Lymphoplasmacytic lymphoma physical examination

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Sara Mohsin, M.D.[2]

Overview

Patients with lymphoplasmacytic lymphoma usually appear oriented to time, place, and person. Physical examination of patients with lymphoplasmacytic lymphoma is usually remarkable for various findings depending on the degree of tissue infiltration by malignant tumor cells, hyperviscosity syndrome, and accumulation of paraprotein. Common physical exam findings include maculopapular lesions, purpura, petechiae, raynaud's phenomenon, skin ulcers, skin necrosis, cold urticaria, macroglobulinemia cutis, pallor, papilledema, retinopathy, lymphadenopathy, jugular venous distension, pleural effusion, lung rales, pulmonary infiltrates, displaced apical impulse, S3 gallop, hepatosplenomegaly causing abdominal distension, peripheral edema due to congestive heart failure, and distal, symmetric, sensorimotor peripheral neuropathy.

Physical Examination

General Appearance

Patients with lymphoplasmacytic lymphoma are generally well-appearing.[1]

Skin

Lesion measuring 4 centimeters on the penis base, with a clear background source[https://openi.nlm.nih.gov/detailedresult.php?img=PMC4861576_abd-91-02-0236-g01&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=62 : Oliveira CC. et al, Universidade do Oeste Paulista, Presidente Prudente, SP, Brazil.
]
Hyperpigmented nodules with hemorrhagic crusting on the back.Source: Haider S. et al, Department of Internal Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267, USA.
The patient presented with tingling ulcers on the feet. [Copyright: ©2013 Fischer et al.]Figure 1B. On further examination, papules were noted on the knees. [Copyright: ©2013 Fischer et al.]Figure1C. Biopsy from a knee papule showed homogeneous extra-vascular eosinophilic hyaline deposits throughout the papillary and reticular dermis (H&E 40×). [Copyright: ©2013 Fischer et al.]Figure 1D. IgM stain demonstrates the extravascular IgM deposits in the dermis (40×). [Copyright: ©2013 Fischer et al.]Source: Fischer I. et al, Department of Dermatology, Klinikum Schwabing, Munich, Germany.

HEENT

Ophthalmoscopic examination revealed dilatation and tortuosity of the retinal veins.Source: Kim YL. et al, Department of Internal Medicine, Eulji University College of Medicine, Seoul, Korea.
Ophthalmologic findings in the presented case. The optic disk of the left eye is shown. The perivenous sheathing is indicated (black arrow). [https://openi.nlm.nih.gov/detailedresult.php?img=PMC4163423_CRIONM2014-165670.002&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=30 Source: Nipp R. et al, Dana-Farber Cancer Institute, 450 Brookline Avenue, Boston, MA 02215, USA.
]
One year after therapy. The right fundus exhibited a roundish, subretinal, pseudovitelliform deposit (a). The deposit displayed uneven hyper-autofluorescence on a fundus autofluorescence photograph (c) and an uneven staining in fluorescein angiography (e). It was associated with macular edema in an OCT horizontal scan (g). The left eye fundus exhibited a large retinal serous detachment (b), with the accumulation of hyper-autofluorescent lipofuscin material in autofluorescence fundus photography (d). Fluorescein angiography was not contributive (f), but OCT showed the absence of central photoreceptors (h). [https://openi.nlm.nih.gov/detailedresult.php?img=PMC3433005_cop-0003-0236-g02&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=27 Source: Brolly A. et al, Department of Ophthalmology, APHP, Hôpital Lariboisière, University Paris Diderot, Sorbonne Paris Cité, Bourges, France.
]
Fluorescein angiography: Hyperviscosity syndrome characterized by bilateral retinal venous dilation and tortuosity, retinal hemorrhages and peripheral microaneurysms.[https://openi.nlm.nih.gov/detailedresult.php?img=PMC3433005_cop-0003-0236-g01&query=waldenstrom+macroglobulinaemia&it=xg&req=4&npos=26 Source: Brolly A. et al, Department of Ophthalmology, APHP, Hôpital Lariboisière, University Paris Diderot, Sorbonne Paris Cité, Bourges, France.
]

Neck

Respiratory

Cardiovascular system

Abdomen

Extremity

Neuromuscular

References

  1. ↑ Waldenström's macroglobulinemia. MedlinePlus (2015) https://www.nlm.nih.gov/medlineplus/ency/article/000588.htm Accessed on November 15th, 2015
  2. ↑ Lin P, Bueso-Ramos C, Wilson CS, Mansoor A, Medeiros LJ (2003). "Waldenstrom macroglobulinemia involving extramedullary sites: morphologic and immunophenotypic findings in 44 patients". Am J Surg Pathol. 27 (8): 1104–13. PMID 12883242.
  3. ↑ 3.0 3.1 Daoud MS, Lust JA, Kyle RA, Pittelkow MR (1999). "Monoclonal gammopathies and associated skin disorders". J Am Acad Dermatol. 40 (4): 507–35, quiz 536-8. PMID 10188670.
  4. ↑ Veltman GA, van Veen S, Kluin-Nelemans JC, Bruijn JA, van Es LA (1997). "Renal disease in Waldenström's macroglobulinaemia". Nephrol Dial Transplant. 12 (6): 1256–9. PMID 9198063.
  5. ↑ Orellana J, Friedman AH (1981). "Ocular manifestations of multiple myeloma, Waldenström's macroglobulinemia and benign monoclonal gammopathy". Surv Ophthalmol. 26 (3): 157–69. PMID 6801795.
  6. ↑ Pilon AF, Rhee PS, Messner LV (2005). "Bilateral, persistent serous macular detachments with Waldenström's macroglobulinemia". Optom Vis Sci. 82 (7): 573–8. PMID 16044069.
  7. ↑ Avashia JH, Fath DF (1989). "Bilateral central retinal vein occlusion in Waldenström's macroglobulinemia". J Am Optom Assoc. 60 (9): 657–8. PMID 2507620.
  8. ↑ Goen TM, Terry JE (1986). "Mid-peripheral hemorrhages secondary to Waldenström's macroglobulinemia". J Am Optom Assoc. 57 (2): 109–12. PMID 3081619.
  9. ↑ Dimopoulos, Meletios A.; Panayiotidis, Panayiotis; Moulopoulos, Lia A.; Sfikakis, Petros; Dalakas, Marinos (2000). "Waldenström's Macroglobulinemia: Clinical Features, Complications, and Management". Journal of Clinical Oncology. 18 (1): 214–214. doi:10.1200/JCO.2000.18.1.214. ISSN 0732-183X.
  10. ↑ 10.0 10.1 Fadil A, Taylor DE (1998). "The lung and Waldenström's macroglobulinemia". South Med J. 91 (7): 681–5. PMID 9671845.
  11. ↑ Coimbra J, Costa AP, Pita F, Rosado P, de Almeida LB (1995). "[Neuropathy in Waldenstrom's macroglobulinemia]". Acta Med Port (in Portuguese). 8 (4): 253–7. PMID 7625222.

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