Painful swelling of the skull as the first symptom of multiple myeloma - a case report.

Background Multiple myeloma is a haematological blood cancer of the bone marrow and is classified by the World Health Organisation (WHO) as a plasma cell neoplasm. In multiple myeloma, normal plasma cells transform into malignant myeloma cells and produce large quantities of an abnormal immunoglobulin called monoclonal protein or M protein. This ultimately causes multiple myeloma symptoms such as bone damage or kidney problems. The annual worldwide incidence of multiple myeloma is estimated to be 6 - 7/100,000 and accounts for 1% of all cancer. In Germany, there are about 6,000 cases of newly diagnosed multiple myeloma per annum. In the current era of new agents, such as immunomodulatory drugs and proteasome inhibitors and antibodies, enormous progress has been achieved in the therapy of multiple myeloma. In orthopaedics, it is essential to be able to recognise the of alarming symptoms of multiple myeloma in clinical routine and to be aware of basic diagnostic features to confirm this disease. Surgical treatment of myeloma-related bone lesions - such as stabilisation of pathological fractures - is an important domain of tumour orthopaedic surgery. Methods A comprehensive literature search was performed in PubMed using the keywords "multiple myeloma" and "diagnostic" or "therapy". This served to evaluate the available primary and secondary literature on the current status of the diagnostic testing and therapy of multiple myeloma. Systematic reviews, meta-analyses and clinical studies as well as international recommendations in therapy were included until the spring of 2016. Results There are now very sensitive screening methods for the diagnosis of multiple myeloma. Accurate diagnosis is generally based on several factors, including physical evaluation, patient history, symptoms, and diagnostic testing results. The standards for initial diagnostic tests are determined by blood and urine tests as well as a bone marrow biopsy and skeletal imaging, such as X-rays, CT scans and MRI scans. Major and minor criteria are required to confirm the diagnosis of multiple myeloma and help to determine the classification and staging of multiple myeloma, and whether it is smoldering myeloma (asymptomatic), symptomatic myeloma, or a monoclonal gammopathy of undetermined significance (MGUS). Multiple myeloma treatment options have increased significantly over the last 10 years. Standard of basic myeloma treatment consists of high dose chemotherapy in combination with autologous stem cell transplantation. Several factors may determine multiple myeloma treatment, such as age and general health, results of laboratory and cytogenetic (genomic) tests as well as symptoms and disease complications. After evaluation of these factors, an individual and often multimodal treatment plan is created and implemented in interdisciplinary cooperation. Conventional treatment options have to be evaluated for older patients (> 70 - 75 years), who are not eligible for high dose chemotherapy and autologous stem cell transplantation due to their age and/or severe comorbidities. It is essential to include supportive therapy in the integral treatment concept, in order to control pain or retain function or mobility. Supportive drugs such as bisphosphonates but also radiation therapy and orthopaedic surgery may be required in order to manage complications of the disease as well as side effects of treatment. Conclusion Current studies show promising results in the treatment of multiple myeloma, due to new agents such as immunomodulatory drugs, proteasome inhibitors and antibodies, which may improve prognosis and survival rate among myeloma patients in the future. However treatment algorithms have become more complex and expensive.

Patient: Male, 48Final Diagnosis: Multiple myelomaSymptoms: Back painMedication: —Clinical Procedure: —Specialty: HematologyObjective:Rare diseaseBackground:Focal segmental glomerulosclerosis (FSGS) is a common cause of nephrotic syndrome in adults, which can be primary, or secondary to various causes. Unlike membranous nephropathy, FSGS is less likely to be associated with malignancy. Few cases have been reported of the occurrence of FSGS with hematological malignancies like multiple myeloma (MM).Case Report:A 48-year-old man presented with nephrotic syndrome and renal impairment and was diagnosed with primary FSGS after kidney biopsy, which showed a segmental scar with diffuse effacement of foot processes on electron microscopy. Treatment with steroids reduced proteinuria and stabilized the renal function. A few months later, the patient presented with acute Kidney Injury, bone pain, and anemia. A diagnosis of MM was made based on the bone marrow biopsy. Treatment of MM decreased proteinuria and improved renal function.Conclusions:There is an association between FSGS and MM through an unclear mechanism.

Patient: Female, 65-year-oldFinal Diagnosis: Multiple myelomaSymptoms: Palatal lesionMedication: —Clinical Procedure: Biopsy and CBCT • laboratory investigationsSpecialty: DentistryObjective:Unusual clinical courseBackground:Multiple myeloma is a hematological malignancy characterized by monoclonal plasma cell proliferation. Jaw lesions are found in nearly 35% of patients with symptomatic myeloma, and lesions occur in the mandible more often than in the maxilla. However, maxillary or mandibular lesions are rarely found as a primary manifestation of the disease. This report describes a case of a 65-year-old Palestinian woman with lytic lesions in the maxilla due to undiagnosed multiple myeloma identified incidentally on cone beam computed tomography (CBCT).Case Report:A 65-year-old Palestinian woman presented to the Oral Maxillofacial Surgery Clinic with an expansion of the maxilla which was initially thought of as an infection. CBCT imaging revealed diffuse osteolytic lesions involving multiple osseous structures. The patient was biopsied. Histopathological examination was suspicious for plasmacytic neoplasm. She was directly referred to the Hematology Department for further laboratory tests. These included complete blood count, liver function test, bone profile, protein electrophoresis, flow cytometry, and bone marrow biopsy, which were performed to confirm the diagnosis of multiple myeloma. The patient was treated with chemotherapy including zoledronic acid, dexamethasone, bortezomib, and cyclophosphamide. She went into remission for a year but unfortunately died 2 years later.Conclusions:Primary myeloma of the maxilla is a rare presentation. The present report illustrates the role of CBCT imaging supported by a multidisciplinary approach to the diagnosis and management of myeloma. Consequently, it is recommended that dental practitioners be aware of radiographic features and possible oral manifestations to avoid any delay in medical intervention.

Breast cancer and synchronous multiple myeloma as a diagnostic challenge: Case report and review of literature

Symptoms of Multiple Myeloma: Results of Hybrid Concept Elicitation/Cognitive Debriefing Interviews

A Case of Acute Promyelocytic Leukemia Concomitant with Plasma Cell Myeloma

Patient: Female, 54Final Diagnosis: Multiple myelomaSymptoms: A 9-month history of blurred visionMedication: Systemic chemotherapy with vincristine • cyclophosphamide • dexamethasoneClinical Procedure: Multiple myeloma patient presenting with corneal opacity and blurred vision as chief complaintSpecialty: Ophthalmology and HematologyObjective:Rare diseaseBackground:A multiple myeloma patient presenting with corneal opacity and blurred vision as chief complaint is rare.Case Report:A 54-year-old woman with a 9-month history of blurred vision without other systemic symptoms consulted an ophthalmologist. The patient had bilateral diffuse corneal opacity at the corneal epithelium and anterior stroma under slit-lamp examination. Decreased corneal endothelial cells density was found by microscopy. During consultation, the patient was noted to have an anemic face. Laboratory analysis and bone marrow were investigated. Serum protein electrophoresis revealed a raised serum kappa paraprotein band (12.4 g/L). The erythrocyte sedimentation rate (ESR) was accelerated to 49 mm/h (normal <20mm/h). There was mild kidney impairment. The blood urea increased to 8.1 mmol/L (normal <7.1 mmol/L) and creatinine increased to 158 μmol/L (normal <133 μmol/L). Then, a bone marrow biopsy was performed, showing 26% pleomorphic plasma cells (normal <15%). The patient was eventually diagnosed as having MM and was treated with systemic chemotherapy.Conclusions:Blurred vision due to corneal opacity can be an initial presentation of MM, of which ophthalmologists should be aware.

Lenalidomide: A double-edged sword for concomitant multiple myeloma and post-essential thrombocythemia myelofibrosis.

Prediction of Malignant Cell Infiltration Patterns with Texture Features of Biopsy-Correlated Positron Emission Tomography of Osteolytic Lesions in Multiple Myeloma

Multiple myeloma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up

No Decrease in Fracture Risk Despite 15 Years of Treatment Evolution in Multiple Myeloma Patients: A Danish Nationwide Case-Control Study

Purpose: To report a case of multiple myeloma presenting with exophthalmos and central retinal vein occlusion. [Editor: The deleted text immediately to the right was not deleted by me.] syndrome associated with retinitis pigmentosa Method: A case report Results: An 88-year-old female patient complained of fullness sensation on in her right eye for several weeks. Three months before ocular presentation, lower back pain with mild numbness radiatinged to the bilateral lower legs was noted. Exophthalmometry revealed 18-mm and 9-mm in the right and left eye respectively. Magnetic resonance image demonstrated a mass lesion about 3×3.8 cm over the superior-lateral quadrant of the right orbit. Multiple myeloma of the right orbit was diagnosed after orbital tumor biopsy, systemic survey and bone marrow aspiration. After radiotherapy for 5 months, the orbital tumor size decreased but central retinal vein occlusion of the left eye was noted. The patient expired due tofrom Streptococcus pneumonia one week later. Conclusion: Ophthalmic presentations of multiple myeloma are rare and the incidence of multiple myeloma as an orbital tumor had beenis reported to be below 1%. Older patients presents with exophthalmos, with symptoms such as generalized fatigue, weight loss or bone pain on movement, the differential diagnosis of multiple myeloma should be included.

P-138: Frequent magnetic resonance imaging partially reduces the development of end organ damage in patients with smoldering myeloma

Chronic pain in the thoracic spine as a symptom of multiple myeloma - case report

Multiple myeloma is a type of plasma cell neoplasm that produces monoclonal immunoglobulin. Multiple myeloma is known to cause immunoglobulin light-chain (AL) amyloidosis, which frequently involves the kidney and heart. Bone pain or fractures caused by osteolytic lesions and physical disorders related to renal or cardiac AL amyloidosis are major initial symptoms in multiple myeloma. Multiple myeloma diagnosed from the gastrointestinal symptoms is rare. We report a case of an 80-year-old man with multiple myeloma accompanied by gastrointestinal AL amyloidosis and secondary protein-losing enteropathy. The diagnostic process was suggestive, in that diarrhea and refractory leg edema related to protein-losing enteropathy were the primary symptoms and the trigger for making a sequential diagnosis of gastrointestinal AL amyloidosis and underlying multiple myeloma. This case is highly suggestive, in that multiple myeloma with gastrointestinal AL amyloidosis should be considered one of the background diseases of protein-losing enteropathy.