Srpski arhiv za celokupno lekarstvo 2011 Volume 139, Issue 1-2, Pages: 95-98
https://doi.org/10.2298/SARH1102095R
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Diffuse large cell lymphoma and colon adenocarcinoma in patient with Waldenström’s macroglobulinaemia
Radojković Milica (Klinika za internu medicinu, Kliničko-bolnički centar „Dr Dragiša Mišović”, Beograd + Medicinski fakultet, Beograd)
Ristić Slobodan (Klinika za internu medicinu, Kliničko-bolnički centar „Dr Dragiša Mišović”, Beograd + Medicinski fakultet, Beograd)
Čolović Nataša (Medicinski fakultet, Beograd + Institut za hematologiju, Klinički centar Srbije, Beograd)
Čemerikić-Martinović Vesna (Histolab, Beograd)
Čolović Milica (Medicinski fakultet, Beograd + Institut za hematologiju, Klinički centar Srbije, Beograd)
Introduction. Waldenström’s macroglobulinaemia is a rare B cell
lymphoproliferative disorder characterized by lymphoplasmocyte bone marrow
infiltration and monoclonal IgM gammopathy. In the majority of cases,
Waldenström’s macroglobulinaemia is a chronic disease with variable course.
Therapy consists of alkylating agents, purine analogs and antiCD20 monoclonal
antibody. In the literature, there have been descriptions of rare cases of
progression of Waldenström’s macroglobulinaemia to aggressive lymphoma, as
well as secondary carcinoma in the patients after treatment of
macroglobulinaemia. Case Outline. A 63-year-old patient was diagnosed with
serum monoclonal IgM kappa gammopathy (Waldenström’s macroglobulinaemia).
Chemotherapy was applied and a good clinical and haematological response had
been achieved. Ten years later, the patient was diagnosed with colon
adenocarcinoma as a secondary malignancy, and operated on. Within one month,
the patient rapidly developed a large neck tumour mass. Tumour biopsy
revealed the diagnosis of diffuse large B cell lymphoma with the expression
of monoclonal lambda chain, which more likely pointed out to coexistence of
two different B cell lymphoproliferative disorders, rather than the
transformation of Waldenström’s macroglobulinaemia to aggressive lymphoma.
The patient was treated with chemotherapy following R-CHOP protocol, and
clinical remission was achieved. Seven months later, despite the successful
treatment of lymphoproliferative disorder, dissemination of adenocarcinoma
led to the lethal outcome. Conclusion. The patient was diagnosed with a rare
occurrence of three neoplastic diseases: Waldenström’s macroglobulinaemia,
colon adenocarcinoma and diffuse large B cell lymphoma. The possible
mechanisms of the combined appearance of lymphoproliferative and other
malignant diseases include the previous treatment with alkylating agents,
genetic, immunomodulatory and environmental factors.
Keywords: macroglobulinaemia, diffuse large B cell lymphoma, colon adenocarcinoma
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