Lymphoplasmacytic lymphoma with IgA hypergammaglobulinemia and liver involvement.

BACKGROUND

Lymphoplasmacytic lymphoma (LPL) is a low grade lymphoma. Most cases are Waldenstorm macroglobulinemia which has IgM hypergammaglobulinemia. Lymphoplasmacytic lymphoma with IgA hypergammaglobulinemia is less than 5%. Liver involvement was reported in 20%. However this disease has been found to be mostly presented with lymphadenopathy and hypergammaglobulinemia.

CASE REPORT: We present a forty-year-old woman with anemia, renal insufficiency and abnormal liver function test. Liver biopsy showed atypical clonal B-cell lymphoproliferation, small cells with prominent plasmacytic differentiation. Serum protein electrophoresis showed monoclonal gammopathy which was IgA. Rituximab, fludarabine and cyclophosphamide were given and resulting in partial response.

CONCLUSION

The presentation of LPL can mimic multiple myeloma (anemia, renal failure and monoclonal gammopathy). Definite histological and immunological technique should be done to confirm the diagnosis.