PMC5684595_01
Peripheral blood smears from (a) Case 1 and (b) Case 2, which exhibit rouleaux formation of the red blood cells.
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fig1
A peripheral blood smear clearly exhibited rouleaux formation (Figure 1).
Immunostaining of lymphoplasmacytic lymphoma (LPL) cells in the bone marrow clot preparation from Case 1. The LPL cells were diffusely positive for CD20 but only sporadically positive for CD38 (original magnification, x400).
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fig2
As shown in Figure 2, the bone marrow was infiltrated with LPL cells that were diffusely positive for CD20 but only sporadically positive for CD38.
Fundoscopic findings. (a) Case 1 exhibited bilateral central retinal vein occlusion (CRVO) and optic nerve head edema with diffuse peripheral and central retinal hemorrhages that were accompanied by a large vitreous hemorrhage. (b) Case 2 exhibited bilateral tortuous blood vessels with a rod-like retinal hemorrhage (left eye) without macular edema.
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fig3
Although the patient did not complain of vision problems, fundoscopy revealed bilateral tortuous blood vessels with a few hemorrhages but no macular edema (Figure 3).
PMC5684595_02
Peripheral blood smears from (a) Case 1 and (b) Case 2, which exhibit rouleaux formation of the red blood cells.
CRIHEM2017-3732902.001.jpg
PMC5684595_02_CRIHEM2017-3732902.001.jpg
fig1
A peripheral blood smear clearly exhibited rouleaux formation (Figure 1).
Fundoscopic findings. (a) Case 1 exhibited bilateral central retinal vein occlusion (CRVO) and optic nerve head edema with diffuse peripheral and central retinal hemorrhages that were accompanied by a large vitreous hemorrhage. (b) Case 2 exhibited bilateral tortuous blood vessels with a rod-like retinal hemorrhage (left eye) without macular edema.
CRIHEM2017-3732902.003.jpg
PMC5684595_02_CRIHEM2017-3732902.003.jpg
fig3
Although the patient did not complain of vision problems, fundoscopy revealed bilateral tortuous blood vessels with a few hemorrhages but no macular edema (Figure 3).
Histopathology findings of the biopsied tissue of the right kidney of Case 2. (a) Light microscopy revealed tubulointerstitial nephritis with marked infiltration by lymphoplasmacytic lymphoma (LPL) cells that were diffusely positive for CD20 (G: glomerulus; T: tubules; original magnification, x100). (b) Electron microscopy showed that the renal tissue was infiltrated by LPL cells (original magnification, x1,000). (c) Fluorescence microscopy revealed dot-like IgM depositions in the mesangial region (there were no depositions for IgG, IgA, or C3c). Significant morphological glomerular changes were not noted (photos not shown).
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fig4
Light and electron microscopic studies of the biopsied kidney tissue revealed massive interstitial LPL cell infiltration, while the fluorescence microscopic study revealed mild dot-like mesangial IgM depositions (Figure 4).