Abstract: FR-PO675
Solitary Renal Mass in Waldenström Macroglobulinaemia
Session Information
- Electrolytes and Cancer Trainee Case Reports
November 08, 2019 | Location: Exhibit Hall, Walter E. Washington Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Trainee Case Report
- 1500 Onco-Nephrology
Authors
- Hamill, Mairead, Department of Nephrology, Beaumont Hospital, Dublin 9, Ireland
- Quinn, John, Department of Haematology, Beaumont Hospital, Dublin 9, Ireland
Group or Team Name
- Beaumont Nephrology
Introduction
Waldenström macroglobulinaemia is a rare B-cell lymphoproliferative disorder characterised by the presence of an IgM paraprotein and bone marrow infiltration by lymphoplasmacytic lymphoma. WM is more commonly found in men with a median age of onset of 60- 70 years and has an incidence of 0.3/100,000. WM may present with symptoms related to disease burden such as cytopenias, lymphadenopathy, and constitutional symptoms. Direct renal involvement by WM is a very rare occurrence. Here, we describe a WM case presenting with a large solitary renal mass.
Case Description
A 68 year old Caucasian male was referred with a persistent anaemia and weight loss. On examination, there was no evidence of palpable lymphadenopathy, or organomegaly. Initial investigations revealed a normocytic anaemia with a haemoglobin of 11g/dL, white cell count of 4 x 109/L, platelet count of 314 x109/L and normal renal function. He was referred to haematology as serum protein electrophoresis detected an IgM paraprotein band.
Computed tomography of his thorax, abdomen and pelvis revealed an infiltrative mass expanding from the left pelvicalyceal system with invasion of the renal parenchyma anteriorly. There was prominent left retroperitoneal adenopathy without evidence of metastatic disease. CT-guided biopsy of the renal mass revealed cells with plasmacytoid morphology admixed with intermediate size lymphoid cells. The cells were diffusely positive with CD79 and most cells stained for CD20, consistent with lymphoplasmacytic lymphoma.
Investigations at this point quantified his IgM paraprotein band to 9g/L. Serum free light chain assay revealed free kappa and lambda chains of 43.5mg/L and 19.7mg/L respectively. His ß2 microglobulin was 7.2 mg/L. Urinary Bence-Jones protein was not detected. A bone marrow aspirate and trephine confirmed infiltration by lymphoplasmacytic lymphoma. He was commenced on the dexamethasone, rituximab and cyclophosphamide regimen.
Discussion
This case describes a rare manifestation of WM. Renal involvement by lymphoma is thought to occur by direct infiltration from retroperitoneal adenopathy or haematogeneous dissemination. Our review of the literature identified only six previous cases of renal masses in association with this B-cell lymphoproliferative disorder. This case illustrates the importance of consideration of WM and other lymphomas in the differential diagnosis of a renal mass and the necessity of prompt biopsy.