Presentation
Chronic slow weight loss, mild malaise and lethargy
Patient Data
There is abnormal soft tissue attenuation material in a right paramedian presacral position, extending into sacral foramina and surrounding the iliac arteries. Further abnormal soft tissue is seen anterior to the right kidney within the perinephric space. No splenomegaly.
The bones adjaced to the presacral mass are normal in appearance.
Biopsy result
Markers demonstrate a clonal proliferation of B-cells which are SMIg kappa+ light chain restricted, SMIg M+, CD19+, CD20+, CD22+, CD24+, CD5-, CD43-, CD10-, CD38-, CD23-, FMC7-ve, TDT-ve.
These cells total 71% of NEC.
In conclusion: marker results are consistent with a B-cell non-Hodgkin lymphoma.
This study was performed several months after the CT with which it was compared.
(Ignoring the prostate findings)
Stable 8 x 6 cm soft tissue homogeneous intermediate T1/T2 signal intensity avidly enhancing mass in the posterior right pelvis; high signal DWI on b800 with a low ADC value (incompletely imaged on some of the axial sequences carried out for the prostate). The lesion abuts the sacrum and extends into the right first and second sacral foramina. It also abuts the right common iliac vessels and encases the right internal iliac vessels.
Case Discussion
The presacral mass seen on CT has not changed significantly in size in a several month interval, despite the fact that the patient was not on any treatment (and was largely asymptomatic). This case illustrates the indolent nature of Waldenström macroglobulinemia.
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