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Previous Volume 346:784 March 7, 2002 Number 10 Next

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To the Editor: In Case Record 27-2001 (Aug. 30 issue),¹ Table 1 and the discussion by Dr. Noopur Raje contain errors. Neither multiple myeloma nor the classic (or pure) form of Waldenström's macroglobulinemia is marked by massive splenomegaly. Massive splenomegaly is rarely a feature of Hodgkin's disease.

Harvey E. Finkel, M.D.
92 Dean Rd.
Brookline, MA 02445-4244

References

1. Case Records of the Massachusetts General Hospital (Case 27-2001). N Engl J Med 2001;345:682-687. [Free Full Text]

To the Editor: I agree that Table 1 is somewhat misleading. It should have been entitled "Hematologic Diseases Associated with Splenomegaly and Anemia." The causes of massive splenomegaly mentioned in the discussion include chronic myeloid leukemia, agnogenic myeloid metaplasia, and polycythemia vera. Variants of certain other hematologic cancers, such as chronic lymphocytic leukemia of the prolymphocytic type, and lymphoproliferative disorders, such as marginal-zone lymphoma, are other causes. Although splenomegaly has been described in multiple myeloma, Hodgkin's disease, and Waldenström's macroglobulinemia, these diseases certainly do not constitute the common causes of massive splenomegaly.

Noopur Raje, M.D.
Dana–Farber Cancer Institute
Boston, MA 02115

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