Lytic Bone Lesions as a Prominent Feature in Waldenstrom's Macroglobulinemia

We report a patient with Waldenstrom's macroglobulinemia who had diffuse plasmacytoid infiltration in the bone marrow, immunoglobulin M monoclonal gammopathy, wide-spread osteolytic lesions, recurrent pathologic fractures, and diffuse subcutaneous soft tissue calcifications. The bony lesions were even more pronounced than those usually seen with multiple myeloma and are a rare manifestation of this disease. Such malignant plasma-cell dyscrasia with macroglobulinemia and lytic osseous lesions is best handled clinically according to its general presenting features rather than according to whether it is Waldenstrom's macroglobulinemia or an immunoglobulin M myeloma. The bone lesions may require local palliative radiotherapy and orthopedic measures.