells: monocytoid cells mimicking plasma cell leukemia (Figure 1a), 1 cells with blue cytoplasm and hypersegmented nuclei with minimal chromatin clumping and visible nucleoli (Figure 1b), 2 lymphoplasma cells (Figure 1c) and plasma cells (Figure 1d). Immunophenotyping of the lymphoid blood cells revealed a B cell proliferation CD19 + , CD38 + , CD56 – , CD11a + , CD11b + with a strong expression of IgM ␬. Histologic examination of bone marrow was consistent with a diagnosis of Walden-ström's macroglobulinemia. 3 This diagnosis was unexpected in the light of the clinical presentation with cachexia and anicteric cholestasis and the unusual cytological features of the peripheral lymphoid blood cells. Indeed a few cells resemble activated lymphoid cells but the patient had not had a recent viral infection and had not received any transfusion therapy. Therapy with chlo-rambucil rapidly improved the patient's general status and six months later the IgM ␬ decreased from 52 g/L to 11.4 g/L and the abnormal lymphoïd cells had disappeared. A case of multiple myeloma with multilobulated and convolut-ed plasma cell nuclei.