Waldenström's macroglobulinemia history and symptoms: Difference between revisions

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===Symptomatic:===
===Symptomatic:===
====Constitutional symptoms====
====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>
*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>
:*Fever
*Fever
:*Night sweat
*Night sweat
:*[[Lymphedema]]
*[[Lymphedema]]


====Hyperviscosity syndrome====
====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 hyper viscosity syndrome occur if serum viscosity is >4 centipoises.<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&sectionRank=3&anchor=H29#H6 Accessed on November 10, 2015</ref>
*Clinical manifestation of hyper viscosity syndrome occur if serum viscosity is >4 centipoises.<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&sectionRank=3&anchor=H29#H6 Accessed on November 10, 2015</ref>


====Neurological Symptoms of hyperviscosity====
====Neurological Symptoms of hyperviscosity====
:*Retinal hemorrhage with blurring of vision
*Retinal hemorrhage with blurring of vision
:*Vertigo
*Vertigo
:*Dizziness
*Dizziness
:*Headache
*Headache
:*Nystagmus
*Nystagmus
:*Tinnitus
*Tinnitus
:*Ataxia
*Ataxia


====Vascular symptom====
====Vascular symptom====
:*Oronasal bleeding
*Oronasal bleeding


====Neuropathic symptoms====
====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.
:*Symtoms are associated with Anti-myelin-associated glycoprotein activity.
*Symtoms 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====
====Cryoglobulinemia====
:*Serious symptoms of Waldenström's macroglobulinemia include Raynaud phenomenon, urticaria, purpura, acral cyanosis, and/or tissue necrosis.
*Serious symptoms of Waldenström's macroglobulinemia include Raynaud phenomenon, urticaria, purpura, acral cyanosis, and/or tissue necrosis.


====Renal involvement====
====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====
====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====
====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 on extensor surface
 


==References==
==References==

Revision as of 19:06, 16 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.

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:

Symptoms

Asymptomatic or Smoldering:

Waldenström's macroglobulinemia is asymptomatic in 30% of patients.[1]

Symptomatic:

Constitutional symptoms

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 hyper viscosity syndrome occur if serum viscosity is >4 centipoises.[2]

Neurological Symptoms of hyperviscosity

  • Retinal hemorrhage with blurring of vision
  • Vertigo
  • Dizziness
  • Headache
  • Nystagmus
  • Tinnitus
  • Ataxia

Vascular symptom

  • Oronasal bleeding

Neuropathic symptoms

  • Most prominent neuropathic symptom of Waldenström's macroglobulinemia is progressive sensorimotor peripheral neuropathy, mostly of distal lower extremity.
  • Symtoms 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 Waldenström's macroglobulinemia 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 papule on extensor surface

References

  1. ↑ 1.0 1.1 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. ↑ 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&sectionRank=3&anchor=H29#H6 Accessed on November 10, 2015

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