Xanthomas of the stomach

Abstract

nary parenchyma or in the walls of the blood vessels. These findings, especially the plasmacytoid lymphocytes, are consistent with the pathologic diagnosis of Waldenstrom's macroglobu Iinem ia.' Shortly after the lung biopsy, the patient's hematocrit dropped from 35% to 28%, and she was also noted to have melena and guaiac-positive stools. Repeated upper gastrointestinal endoscopy was performed with the Olympus Model GFB-2 fiberscope. On this examination the body of the stomach was found to be extremely abnormal with hemorrhage, friability, adherent mucus, and nodularity. There were multiple areas of deep, irregular, poorly demarcated ulceration. The biopsy showed heavy infiltration of the stomach with lymphocytes, plasma cells and plasmacytoid lymphocytes (Figure 2). This mixed lymphoid infiltrate is consistent with Waldenstrom's disease.' The patient was treated for a month with 100 mg daily of oral cyclophosphamide, and repeated endoscopy with the Olympus Model GFB2 fiberscope revealed significant improvement. There were 3 to 4 superficial ulcerations in the distal body of the stomach. The mucosa through this area still appeared infiltrated. There was less friability of the mucosa than on the previous examination, but the endoscopic biopsy continued to show the presence of plasmacytoid lymphocytes.