Waldenstrom macroglobulinemia (WM) is a subset of lymphoplasmacytic lymphoma and is categorized under mature B-cell lymphoid neoplasm. This lymphoproliferative disorder is characterized by infiltration of the bone marrow by a clonal lymphoplasmacytic infiltrate (≥10%) and an IgM monoclonal gammopathy. WM infiltrate comprises B–lineage cells with predominance of small lymphocytes, admixed with lymphoplasmacytoid cells, plasma cells and often increased mast cells. This similar spectrum of cells, which is present in the bone marrow, may be present in the peripheral blood as well. With marked plasmacytic differentiation, it may be challenging to differentiate it from plasma cell leukemia. However, this differentiation is crucial for prognostication and therapeutic decision-making. We present a case that manifested with fatigability and dyspnoea, and was misdiagnosed as plasma cell leukemia on peripheral blood film and bone marrow morphology. It finally turned out to be a case of Waldenstrom macroglobulinemia on cytoflorometry, highlighting the role of elaborated workup and ancillary techniques to direct the accurate diagnosis and management.
Author (s) Details
Dr. Bhawna Sethi,
Department of Pathology, Shaheed Hasan Khan Mewati, Government Medical College, Nuh, Haryana, India.
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