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TO THE EDITOR: Lymphoplasmacytic lymphoma (LPL) is a neoplasm of small B lymphocytes, plasmacytoid lymphoid cells, and plasma cells that usually involves bone marrow, and sometimes, the lymph nodes and spleen; which does not fulfill the criteria for any other small B cell lymphoid neoplasms that may also have plasmacytic differentiation [1]. Waldenstrom's macroglobulinemia (WM) comprises a significant proportion of LPL cases and is characterized by bone marrow involvement and an IgM monoclonal gammopathy of any concentration [2].  When WM was first described, the general belief was that it did not extend to the skeletal system. However, following several reports of lytic bone lesions in WM [3-6], this belief has been challenged. It is now considered that bone involvement in WM may not be unusual. The abnormal feature that was commonly observed in these previously reported cases was the presence of a predominant plasmacytic morphology in the bone marrow of the WM patients with lytic bone lesions. Contrary to these reports, we hereby report a rare case of WM with lytic bone lesions, showing a predominant presence of lymphocytic infiltration of the bone marrow, and very few plasmacytic cells.

Waldenstrom's macroglobulinemia presenting with lytic bone lesions: a rare presentation