Relapsed Waldenström macroglobulinemia presenting as bilateral parotid gland enlargement with multiple cystic lesions: A case report.

Relapsed WM can present as bilateral parotid gland enlargement, an exceptionally uncommon extramedullary manifestation.

• The patient was a 79-year-old man with a history of WM.
• He had achieved stable disease for several years after multiple courses of chemotherapy.
• He then developed bilateral parotid gland enlargement that was suspicious for relapsed WM.

Imaging of the enlarged parotid glands showed multiple cystic lesions.

• Imaging studies revealed multiple cystic lesions in the context of bilateral parotid enlargement.
• The abstract does not specify the imaging modalities used.

Relapsed WM was considered the most likely diagnosis based on elevated serum IgM and clonal IgH gene rearrangement in fine-needle aspirates.

• Serum immunoglobulin M (IgM) levels were markedly elevated.
• Polymerase chain reaction analysis of fine-needle aspirates demonstrated immunoglobulin heavy chain (IgH) gene rearrangement.
• The diagnosis was described as 'most likely' rather than definitively confirmed by the abstract's wording.

Because of poor clinical condition, the patient received palliative care and died of sepsis 4 months after parotid enlargement appeared.

• No further disease-directed therapy was given due to poor clinical condition.
• Death was attributed to sepsis.
• Time from presentation of parotid enlargement to death was 4 months.

Relapsed WM should be considered in the differential diagnosis of parotid gland enlargement, especially with a prior lymphoplasmacytic malignancy.

• This is the authors' stated conclusion from a single case.
• The emphasis is on patients with a history of lymphoplasmacytic malignancy.