Waldenström's macroglobulinemia history and symptoms: Difference between revisions
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*Gastrointestinal involvement | *Gastrointestinal involvement | ||
==Asymptomatic or Smoldering Waldenström's macroglobulinemia== | |||
Waldenström's macroglobulinemia is asymptomatic in 30% of patients.<ref name="HS">Waldenström's macroglobulinemia symptoms and signs. Cancer.Net (2015)http://www.cancer.net/cancer-types/waldenstrom’s-macroglobulinemia/symptoms-and-signs Accessed on November 10, 2015</ref> | |||
=== | ==Symptomatic Waldenström's macroglobulinemia== | ||
===Constitutional symptoms=== | |||
*Weight loss<ref name="HS">Waldenström's macroglobulinemia symptoms and signs. Cancer.Net (2015)http://www.cancer.net/cancer-types/waldenstrom’s-macroglobulinemia/symptoms-and-signs Accessed on November 10, 2015</ref><ref name="HF">Waldenström's macroglobulinemia. UpToDate (2015)http://www.uptodate.com/contents/epidemiology-pathogenesis-clinical-manifestations-and-diagnosis-of-waldenstrom-macroglobulinemia?source=machineLearning&search=Waldenström%27s+macroglobulinemia&selectedTitle=1%7E80§ionRank=3&anchor=H29#H6 Accessed on November 10, 2015</ref> | |||
*[[Fever]] | *[[Fever]] | ||
*[[Night sweat]] | *[[Night sweat]] | ||
*[[Lymphedema]] | *[[Lymphedema]] | ||
===Hyperviscosity syndrome=== | |||
*Accumulation of IgM proteins in blood can increase the viscosity of blood, slowing down the flow of blood to different organs. | *Accumulation of IgM proteins in blood can increase the viscosity of blood, slowing down the flow of blood to different organs. | ||
*Clinical manifestation of hyperviscosity syndrome occur if serum viscosity is >4 centipoises. | *Clinical manifestation of hyperviscosity syndrome occur if serum viscosity is >4 centipoises. | ||
===Neurological Symptoms of hyperviscosity=== | |||
*Retinal [[hemorrhage]] with blurring of vision | *Retinal [[hemorrhage]] with blurring of vision | ||
*[[Vertigo]] | *[[Vertigo]] | ||
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*[[Ataxia]] | *[[Ataxia]] | ||
===Vascular symptom=== | |||
*Oronasal bleeding | *Oronasal bleeding | ||
===Neuropathic symptoms=== | |||
*Most prominent neuropathic symptom of Waldenström's macroglobulinemia is progressive sensorimotor [[peripheral neuropathy]], mostly of distal lower extremity. | *Most prominent neuropathic symptom of Waldenström's macroglobulinemia is progressive sensorimotor [[peripheral neuropathy]], mostly of distal lower extremity. | ||
*Symptoms are associated with Anti-myelin-associated glycoprotein activity. | *Symptoms are associated with Anti-myelin-associated glycoprotein activity. | ||
*Less common neuropathic manifestations are [[cranial nerve palsies]], [[mononeuropathy]], [[mononeuritis multiplex]], multifocal leukoencephalopathy, and sudden deafness. | *Less common neuropathic manifestations are [[cranial nerve palsies]], [[mononeuropathy]], [[mononeuritis multiplex]], multifocal leukoencephalopathy, and sudden deafness. | ||
===Cryoglobulinemia=== | |||
*Serious symptoms of Cryoglobulinemia include [[Raynaud phenomenon]], [[urticaria]], [[purpura]], acral [[cyanosis]], and/or tissue [[necrosis]]. | *Serious symptoms of Cryoglobulinemia include [[Raynaud phenomenon]], [[urticaria]], [[purpura]], acral [[cyanosis]], and/or tissue [[necrosis]]. | ||
===Renal involvement=== | |||
*In few cases of Waldenström's macroglobulinemia, deposits of IgM in the glomerular basement membrane and infiltration of lymphocytes or plasmacytoid cells occur. | *In few cases of Waldenström's macroglobulinemia, deposits of IgM in the glomerular basement membrane and infiltration of lymphocytes or plasmacytoid cells occur. | ||
*Immune-mediated [[glomerulonephritis]], typically due to IgM deposition or cryoglobulinemia | *Immune-mediated [[glomerulonephritis]], typically due to IgM deposition or cryoglobulinemia | ||
*Renal [[amyloidosis]] can lead to [[Nephrotic syndrome]] in few cases. | *Renal [[amyloidosis]] can lead to [[Nephrotic syndrome]] in few cases. | ||
===Gastrointestinal involvement=== | |||
*Deposition of monoclonal IgM protein in the [[lamina propria]] of intestine can produce diarrhea/steatorrhea due to malabsorption. | *Deposition of monoclonal IgM protein in the [[lamina propria]] of intestine can produce diarrhea/steatorrhea due to malabsorption. | ||
===Cutaneous involvement=== | |||
*Infiltration of dermis by Lymphoplasmacytoid cells can produce macular or papulonodular lesions | *Infiltration of dermis by Lymphoplasmacytoid cells can produce macular or papulonodular lesions | ||
*Deposition of IgM on epidermal basement membrane proteins can lead to multiple flesh colored pruritic [[papule]] on extensor surface | *Deposition of IgM on epidermal basement membrane proteins can lead to multiple flesh colored pruritic [[papule]]s on extensor surface | ||
==References== | ==References== | ||
Revision as of 19:49, 17 November 2015
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Mirdula Sharma, MBBS [2]
Overview
The hallmark of Waldenström's macroglobulinemia is hyperviscosity syndrome. A positive history of oronasal bleeding and peripheral neuropathy is suggestive of Waldenström's macroglobulinemia.[1][2]
History
When evaluating a patient suspected of Waldenström's macroglobulinemia, you should take a detailed history of the presenting symptoms (duration, onset, progression), a thorough past medical history review, and a review of any other associated symptoms. When obtaining the history focus on a possible associated syndromes such as:[1][2]
- Hyperviscosity syndrome
- Peripheral neuropathy
- Cryoglobulinemia
- Renal involvement
- Gastrointestinal involvement
Asymptomatic or Smoldering Waldenström's macroglobulinemia
Waldenström's macroglobulinemia is asymptomatic in 30% of patients.[1]
Symptomatic Waldenström's macroglobulinemia
Constitutional symptoms
- Weight loss[1][2]
- Fever
- Night sweat
- Lymphedema
Hyperviscosity syndrome
- Accumulation of IgM proteins in blood can increase the viscosity of blood, slowing down the flow of blood to different organs.
- Clinical manifestation of hyperviscosity syndrome occur if serum viscosity is >4 centipoises.
Neurological Symptoms of hyperviscosity
Vascular symptom
- Oronasal bleeding
Neuropathic symptoms
- Most prominent neuropathic symptom of Waldenström's macroglobulinemia is progressive sensorimotor peripheral neuropathy, mostly of distal lower extremity.
- Symptoms are associated with Anti-myelin-associated glycoprotein activity.
- Less common neuropathic manifestations are cranial nerve palsies, mononeuropathy, mononeuritis multiplex, multifocal leukoencephalopathy, and sudden deafness.
Cryoglobulinemia
- Serious symptoms of Cryoglobulinemia include Raynaud phenomenon, urticaria, purpura, acral cyanosis, and/or tissue necrosis.
Renal involvement
- In few cases of Waldenström's macroglobulinemia, deposits of IgM in the glomerular basement membrane and infiltration of lymphocytes or plasmacytoid cells occur.
- Immune-mediated glomerulonephritis, typically due to IgM deposition or cryoglobulinemia
- Renal amyloidosis can lead to Nephrotic syndrome in few cases.
Gastrointestinal involvement
- Deposition of monoclonal IgM protein in the lamina propria of intestine can produce diarrhea/steatorrhea due to malabsorption.
Cutaneous involvement
- Infiltration of dermis by Lymphoplasmacytoid cells can produce macular or papulonodular lesions
- Deposition of IgM on epidermal basement membrane proteins can lead to multiple flesh colored pruritic papules on extensor surface
References
- ↑ 1.0 1.1 1.2 1.3 Waldenström's macroglobulinemia symptoms and signs. Cancer.Net (2015)http://www.cancer.net/cancer-types/waldenstrom’s-macroglobulinemia/symptoms-and-signs Accessed on November 10, 2015
- ↑ 2.0 2.1 2.2 Waldenström's macroglobulinemia. UpToDate (2015)http://www.uptodate.com/contents/epidemiology-pathogenesis-clinical-manifestations-and-diagnosis-of-waldenstrom-macroglobulinemia?source=machineLearning&search=Waldenström%27s+macroglobulinemia&selectedTitle=1%7E80§ionRank=3&anchor=H29#H6 Accessed on November 10, 2015