A 65-year-old white female presents with weight loss and fatigue. On examination, she has lymphadenopathy, hepatomegaly, and mild splenomegaly. Her hemoglobin level is 9.0 g/dL (N 12.0“16.0), and a chemistry panel reveals a serum protein level of 9.0 g/dL (N 6.0“8.0). You order a chest radiograph, which shows clear lung fields and no evidence of lytic lesions in the thoracic spine. Serum protein electrophoresis reveals a monoclonal gamma-globulin spike, which on immunoelectrophoresis is found to be due to IgM kappa-protein. Urine for Bence-Jones protein is positive. A bone marrow biopsy from the iliac crest demonstrates hypercellularity, with a large number of lymphocytes, but normal-appearing plasma cells. Which one of the following is the most likely diagnosis?
A. Multiple myeloma
B. Waldenström™s macroglobulinemia
C. Sarcoidosis
D. Monoclonal gammopathy of undetermined significance
E. Non-Hodgkin™s lymphoma
meshi must have a nice DDx on these...waiting
B...
MM -- no organomegaly, ig G gammopathy
MGUS -- no organomegally, only hypergammaglobulinema,
But Ans: E?
because i remember NHL could have hyper gamma
but confusion IgM
waiting
waldenstrom...IgM and light chain in urine
B is the answer :
Explanation: The patient has symptoms, signs, and laboratory findings consistent with a diagnosis of Waldenström™s macroglobulinemia. This illness is due to an uncontrolled proliferation of lymphocytes and plasma cells, which produce IgM proteins with kappa light chains. The average age at the time of diagnosis is 65 years. Weakness, fatigue, weight loss, bleeding, and recurrent infections are common presenting symptoms. Physical findings include pallor, hepatosplenomegaly, and lymphadenopathy. Typical laboratory findings include moderate anemia and monoclonal IgM peaks on serum electrophoresis. Bence-Jones protein is seen in 80% of cases, but is typically absent in monoclonal gammopathy of undetermined significance. Unlike in multiple myeloma, lytic bone lesions are not seen, and marrow biopsy reveals mostly lymphocytes. Sarcoidosis usually presents with hilar lymphadenopathy and a polyclonal gammopathy. Non-Hodgkin™s lymphoma presents with similar symptoms, lymphadenopathy, and hepatosplenomegaly, but generally lacks a monoclonal gammopathy and Bence-Jones proteinemia, and has distinctive malignant lymphocytes on bone marrow biopsy
NHL---'distinctive malignant lymphocytes on bone marrow biopsy' liked it.
Thanks, Meshi.