A 62-year-old man presented with a 7-year history of progressive enlargement of lymph nodes and significant weight loss. Physical examination showed firm to hard submental, submandibular, occipital, cervical, axillary, epitrochlear, and groin lymphadenopathy ( Fig 1A). The tonsils were not enlarged. There was otherwise no organomegaly. Plain radiographs of the enlarged lymph nodes showed fine punctate to coarse calcification (arrows in Fig 1B, calcification in submandibular and occipital nodes; Fig 1C, calcifications in bilateral submental, submanidublar, and cervical lymph nodes; Fig 1D, massive axillary lymph nodes with calcification; Fig 1E, diffuse groin, iliac, and para-aortic lymphadenopathy with fine to coarse calcification). A positron emission tomography (PET)/computed tomography scan showed similar calcifications in the salivary glands, mesentery, peritoneal cavity, and enlarged lymph nodes in the parotid, submandibular, sublingual, cervival, axillary, mediastinal, hilar, abdominal, para-aortic, iliac, and groin areas (Fig 2A, arrows). However, the lymphadenopathy was eu-metabolic with no increase in [ 18 F]fluorodeoxyglucose (FDG) uptake (Fig 2B, arrows) on PET scan. The liver, spleen, and kidneys were normal in size with no abnormal FDG uptake. Further investigations showed normal blood counts and liver and renal function tests. His immunoglobulin M (IgM) was increased to 1,720 mg/dL (reference range, 55 to 307 mg/dL). Serum immunoelectrophoresis showed a monoclonal band, which was confirmed to be IgM lambda on immunofixation. Urine immunofixation also con-Fig 1.