SYNOPSISThe clinical course and pathological features of four cases of Waldenstrom's macroglobulinaemia are described. One was associated with a localized carcinoma of the bronchus and one with a chromophobe adenoma of the pituitary.Trypsin digest preparations of the retina were examined in two cases, one with severe retinopathy and the other with no clinical evidence of ocular disease, and the findings are briefly described. (1960). Opinion is still divided as to whether the condition is a disease entity or a syndrome.Of the 20 cases which have been reported in this country, and in which the diagnosis has been supported by ultracentrifugal studies, only four have been examined after death (McFarlane, Dovey, Slack, and Papastamatis, 1952; Martin, 1960). A detailed description of four cases which subsequently came to necropsy and have not previously been reported seems to be justified. Digitalis, mersalyl, and transfusion of 6 pints of blood relieved the cardiac failure within a week of admission.Subsequently a chest radiograph showed a mass in the lower part of the right hilum consistent with a bronchial neoplasm. Radiographs of the skeleton showed osteoporosis only. LYMPH NODE BIOPSIES Sections of lymph nodes obtained from the right groin and left axilla showed no evidence of carcinomatous involvement. The lymphoid follicles were obscured but reticulin preparations showed the architecture of the nodes to be preserved (Fig. 1). A cellular infiltrate was present, particularly in the pulp and in the pericapsular tissues (Fig. 2). It consisted of lymphocytes, plasma cells, cells intermediate in morphology between plasma cells and lymphocytes, reticulum cells, and occasional tissue mast cells, seen best in Romanowsky-stained imprint preparations. When stained by the UnnaPappenheim method, the plasma cells were typically pyroninophilic, while the majority of the intermediate or 'lymphoid-plasma' cells were pyronin-negative. The sinuses of both nodes were haemorrhagic, and contained reticulum cells showing erythrophagocytosis. Haemosiderin granules were present in the inguinal node but not in the axillary node. The most striking feature of lymph node imprints subjected to the periodic acid-Schiff reaction was the intense background staining associated with a negative reaction in the majority of the lymphoid 351 on 11 May 2018 by guest. Protected by copyright.