Lymphoplasmacytic lymphoma history and symptoms: Difference between revisions

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{{Lymphoplasmacytic lymphoma}}
{{Lymphoplasmacytic lymphoma}}


{{CMG}}; {{AE}}  
{{CMG}}; {{AE}}{{S.M.}}  
==Overview==
==Overview==
The majority of patients with [disease name] are asymptomatic.
Many [[patients]] with [[lymphoplasmacytic lymphoma]] are [[asymptomatic]]. The [[disease]] is subtle and [[symptoms]] are nonspecific and are [[Causes|caused]] by [[tumor]] [[Infiltration (medical)|infiltration]], [[Circulatory|circulating]] [[Monoclonal antibody|monoclonal]] [[IgM]], [[IgM]] [[Deposition (physics)|deposition]] into [[tissues]], [[amyloidogenic]] properties of [[IgM]], and [[autoantibody]] [[Activity (chemistry)|activity]] of [[IgM]]. The most common [[symptoms]] of [[lymphoplasmacytic lymphoma]] include [[weakness]], [[anorexia]], unexplained [[weight loss]], [[fever]], [[heavy sweating]], [[Blurred vision|blurry vision]], [[peripheral neuropathy]], and [[abdominal pain]]. Less common [[symptoms]] of the [[disease]] include [[enlarged lymph nodes]], [[abdominal distension]], [[headache]], painless [[Lump|lumps]], [[Raynaud's phenomenon|raynaud phenomenon]], [[altered mental status]], [[mucosal bleeding]], [[vision problems]], [[kidney]] issues, [[heart]] problems, [[infections]], [[Gastrointestinal tract|GIT]] problems, and other [[symptoms]] due to [[cryoglobulinemia]], [[cold agglutinin disease]], [[hyperviscosity syndrome]], and [[Bing-Neel syndrome|bing-neel syndrome]].  


OR
==History and Symptoms==
=== History ===
* The onset of [[lymphoplasmacytic lymphoma]] is insidious and non-specific.
* Approximately 25% of [[patients]] with [[Lymphoplasmacytic lymphoma|LPL]] are [[asymptomatic]] upon [[Presentation (Obstetrics)|presentation]]; their [[diagnosis]] is often made [[Incidental finding|incidentally]] from routine [[blood tests]] [[done]] for some other [[Reasoning|reason]]. [[Waldenström's macroglobulinemia|WM]] found this way is sometimes called [[asymptomatic]] or Smoldering WM (SWM).<ref name="pmid11736938">{{cite journal| author=García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A et al.| title=Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases. | journal=Br J Haematol | year= 2001 | volume= 115 | issue= 3 | pages= 575-82 | pmid=11736938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11736938  }} </ref>
* [[Symptoms]] develop depending on the [[tissues]] involved in the [[malignant]] cell [[Infiltration (medical)|infiltration]] or [[IgM]] [[Deposition (physics)|deposition]].<ref name="pmid10623712">{{cite journal| author=Dimopoulos MA, Panayiotidis P, Moulopoulos LA, Sfikakis P, Dalakas M| title=Waldenström's macroglobulinemia: clinical features, complications, and management. | journal=J Clin Oncol | year= 2000 | volume= 18 | issue= 1 | pages= 214-26 | pmid=10623712 | doi=10.1200/JCO.2000.18.1.214 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10623712  }} </ref>
=== Manifestations of Lymphoplasmacytic lymphoma ===
Following is a list of [[Lymphoplasmacytic lymphoma|LPL]] manifestations with attributable [[causes]]:<ref name="pmid15735132">{{cite journal| author=Dimopoulos MA, Kyle RA, Anagnostopoulos A, Treon SP| title=Diagnosis and management of Waldenstrom's macroglobulinemia. | journal=J Clin Oncol | year= 2005 | volume= 23 | issue= 7 | pages= 1564-77 | pmid=15735132 | doi=10.1200/JCO.2005.03.144 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15735132  }} </ref><ref name="DimopoulosPanayiotidis2000">{{cite journal|last1=Dimopoulos|first1=Meletios A.|last2=Panayiotidis|first2=Panayiotis|last3=Moulopoulos|first3=Lia A.|last4=Sfikakis|first4=Petros|last5=Dalakas|first5=Marinos|title=Waldenström’s Macroglobulinemia: Clinical Features, Complications, and Management|journal=Journal of Clinical Oncology|volume=18|issue=1|year=2000|pages=214–214|issn=0732-183X|doi=10.1200/JCO.2000.18.1.214}}</ref><ref name="pmid3110508">{{cite journal| author=Kyle RA, Garton JP| title=The spectrum of IgM monoclonal gammopathy in 430 cases. | journal=Mayo Clin Proc | year= 1987 | volume= 62 | issue= 8 | pages= 719-31 | pmid=3110508 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3110508  }} </ref><ref name="pmid12883242">{{cite journal| author=Lin P, Bueso-Ramos C, Wilson CS, Mansoor A, Medeiros LJ| title=Waldenstrom macroglobulinemia involving extramedullary sites: morphologic and immunophenotypic findings in 44 patients. | journal=Am J Surg Pathol | year= 2003 | volume= 27 | issue= 8 | pages= 1104-13 | pmid=12883242 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12883242  }} </ref><ref name="pmid8123836">{{cite journal| author=Dimopoulos MA, Alexanian R| title=Waldenstrom's macroglobulinemia. | journal=Blood | year= 1994 | volume= 83 | issue= 6 | pages= 1452-9 | pmid=8123836 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=8123836  }} </ref><ref name="pmid6767276">{{cite journal| author=Fudenberg HH, Virella G| title=Multiple myeloma and Waldenström macroglobulinemia: unusual presentations. | journal=Semin Hematol | year= 1980 | volume= 17 | issue= 1 | pages= 63-79 | pmid=6767276 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6767276  }} </ref><ref name="pmid9671845">{{cite journal| author=Fadil A, Taylor DE| title=The lung and Waldenström's macroglobulinemia. | journal=South Med J | year= 1998 | volume= 91 | issue= 7 | pages= 681-5 | pmid=9671845 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9671845  }} </ref><ref name="pmid9198063">{{cite journal| author=Veltman GA, van Veen S, Kluin-Nelemans JC, Bruijn JA, van Es LA| title=Renal disease in Waldenström's macroglobulinaemia. | journal=Nephrol Dial Transplant | year= 1997 | volume= 12 | issue= 6 | pages= 1256-9 | pmid=9198063 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9198063  }} </ref><ref name="pmid10188670">{{cite journal| author=Daoud MS, Lust JA, Kyle RA, Pittelkow MR| title=Monoclonal gammopathies and associated skin disorders. | journal=J Am Acad Dermatol | year= 1999 | volume= 40 | issue= 4 | pages= 507-35; quiz 536-8 | pmid=10188670 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10188670  }} </ref><ref name="pmid6801795">{{cite journal| author=Orellana J, Friedman AH| title=Ocular manifestations of multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy. | journal=Surv Ophthalmol | year= 1981 | volume= 26 | issue= 3 | pages= 157-69 | pmid=6801795 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6801795  }} </ref><ref name="pmid9686227">{{cite journal| author=Civit T, Coulbois S, Baylac F, Taillandier L, Auque J| title=[Waldenström's macroglobulinemia and cerebral lymphoplasmocytic proliferation: Bing and Neel syndrome. Apropos of a new case]. | journal=Neurochirurgie | year= 1997 | volume= 43 | issue= 4 | pages= 245-9 | pmid=9686227 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9686227  }} </ref><ref name="pmid10357087">{{cite journal| author=Kwaan HC, Bongu A| title=The hyperviscosity syndromes. | journal=Semin Thromb Hemost | year= 1999 | volume= 25 | issue= 2 | pages= 199-208 | pmid=10357087 | doi=10.1055/s-2007-994921 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=10357087  }} </ref><ref name="pmid3094151">{{cite journal| author=Farhangi M, Merlini G| title=The clinical implications of monoclonal immunoglobulins. | journal=Semin Oncol | year= 1986 | volume= 13 | issue= 3 | pages= 366-79 | pmid=3094151 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=3094151  }} </ref><ref name="pmid2104668">{{cite journal| author=| title=Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 3-1990. A 66-year-old woman with Waldenström's macroglobulinemia, diarrhea, anemia, and persistent gastrointestinal bleeding. | journal=N Engl J Med | year= 1990 | volume= 322 | issue= 3 | pages= 183-92 | pmid=2104668 | doi=10.1056/NEJM199001183220308 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=2104668  }} </ref><ref name="GertzKyle1993">{{cite journal|last1=Gertz|first1=M A|last2=Kyle|first2=R A|last3=Noel|first3=P|title=Primary systemic amyloidosis: a rare complication of immunoglobulin M monoclonal gammopathies and Waldenström's macroglobulinemia.|journal=Journal of Clinical Oncology|volume=11|issue=5|year=1993|pages=914–920|issn=0732-183X|doi=10.1200/JCO.1993.11.5.914}}</ref><ref name="pmid12720162">{{cite journal| author=Gertz MA, Kyle RA| title=Amyloidosis with IgM monoclonal gammopathies. | journal=Semin Oncol | year= 2003 | volume= 30 | issue= 2 | pages= 325-8 | pmid=12720162 | doi=10.1053/sonc.2003.50060 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12720162  }} </ref><ref name="pmid11530809">{{cite journal| author=Gardyn J, Schwartz A, Gal R, Lewinski U, Kristt D, Cohen AM| title=Waldenström's macroglobulinemia associated with AA amyloidosis. | journal=Int J Hematol | year= 2001 | volume= 74 | issue= 1 | pages= 76-8 | pmid=11530809 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11530809  }} </ref><ref name="pmid9603799">{{cite journal| author=Ropper AH, Gorson KC| title=Neuropathies associated with paraproteinemia. | journal=N Engl J Med | year= 1998 | volume= 338 | issue= 22 | pages= 1601-7 | pmid=9603799 | doi=10.1056/NEJM199805283382207 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=9603799  }} </ref><ref name="pmid11556684">{{cite journal| author=Vital A| title=Paraproteinemic neuropathies. | journal=Brain Pathol | year= 2001 | volume= 11 | issue= 4 | pages= 399-407 | pmid=11556684 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11556684  }} </ref><ref name="pmid6807086">{{cite journal| author=Crisp D, Pruzanski W| title=B-cell neoplasms with homogeneous cold-reacting antibodies (cold agglutinins). | journal=Am J Med | year= 1982 | volume= 72 | issue= 6 | pages= 915-22 | pmid=6807086 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6807086  }} </ref><ref name="pmid6777101">{{cite journal| author=Lindström FD, Hed J, Eneström S| title=Renal pathology of Waldenström's macroglobulinaemia with monoclonal antiglomerular antibodies and nephrotic syndrome. | journal=Clin Exp Immunol | year= 1980 | volume= 41 | issue= 2 | pages= 196-204 | pmid=6777101 | doi= | pmc=1537007 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=6777101  }} </ref><ref name="pmid15019332">{{cite journal| author=Sen HN, Chan CC, Caruso RC, Fariss RN, Nussenblatt RB, Buggage RR| title=Waldenström's macroglobulinemia-associated retinopathy. | journal=Ophthalmology | year= 2004 | volume= 111 | issue= 3 | pages= 535-9 | pmid=15019332 | doi=10.1016/j.ophtha.2003.05.036 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=15019332  }} </ref>


The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. Common symptoms of [disease] include [symptom 1], [symptom 2], and [symptom 3]. Less common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
{| class="wikitable"
 
|+ '''Manifestations of Lymphoplasmacytic lymphoma'''
==History and Symptoms==
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Cause
*The majority of patients with [disease name] are asymptomatic.
! style="background:#4479BA; color: #FFFFFF;" align="center" + |Manifestations
OR
|-
*The hallmark of [disease name] is [finding]. A positive history of [finding 1] and [finding 2] is suggestive of [disease name]. The most common symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3].
! style="background:#DCDCDC;" align="center" + |[[Tumor]] [[Infiltration (medical)|infiltration]]
*Symptoms of [disease name] include [symptom 1], [symptom 2], and [symptom 3]. 
| style="background:#F5F5F5;" align="center" + |
===History===
* [[Cytopenia]]
Patients with [disease name]] may have a positive history of:
* [[Fever]]
*[History finding 1]
* [[Night sweats]]
*[History finding 2]
* [[Weight loss]]
*[History finding 3]
* [[Lymphadenopathy]]
* [[Hepatomegaly]]
* [[Splenomegaly]]
* [[Pulmonary]] [[Infiltration (medical)|infiltrates]]
* [[Nodules]] or [[Mass|masses]]
* [[Pleural effusion]]
* [[Abdominal pain]]
* [[Swelling]]
* [[Blood]] in [[stools]] [[secondary]] to [[stomach]] and [[bowel]] [[Infiltration (medical)|infiltration]]
* [[Renal]] and perirenal [[Mass|masses]]
* [[Maculopapular]] [[lesions]]
* [[Plaques]] or [[nodules]] [[secondary]] to [[dermis]] [[Infiltration (medical)|infiltration]]
*[[Lesions]] involving retro-[[Orbit (anatomy)|orbital]] [[lymphoid tissue]] and [[lacrimal glands]]
*[[Infiltration (medical)|Infiltration]] of the [[conjunctiva]] and [[malignant]] vitreitis
* [[Bing-Neel syndrome]] consists of:
**[[Confusion]]
** [[Memory loss]]
** [[Disorientation]]
** [[Motor control|Motor]] [[dysfunction]]
** [[Coma]]
|-
! style="background:#DCDCDC;" align="center" + |[[Circulatory|Circulating]] [[Monoclonal antibody|monoclonal]] [[IgM]]
| style="background:#F5F5F5;" align="center" + |
* [[Hyperviscosity syndrome]]
* Type 1 [[Cryoglobulinemia]] which consists of:
**[[Raynaud's phenomenon]]
**[[Skin]] [[ulcers]]
**[[Skin]] [[necrosis]]
** [[Cold urticaria]]
* Frequent [[bruising]]
* Prolonged [[bleeding time]]
* Prolonged [[clotting]] time
|-
! style="background:#DCDCDC;" align="center" + |[[IgM]] [[Deposition (physics)|deposition]] into [[tissues]]
| style="background:#F5F5F5;" align="center" + |
* Sub-[[endothelial]] [[Deposition (physics)|deposits]] in [[Glomerular capsule|glomerular loops]] leading to:
**Non-[[Selection|selective]] [[proteinuria]]
**[[Dehydration]]
**[[Uremia]]
* Firm, [[flesh]]-[[Color|colored]] [[skin]] [[papules]] and [[nodules]], called [[macroglobulinemia]] [[cutis]]
* [[Diarrhea]]
* [[Malabsorption]]
* [[Gastrointestinal bleeding]]
|-
! style="background:#DCDCDC;" align="center" + |[[Amyloidogenic]] properties of [[IgM]]
| style="background:#F5F5F5;" align="center" + |
* [[Organs]] more commonly [[Affect|affected]] by [[amyloidosis]] are:
**[[Heart]] (44%):
***Unexplained [[cardiac failure]]
**[[Peripheral nerves]] (38%)
**[[Kidneys]] (32%):
***[[Nephrotic syndrome]]
**[[Soft tissue|Soft tissues]] (18%):
**[[Liver]] (14%)
**[[Lungs]] (10%)
**[[Gastrointestinal]] involvement:
***[[Intestinal]] dysmotility
**[[Skin]]:
***[[Purpura]]
**[[Tongue]]:
***[[Macroglossia]]
|-
! style="background:#DCDCDC;" align="center" + |[[Autoantibody]] [[Activity (chemistry)|activity]] of [[IgM]]
| style="background:#F5F5F5;" align="center" + |
* [[Distal]], [[Symmetric function|symmetric]], [[Chronic (medical)|chronic]] [[myelin]]-[[Association (statistics)|associated]] [[glycoprotein]] [[antibody]]-positive [[demyelinating]] [[peripheral neuropathy]]
* Type 2 [[cryoglobulinemia]] characterized by [[vasculitis]] [[Affect|affecting]] small [[vessels]] of:
**[[Skin]]
**[[Kidneys]]
**[[Liver]]
**[[Peripheral nerves]]
* Extravascular [[chronic hemolytic anemia]] called [[cold agglutinin disease]] exacerbated by [[cold exposure]]
* [[Glomerulonephritis]]
* [[Paraneoplastic]] [[pemphigus]]
* [[Retinitis]]/[[retinopathy]]
|}
==== Common Symptoms ====
Common [[symptoms]] of [[lymphoplasmacytic lymphoma]] include:<ref name="pmid11736938">{{cite journal| author=García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A et al.| title=Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases. | journal=Br J Haematol | year= 2001 | volume= 115 | issue= 3 | pages= 575-82 | pmid=11736938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11736938  }} </ref><ref name="pmid12720138">{{cite journal| author=Merlini G, Baldini L, Broglia C, Comelli M, Goldaniga M, Palladini G et al.| title=Prognostic factors in symptomatic Waldenstrom's macroglobulinemia. | journal=Semin Oncol | year= 2003 | volume= 30 | issue= 2 | pages= 211-5 | pmid=12720138 | doi=10.1053/sonc.2003.50064 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12720138  }} </ref>
* [[B symptoms|Constitutional B symptoms]] as seen in other types of [[NHL]]:
**[[Weakness]] (due to [[normocytic anemia]] [[Association (statistics)|associated]] with [[IgM]] [[Binding (molecular)|binding]] to [[RBCs]])
**[[Anorexia]]
**Unexplained [[weight loss]]
**Unexplained [[fever]]
**Heavy [[sweating]], especially at [[Night Sweats|night]] [[Causes|causing]] drenching of one's cloths and bedsheet
**Severe/extensive [[skin]] [[itchiness]]
*[[Fatigue]]
*[[Sensorimotor]] [[peripheral neuropathy]] (mostly [[Association (statistics)|associated]] with [[numbness]] and [[tingling]], i.e. [[painful]] pins and needle [[Sensation|sensation,]] of the [[fingers]] or [[toes]])
*[[Blurred vision|Blurry vision]] or [[Blind spot (vision)|blind spots]]
*[[Abdominal pain]]


===Common Symptoms===
==== Less Common Symptoms ====
Common symptoms of [disease] include:
Less common [[symptoms]] of [[lymphoplasmacytic lymphoma]] include:<ref name="pmid11736938">{{cite journal| author=García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A et al.| title=Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases. | journal=Br J Haematol | year= 2001 | volume= 115 | issue= 3 | pages= 575-82 | pmid=11736938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11736938  }} </ref><ref name="pmid12720138">{{cite journal| author=Merlini G, Baldini L, Broglia C, Comelli M, Goldaniga M, Palladini G et al.| title=Prognostic factors in symptomatic Waldenstrom's macroglobulinemia. | journal=Semin Oncol | year= 2003 | volume= 30 | issue= 2 | pages= 211-5 | pmid=12720138 | doi=10.1053/sonc.2003.50064 | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=12720138  }} </ref>
*[Symptom 1]
*[[Enlarged lymph nodes]] ([[Appearance|appearing]] as 1-2 inches sized [[Lump|lumps]] under the [[skin]] in [[neck]], [[groin]] or the [[armpits]]).
*[Symptom 2]
*[[Swollen belly]]/[[abdomen]] (due to [[hepatosplenomegaly]]).
*[Symptom 3]
*[[Pain]] or a [[feeling]] of fullness below the [[ribs]] on the left side.
*Painless [[Lump|lumps]] in the [[neck]], [[underarm]], [[stomach]], or [[groin]].
*[[Headache]].
*Raised [[Pinks|pink]]/[[flesh]]-[[Color|colored]] [[lesions]] on [[skin]].
*[[Altered mental status]] due to decreased [[blood flow]] and [[Infiltration (medical)|infiltration]] of [[CNS]] leading to:
**[[Bing-Neel syndrome]] which includes:
***[[Confusion]]
***[[Dizziness]]
***[[Memory loss]]
***[[Motor disorders]]
*[[Symptoms]] resembling [[stroke]] like [[slurred speech]] or [[weakness]] on one side of [[body]] (such [[patients]] are advised to [[Consultation|consult]] from their [[Doctor of Medicine|doctor]] right away).
*[[Abnormal]] [[mucous membrane]] [[bleeding]] ([[epistaxis]], [[bleeding gums]]).
*[[Vision problems]] ([[blurred vision]], [[double vision]] or [[Blind spot|blind spots]]).
*[[Kidney]] problems (leading to [[weakness]], trouble [[breathing]] and [[fluid]] buildup in [[body]] [[tissues]] [[Association (statistics)|associated]] with accumulation of excess [[salt]], [[fluid]] and waste [[Product (chemistry)|products]] in [[blood]] [[secondary]] to [[amyloidosis]]).
*[[Heart]] problems ([[Secondary]] to [[amyloidosis]], build up of [[M protein]] in [[heart]] [[Affect|affects]] its [[Pump|pumping]] ability, and also the [[heart]] has to work harder to [[pump]] the thick [[blood]] ultimately leading to [[CHF]] with following [[symptoms]]):
**[[Palpitations]]
**[[Feeling]] of [[tiredness]] and [[weakness]]
**[[Cough]]
**[[Shortness of breath]]
**Rapid [[weight gain]]
**[[Swelling]] of [[feet]] and [[legs]]
*[[Infections]] (high levels of [[abnormal]] [[antibody]] in WM slows down the [[Product (biology)|production]] of [[normal]] [[antibodies]])
*[[Digestive]] problems due to [[Deposition (physics)|deposition]] of [[IgM]] [[protein]] in the [[lamina propria]] of the [[intestinal wall]] include:
**[[Diarrhea]]
**Poor [[absorption]] of [[vitamins]]
**[[Gastrointestinal bleeding|GIT bleeding]]/[[steatorrhea]] ([[Blood in stool|blood in stools]]/[[Stools are black and tarry|dark stools]])
*[[Sensitivity]] to [[cold]] ([[Raynaud's phenomenon]] due to [[cryoglobulinemia]] in 5% WM [[patients]]), which is [[Association (statistics)|associated]] with reduced [[blood flow]] leading to [[pain]], [[itching]], [[Bluish discoloration of the skin|bluish discoloration]] or [[Sore|sores]] in following [[Human body|body]] parts:
**Tip of [[nose]]
**[[Ears]]
**[[Fingers]]
**[[Toes]]
*[[Clinical]] manifestations of '''[[cryoglobulinemia]]''' include:
**[[Numbness]] and [[tingling]] in [[hands]] and [[feet]]
**[[Joint aches]]
**Small [[bruises]]
**[[Skin]] [[ulcers]]
**[[Purpura]]
**Digital [[ischemia]]
**[[Arthralgia]]
**[[Fever]]
**[[Raynaud phenomenon]]
*[[Clinical]] manifestations of '''[[Cold agglutinin disease]]''' include:
**[[Livedo reticularis]]
**[[Acrocyanosis]]
**[[Raynaud's phenomenon|Raynaud phenomenon]]


===Less Common Symptoms===
==== Symptoms Secondary to Hyperviscosity Syndrome ====
Less common symptoms of [disease name] include
The [[lymphoma]] [[Cells (biology)|cells]] make varying [[Amount of substance|amounts]] of a [[Monoclonal antibodies|monoclonal]] [[protein]] called [[immunoglobulin M]] ([[IgM]], or [[macroglobulin]]). Higher [[Amount of substance|amounts]] of this [[protein]] than normal in [[blood]] tends to make it thick leading to [[hyperviscosity syndrome]] which occurs in approximately 15-20% [[patients]] of WM. When [[blood]] becomes thick, it is harder for [[blood]] to [[flow]] through small [[blood vessels]], and when this occurs, the [[condition]] is termed as [[Waldenström's macroglobulinemia|Waldenstrom macroglobulinemia]]. This [[Excess risk|excess]] [[Amount of substance|amount]] of [[IgM]] [[antibodies]] can be ultimately [[Association (statistics)|associated]] with [[circulatory]] problems leading to less [[blood flow]] to the [[brain]], [[eyes]] or other [[organs]]. [[Clinical]] manifestations of [[hyperviscosity syndrome]] occur only if [[serum]] [[viscosity]] is >4 centipoises and include:<ref name="pmid11736938">{{cite journal| author=García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A et al.| title=Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases. | journal=Br J Haematol | year= 2001 | volume= 115 | issue= 3 | pages= 575-82 | pmid=11736938 | doi= | pmc= | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=11736938  }} </ref>
*[Symptom 1]
*[[Symptoms]] resembling those of [[stroke]]
*[Symptom 2]
* [[Retinal]] [[hemorrhage]] with [[Blurred vision|blurring of vision]]/[[loss of vision]]
*[Symptom 3]
*[[Dizziness]]
*[[Headache]]
*[[Loss of coordination]]
*[[Nystagmus]]
*[[Tinnitus]]
*[[Bleeding]]
*[[Shortness of breath]]
*[[Numbness]] and [[tingling]] of the [[fingers]] or [[toes]] (called [[peripheral neuropathy]])
*[[Muscle weakness]]
*[[Confusion]]
*Not all people with LPL develop [[hyperviscosity]], [[cryoglobulins]], or [[amyloidosis]]


==References==
==References==
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[[Category: (name of the system)]]
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[[Category:Blood]]
[[Category:Hematology]]

Latest revision as of 14:30, 15 August 2019

Lymphoplasmacytic lymphoma Microchapters

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]

Overview

Many patients with lymphoplasmacytic lymphoma are asymptomatic. The disease is subtle and symptoms are nonspecific and are caused by tumor infiltration, circulating monoclonal IgM, IgM deposition into tissues, amyloidogenic properties of IgM, and autoantibody activity of IgM. The most common symptoms of lymphoplasmacytic lymphoma include weakness, anorexia, unexplained weight loss, fever, heavy sweating, blurry vision, peripheral neuropathy, and abdominal pain. Less common symptoms of the disease include enlarged lymph nodes, abdominal distension, headache, painless lumps, raynaud phenomenon, altered mental status, mucosal bleeding, vision problems, kidney issues, heart problems, infections, GIT problems, and other symptoms due to cryoglobulinemia, cold agglutinin disease, hyperviscosity syndrome, and bing-neel syndrome.

History and Symptoms

History

Manifestations of Lymphoplasmacytic lymphoma

Following is a list of LPL manifestations with attributable causes:[3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24]

Manifestations of Lymphoplasmacytic lymphoma
Cause Manifestations
Tumor infiltration
Circulating monoclonal IgM
IgM deposition into tissues
Amyloidogenic properties of IgM
Autoantibody activity of IgM

Common Symptoms

Common symptoms of lymphoplasmacytic lymphoma include:[1][25]

Less Common Symptoms

Less common symptoms of lymphoplasmacytic lymphoma include:[1][25]

Symptoms Secondary to Hyperviscosity Syndrome

The lymphoma cells make varying amounts of a monoclonal protein called immunoglobulin M (IgM, or macroglobulin). Higher amounts of this protein than normal in blood tends to make it thick leading to hyperviscosity syndrome which occurs in approximately 15-20% patients of WM. When blood becomes thick, it is harder for blood to flow through small blood vessels, and when this occurs, the condition is termed as Waldenstrom macroglobulinemia. This excess amount of IgM antibodies can be ultimately associated with circulatory problems leading to less blood flow to the brain, eyes or other organs. Clinical manifestations of hyperviscosity syndrome occur only if serum viscosity is >4 centipoises and include:[1]

References

  1. ↑ 1.0 1.1 1.2 1.3 García-Sanz R, Montoto S, Torrequebrada A, de Coca AG, Petit J, Sureda A; et al. (2001). "Waldenström macroglobulinaemia: presenting features and outcome in a series with 217 cases". Br J Haematol. 115 (3): 575–82. PMID 11736938.
  2. ↑ Dimopoulos MA, Panayiotidis P, Moulopoulos LA, Sfikakis P, Dalakas M (2000). "Waldenström's macroglobulinemia: clinical features, complications, and management". J Clin Oncol. 18 (1): 214–26. doi:10.1200/JCO.2000.18.1.214. PMID 10623712.
  3. ↑ Dimopoulos MA, Kyle RA, Anagnostopoulos A, Treon SP (2005). "Diagnosis and management of Waldenstrom's macroglobulinemia". J Clin Oncol. 23 (7): 1564–77. doi:10.1200/JCO.2005.03.144. PMID 15735132.
  4. ↑ Dimopoulos, Meletios A.; Panayiotidis, Panayiotis; Moulopoulos, Lia A.; Sfikakis, Petros; Dalakas, Marinos (2000). "Waldenström's Macroglobulinemia: Clinical Features, Complications, and Management". Journal of Clinical Oncology. 18 (1): 214–214. doi:10.1200/JCO.2000.18.1.214. ISSN 0732-183X.
  5. ↑ Kyle RA, Garton JP (1987). "The spectrum of IgM monoclonal gammopathy in 430 cases". Mayo Clin Proc. 62 (8): 719–31. PMID 3110508.
  6. ↑ Lin P, Bueso-Ramos C, Wilson CS, Mansoor A, Medeiros LJ (2003). "Waldenstrom macroglobulinemia involving extramedullary sites: morphologic and immunophenotypic findings in 44 patients". Am J Surg Pathol. 27 (8): 1104–13. PMID 12883242.
  7. ↑ Dimopoulos MA, Alexanian R (1994). "Waldenstrom's macroglobulinemia". Blood. 83 (6): 1452–9. PMID 8123836.
  8. ↑ Fudenberg HH, Virella G (1980). "Multiple myeloma and Waldenström macroglobulinemia: unusual presentations". Semin Hematol. 17 (1): 63–79. PMID 6767276.
  9. ↑ Fadil A, Taylor DE (1998). "The lung and Waldenström's macroglobulinemia". South Med J. 91 (7): 681–5. PMID 9671845.
  10. ↑ Veltman GA, van Veen S, Kluin-Nelemans JC, Bruijn JA, van Es LA (1997). "Renal disease in Waldenström's macroglobulinaemia". Nephrol Dial Transplant. 12 (6): 1256–9. PMID 9198063.
  11. ↑ Daoud MS, Lust JA, Kyle RA, Pittelkow MR (1999). "Monoclonal gammopathies and associated skin disorders". J Am Acad Dermatol. 40 (4): 507–35, quiz 536-8. PMID 10188670.
  12. ↑ Orellana J, Friedman AH (1981). "Ocular manifestations of multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy". Surv Ophthalmol. 26 (3): 157–69. PMID 6801795.
  13. ↑ Civit T, Coulbois S, Baylac F, Taillandier L, Auque J (1997). "[Waldenström's macroglobulinemia and cerebral lymphoplasmocytic proliferation: Bing and Neel syndrome. Apropos of a new case]". Neurochirurgie. 43 (4): 245–9. PMID 9686227.
  14. ↑ Kwaan HC, Bongu A (1999). "The hyperviscosity syndromes". Semin Thromb Hemost. 25 (2): 199–208. doi:10.1055/s-2007-994921. PMID 10357087.
  15. ↑ Farhangi M, Merlini G (1986). "The clinical implications of monoclonal immunoglobulins". Semin Oncol. 13 (3): 366–79. PMID 3094151.
  16. ↑ "Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. Case 3-1990. A 66-year-old woman with Waldenström's macroglobulinemia, diarrhea, anemia, and persistent gastrointestinal bleeding". N Engl J Med. 322 (3): 183–92. 1990. doi:10.1056/NEJM199001183220308. PMID 2104668.
  17. ↑ Gertz, M A; Kyle, R A; Noel, P (1993). "Primary systemic amyloidosis: a rare complication of immunoglobulin M monoclonal gammopathies and Waldenström's macroglobulinemia". Journal of Clinical Oncology. 11 (5): 914–920. doi:10.1200/JCO.1993.11.5.914. ISSN 0732-183X.
  18. ↑ Gertz MA, Kyle RA (2003). "Amyloidosis with IgM monoclonal gammopathies". Semin Oncol. 30 (2): 325–8. doi:10.1053/sonc.2003.50060. PMID 12720162.
  19. ↑ Gardyn J, Schwartz A, Gal R, Lewinski U, Kristt D, Cohen AM (2001). "Waldenström's macroglobulinemia associated with AA amyloidosis". Int J Hematol. 74 (1): 76–8. PMID 11530809.
  20. ↑ Ropper AH, Gorson KC (1998). "Neuropathies associated with paraproteinemia". N Engl J Med. 338 (22): 1601–7. doi:10.1056/NEJM199805283382207. PMID 9603799.
  21. ↑ Vital A (2001). "Paraproteinemic neuropathies". Brain Pathol. 11 (4): 399–407. PMID 11556684.
  22. ↑ Crisp D, Pruzanski W (1982). "B-cell neoplasms with homogeneous cold-reacting antibodies (cold agglutinins)". Am J Med. 72 (6): 915–22. PMID 6807086.
  23. ↑ Lindström FD, Hed J, Eneström S (1980). "Renal pathology of Waldenström's macroglobulinaemia with monoclonal antiglomerular antibodies and nephrotic syndrome". Clin Exp Immunol. 41 (2): 196–204. PMC 1537007. PMID 6777101.
  24. ↑ Sen HN, Chan CC, Caruso RC, Fariss RN, Nussenblatt RB, Buggage RR (2004). "Waldenström's macroglobulinemia-associated retinopathy". Ophthalmology. 111 (3): 535–9. doi:10.1016/j.ophtha.2003.05.036. PMID 15019332.
  25. ↑ 25.0 25.1 Merlini G, Baldini L, Broglia C, Comelli M, Goldaniga M, Palladini G; et al. (2003). "Prognostic factors in symptomatic Waldenstrom's macroglobulinemia". Semin Oncol. 30 (2): 211–5. doi:10.1053/sonc.2003.50064. PMID 12720138.

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