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Case 244: Systemic Amyloidosis-A Complication of Waldenström Macroglobulinemia.

Abstract History A 68-year-old man was admitted to the hospital for work-up because of generalized fatigue, anorexia, chronic diarrhea, and weight loss. Laboratory work-up revealed an erythrocyte sedimentation rate of 58 mm/h (reference range, 3-23 mm/h), a hemoglobin level of 14.1 g/dL (reference range, 13.8-17.5 g/dL), a leukocyte count of 8.1 × 10(9)/L (reference range, [3.4-9.7] × 10(9)/L), a platelet count of 223 × 10(9)/L (reference range, [158-424] × 10(9)/L), an alkaline phosphatase level of 85 U/L (1.42 μkat/L) (normal level, <142 U/L [2.37 μkat/L]), a serum creatinine level of 93 μmol/L (reference range, 79-125 μmol/L), a serum total protein level of 82 g/L (reference range, 66-81 g/L), a serum albumin level of 39.3 g/L (reference range, 40.2-47.6 g/L), an albumin-to-globulin ratio (a test showing relative amounts of major plasma proteins) of 0.92 (reference range, 0.8-2.0), a urine protein level of 15 mg/dL (normal level, <20 mg/dL), a total serum calcium level of 2.46 mmol/L (reference range, 2.14-2.53 mmol/L), and a carcinoembryonic antigen value of 2.69 μg/L (normal value, <3.4 μg/L). Serology findings were negative for celiac disease. Thyroid function was normal, as were 5-hydroxyindoleacetic acid and chromogranin A levels. Initial radiologic examination included chest radiography and plain abdominal erect radiography. Gastrointestinal endoscopy was performed to rule out inflammatory bowel disease or gastrointestinal neoplasm as a cause of chronic diarrhea. Endoscopic mucosal resection of two polyps from the cardia and duodenal bulb was performed during esophagogastroduodenoscopy, but histologic findings at hematoxylin-eosin staining were normal. Colonoscopy revealed diverticulosis involving the entire colon. Serum immunoelectrophoresis showed a monoclonal band, which was confirmed to be immunoglobulin Mλ at immunofixation. After histologic analysis of the bone marrow biopsy specimen, diagnosis of Waldenström macroglobulinemia was established, and computed tomography (CT) of the thorax, abdomen, and pelvis was requested to depict lymphadenopathy and organomegaly. On the basis of CT findings, two more specimens considered highly sensitive for the CT diagnosis were obtained via minimally invasive biopsy, but the results were negative. Magnetic resonance (MR) imaging was performed a year later to control the progression of CT findings.
PMID
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Authors

Mayor MeshTerms
Keywords
Journal Title radiology
Publication Year Start




PMID- 28723285
OWN - NLM
STAT- MEDLINE
DA  - 20170720
DCOM- 20170731
LR  - 20170731
IS  - 1527-1315 (Electronic)
IS  - 0033-8419 (Linking)
VI  - 284
IP  - 2
DP  - 2017 Aug
TI  - Case 244: Systemic Amyloidosis-A Complication of Waldenstrom Macroglobulinemia.
PG  - 597-602
LID - 10.1148/radiol.2017151156 [doi]
AB  - History A 68-year-old man was admitted to the hospital for work-up because of
      generalized fatigue, anorexia, chronic diarrhea, and weight loss. Laboratory
      work-up revealed an erythrocyte sedimentation rate of 58 mm/h (reference range,
      3-23 mm/h), a hemoglobin level of 14.1 g/dL (reference range, 13.8-17.5 g/dL), a 
      leukocyte count of 8.1 x 109/L (reference range, [3.4-9.7] x 109/L), a platelet
      count of 223 x 109/L (reference range, [158-424] x 109/L), an alkaline
      phosphatase level of 85 U/L (1.42 mukat/L) (normal level, &lt;142 U/L [2.37
      mukat/L]), a serum creatinine level of 93 mumol/L (reference range, 79-125
      mumol/L), a serum total protein level of 82 g/L (reference range, 66-81 g/L), a
      serum albumin level of 39.3 g/L (reference range, 40.2-47.6 g/L), an
      albumin-to-globulin ratio (a test showing relative amounts of major plasma
      proteins) of 0.92 (reference range, 0.8-2.0), a urine protein level of 15 mg/dL
      (normal level, &lt;20 mg/dL), a total serum calcium level of 2.46 mmol/L (reference 
      range, 2.14-2.53 mmol/L), and a carcinoembryonic antigen value of 2.69 mug/L
      (normal value, &lt;3.4 mug/L). Serology findings were negative for celiac disease.
      Thyroid function was normal, as were 5-hydroxyindoleacetic acid and chromogranin 
      A levels. Initial radiologic examination included chest radiography and plain
      abdominal erect radiography. Gastrointestinal endoscopy was performed to rule out
      inflammatory bowel disease or gastrointestinal neoplasm as a cause of chronic
      diarrhea. Endoscopic mucosal resection of two polyps from the cardia and duodenal
      bulb was performed during esophagogastroduodenoscopy, but histologic findings at 
      hematoxylin-eosin staining were normal. Colonoscopy revealed diverticulosis
      involving the entire colon. Serum immunoelectrophoresis showed a monoclonal band,
      which was confirmed to be immunoglobulin Mlambda at immunofixation. After
      histologic analysis of the bone marrow biopsy specimen, diagnosis of Waldenstrom 
      macroglobulinemia was established, and computed tomography (CT) of the thorax,
      abdomen, and pelvis was requested to depict lymphadenopathy and organomegaly. On 
      the basis of CT findings, two more specimens considered highly sensitive for the 
      CT diagnosis were obtained via minimally invasive biopsy, but the results were
      negative. Magnetic resonance (MR) imaging was performed a year later to control
      the progression of CT findings.
FAU - Hrabak-Paar, Maja
AU  - Hrabak-Paar M
AD  - From the Department of Diagnostic and Interventional Radiology, University
      Hospital Center Zagreb, University of Zagreb School of Medicine, Kispaticeva 12, 
      HR-10000 Zagreb, Croatia (M.H.P., M.K.); and Clinic of Radiology and Nuclear
      Medicine, University of Basel Hospital, Basel, Switzerland (M.H.P.).
FAU - Kralik, Marko
AU  - Kralik M
AD  - From the Department of Diagnostic and Interventional Radiology, University
      Hospital Center Zagreb, University of Zagreb School of Medicine, Kispaticeva 12, 
      HR-10000 Zagreb, Croatia (M.H.P., M.K.); and Clinic of Radiology and Nuclear
      Medicine, University of Basel Hospital, Basel, Switzerland (M.H.P.).
LA  - eng
PT  - Case Reports
PT  - Journal Article
PL  - United States
TA  - Radiology
JT  - Radiology
JID - 0401260
RN  - 0 (Contrast Media)
RN  - 3U05FHG59S (Congo Red)
SB  - AIM
SB  - IM
MH  - Aged
MH  - Amyloidosis/*diagnostic imaging/*etiology
MH  - Biopsy
MH  - Congo Red
MH  - Contrast Media
MH  - Diagnosis, Differential
MH  - Humans
MH  - Male
MH  - Waldenstrom Macroglobulinemia/*complications/*diagnostic imaging
EDAT- 2017/07/21 06:00
MHDA- 2017/08/02 06:00
CRDT- 2017/07/21 06:00
AID - 10.1148/radiol.2017151156 [doi]
PST - ppublish
SO  - Radiology. 2017 Aug;284(2):597-602. doi: 10.1148/radiol.2017151156.