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Simultaneous presentation of Waldenström macroglobulinemia and multiple myeloma: multidisciplinary diagnosis, treatment and 30-month follow-up.
[waldenström macroglobulinemia]
Waldenström
macroglobulinemia
and
multiple
myeloma
are
mature
B-
cell
neoplasms
deriving
from
post-germinal
cells
at
different
stages
of
differentiation
.
The
simultaneous
presentation
of
Waldenström
macroglobulinemia
and
multiple
myeloma
in
the
same
patient
is
a
very
rare
phenomenon
and
,
so
far
,
only
two
cases
have
been
described
.
We
report
the
case
of
a
75
-
year
Caucasian
female
patient
,
with
a
silent
clinical
history
,
who
presented
with
anemia
and
two
different
monoclonal
proteins
(
IgM
κ
and
IgG
κ
)
.
The
trephine
biopsy
showed
the
presence
of
a
dual
population
,
represented
by
small
lymphoplasmacytoid
cells
and
by
plasma
cells
,
which
infiltrated
the
bone
marrow
with
a
clearly
different
pattern
.
Both
immunohistochemistry
and
flow
cytometry
demonstrated
the
biclonal
origin
such
neoplastic
cells
,
since
lymphoplasmacytoid
cells
resulted
IgMκ
while
plasma
cells
were
IgG
κ
.
This
biclonal
pattern
was
further
confirmed
by
the
demonstration
of
a
different
IgH
gene
rearrangement
of
the
two
neoplasms
.
The
patient
was
treated
with
bortezomib
,
dexamethasone
and
rituximab
,
achieving
partial
remission
of
both
Waldenström
macroglobulinemia
and
multiple
myeloma
.
After
a
30
-
month
follow-up
,
she
is
in
stable
disease
.
Multiple
myeloma
has
been
described
in
association
with
other
indolent
B-
cell
neoplasms
,
mostly
chronic
lymphocytic
leukemia
,
while
Waldenström
macroglobulinemia
can
be
followed
by
diffuse
large
B-
cell
lymphoma
in
some
instances
,
after
chemotherapy
.
The
association
of
Waldenström
macroglobulinemia
and
multiple
myeloma
seems
to
be
very
rare
.
Our
study
shows
that
an
integrated
diagnostic
work-up
is
very
useful
in
such
cases
,
with
an
interesting
role
for
flow
cytometry
.
[
J
Clin
Exp
Hematop
53
(
1
)
:
29
-
36
,
2013
]
.
Diseases
Validation
Diseases presenting
"anemia"
symptom
22q11.2 deletion syndrome
alpha-thalassemia
canavan disease
child syndrome
coats disease
congenital toxoplasmosis
cowden syndrome
cutaneous mastocytosis
cystinuria
dedifferentiated liposarcoma
dracunculiasis
erythropoietic protoporphyria
esophageal adenocarcinoma
hirschsprung disease
holt-oram syndrome
homocystinuria without methylmalonic aciduria
kallmann syndrome
kindler syndrome
lamellar ichthyosis
liposarcoma
omenn syndrome
scrub typhus
sneddon syndrome
typhoid
waldenström macroglobulinemia
werner syndrome
wiskott-aldrich syndrome
This symptom has already been validated