Widespread Multi-Organ Involvement by Lymphoplasmacytic B-Cell Lymphoma in a Patient with Multiple Comorbidities: A Case Report

Abstract

Lymphoplasmacytic lymphoma (LPL) is an uncommon B-cell non-Hodgkin lymphoma in which the affected tissue, usually bone marrow, is infiltrated by small lymphocytes, plasmacytoid lymphocytes, and plasma cells. The lymph nodes, spleen and other tissues/organs in the body are less commonly infiltrated by the neoplastic cells. The clinical course of LPL is indolent although some studies report a more aggressive course and adverse outcomes especially in patients with other primary malignancies including skin cancers. We report an unusual finding of widespread multi-organ involvement by LPL in a 69-year-old male with multiple comorbid conditions and malignant melanoma. He initially presented to the hospital three years ago with hepatosplenomegaly and lymphadenopathy. Pathologic work-up including bone marrow evaluation confirmed the diagnosis of LPL. He was also diagnosed with Waldenström macroglobulinemia. Patient received chemotherapy and was well until about eight months ago when he re-presented with abdominal discomfort from a possible spontaneous bacterial peritonitis. However, during his hospital admission, he developed multiple complications including atrial fibrillation with rapid ventricular rate, persistent hypotension and decreased urinary output. He deteriorated despite active management and was transitioned to comfort care. He was later pronounced dead. Autopsy showed involvement of multiple tissues and organs including the peritoneum, parathyroid glands, heart, and brain by the patient's known B-cell lymphoma. There was extensive involvement of the bone marrow, spleen, liver and multiple lymph nodes. Histologic sections taken from the involved tissues and organs revealed infiltration by small B-cells with plasmacytoid lymphocytes and plasma cells. Sections from the scalp lesions showed in-situ and invasive malignant melanoma with involvement of the left lung.

An Atypical Cutaneous and Histopathological Manifestation of Secondary Syphilis in an HIV-Positive Male: A Case Report

“…While the lymphoplasmacytic infiltrate is a key identifying feature of secondary syphilis, there are a plethora of other inflammatory diseases that involve a lymphoplasmacytic infiltrate, and it is the characterization of the infiltrate that helps distinguish between the diseases. These diseases include, but are not limited to, Hashimoto thyroiditis (Figure 5), B-cell lymphoma (Figure 6), and lichen planus [18,19]. (Figure 7) illustrates the difference between the lymphoplasmacytic infiltrate of secondary syphilis versus lichen planus, which was included in our differential diagnosis.…”