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Virtual case of the month
Recurrent gastrointestinal bleeding in a patient with IgM paraproteinaemia
  1. Sanjay de Mel1,
  2. Muhammad Bilal Abid1,
  3. Kok-Siong Poon2,
  4. Sau-Yoke Ng2,
  5. Li-Mei Poon1,
  6. Shi Wang3
  1. 1 Department of Haematology-Oncology, National University Cancer Institute Singapore, National University Health System, Singapore, Singapore
  2. 2 Department of Laboratory Medicine, Molecular Diagnosis Centre, National University Health System, Singapore, Singapore
  3. 3 Department of Pathology, National University Health System, Singapore, Singapore
  1. Correspondence to Dr Sanjay de Mel, Department of Haematology-Oncology, National University Cancer Institute, National University Health System, Singapore, Singapore; wspdm199{at}yahoo.com

https://doi.org/10.1136/jclinpath-2017-204415

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    Clinical question

    A 64-year-old man presented with gastrointestinal bleeding and inguinal lymphadenopathy. His lymph node biopsy is presented in slide A. An IgM paraprotein was detected in his serum while a full blood count and film suggested iron deficiency with no lymphocytosis. A small bowel mass was detected on CT scan but the patient declined further investigations including bone marrow studies. He was treated based on the lymph node histology with transient resolution of the bleeding. He subsequently underwent resection of the small bowel mass due to recurrent bleeding. The histology of the small bowel mass is presented in slide B.

    Review the high-quality, interactive digital Aperio slide at http://virtualacp.com/JCPCases/jclinpath-2017-204415_A/ and http://virtualacp.com/JCPCases/jclinpath-2017-204415_B/ …

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    Footnotes

    • Handling editor Iskander Chaudhry.

    • Contributors SdM conceived of the study and wrote the manuscript. MBA co-wrote the manuscript. K-SP and S-YN performed and provided the pyrosequencing data. SW provided the histopathology images and descriptions. L-MP assisted in the writing and performed a critical review of the manuscript. All authors read and approved the final manuscript.

    • Competing interests None declared.

    • Patient consent Obtained.

    • Provenance and peer review Commissioned; internally peer reviewed.