Mesenteric Mass Causing Bowel Obstruction in Waldenström Macroglobulinemia

Area of Science:

• Hematology
• Oncology
• Gastroenterology

Background:

• Waldenström macroglobulinemia (WM) is an indolent lymphoplasmacytic lymphoma characterized by bone marrow infiltration and monoclonal IgM production.
• While typically slow-progressing, WM can present with rare, severe complications like abdominal masses causing intestinal obstruction.

Observation:

• A 62-year-old male with WM presented with pulmonary lesions and PET-CT findings of abdominal/mesenteric lymphoproliferative disease.
• Initial chemotherapy with bendamustine and rituximab was administered.
• The patient developed severe gastrointestinal symptoms including abdominal cramps, weight loss, and bowel obstruction.

Findings:

• Histopathology confirmed WM and a low-grade B-cell non-Hodgkin lymphoma in an abdominal mass.
• Laparoscopic enterectomy revealed transmural intestinal ischemia and fibrosis, with no residual lymphoma.
• Post-surgical recovery was uneventful with symptom resolution.

Implications:

• This case highlights a rare but critical gastrointestinal complication of WM requiring surgical management.
• It underscores the necessity of a multidisciplinary approach for managing atypical hematologic malignancy presentations.
• Early recognition and surgical intervention are crucial for severe GI complications in WM patients.