Urological Surgery Podium Presentation: Stopping the Flow: A Peculiar Case of Enlarged Prostate, Kidney Injury, Cardiac Dysfunction, and Colonic Polyps

Introduction/Purpose: Waldenstrom Macroglobulinemia is a rare form of Non-Hodgkin's lymphoma. Surgical management of such condition is poorly documented; however, surgical biopsy is key to making the diagnosis. The following case illustrates a peculiar case of Waldenstrom Macroglobulinemia complicated by immunoglobulin light chain amyloidosis.

Methods or Case Description: A 70-year old male presented with acute kidney injury and was found to have proteinuria secondary to prostatic enlargement. Urologic management included a workup for prostatic cancer as well as benign prostatic hypertrophy. The patient underwent a transurethral resection of the prostate (TURP). Following this management, proteinuria persisted without an identifiable cause. The decision was made to biopsy the kidneys at this time; results showed deposition of amyloid. Although no biopsy was performed, we suspect the prostate contained amyloid depositions. The patient had failure to thrive secondary to decreased oral intake; esophagogastroduodenoscopy was completed with biopsy of the esophageal and gastric tissue. Concurrently, the patient’s cardiac function appeared to deteriorate. Upon echocardiogram, specific hypertrophy of the left ventricle was found and an endomyocardial biopsy was completed. Combined biopsy results alluded to systemic light chain amyloidosis; further workup identified Waldenstrom Macroglobulinemia as the underlying cause.

Outcomes: The patient underwent successful kidney, endomyocardial, gastric, and esophageal biopsies as well as a TURP. Subsequent percutaneous endoscopic gastrostomy tube was placed for nutritional management. Medical management included chemotherapy, kidney function monitoring, and nutritional status evaluation secondary to decreased absorption capabilities. The surgical team continues to follow the patient for possible resection of tissues as needed.

Conclusion: Waldenstrom Macroglobulinemia requires a high index of suspicion. This case illustrates an uncommon presentation of light chain amyloidosis. Diligent evaluation of prostatic enlargement and decreased kidney function is required.