Case Of Multiple Myeloma Presenting Research Articles

POSTER: MM-224 A Rare Case of Multiple Myeloma Presenting as a Cranial Nerve Palsy

POSTER: MM-224 A Rare Case of Multiple Myeloma Presenting as a Cranial Nerve Palsy

MM-224 A Rare Case of Multiple Myeloma Presenting as a Cranial Nerve Palsy

MM-224 A Rare Case of Multiple Myeloma Presenting as a Cranial Nerve Palsy

Pancytopenia as the initial presenting feature in multiple myeloma: a case series

Multiple myeloma is a plasma cell neoplasm characterized by abnormal proliferation of clonal cells in the bone marrow. Anaemia is generally the most common feature from hematologic aspect and bone pain being the other important symptom, but pancytopenia as the presenting feature is unusual. Here, we shared our experience of 3 cases with non-specific symptoms with pancytopenia which on through evaluation revealed our diagnosis. A hospital based observational descriptive case series was conducted wherein all the cases of multiple myeloma presenting with pancytopenia were included. Complete blood picture, peripheral smear, bone marrow aspirate and serum protein electrophoresis were reviewed and analysed. Pancytopenia as the initial presenting feature of multiple myeloma is an unique manifestation and diagnosing such cases require high degree of suspicion to avoid delay in the initiation of treatment.

A Case of Multiple Myeloma Presenting With Resistant Hypercalcemia

A Case of Multiple Myeloma Presenting With Resistant Hypercalcemia

A case of multiple myeloma presenting with rapidly progressive glomerulonephritis

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Case Report of Multiple Myeloma Presenting with Unique Skin Manifestation with Literature Review

Multiple myeloma (MM), although a rare disease, is the second most common hematologic malignancy. MM is associated with significant morbidity due to its end-organ destruction. It is a disease of the older population and advancements in the diagnosis, monitoring, and treatment of MM are of the utmost importance as the general population lives longer due to other improvements in health care. Herein, we present an interesting case of MM presenting with initially skin manifestation which unfortunately is associated with a poor prognosis due to a relationship indicating higher tumor burden. Despite being on multiple treatment, our patient continued to progress with her disease...

S2460 A Rare Case of Multiple Myeloma Presenting as Cholestatic Liver Disease Due to Plasmocytes Infiltration

S2460 A Rare Case of Multiple Myeloma Presenting as Cholestatic Liver Disease Due to Plasmocytes Infiltration

A Case of Multiple Myeloma Presenting with Neck Pain and Tetraparesis

A Case of Multiple Myeloma Presenting with Neck Pain and Tetraparesis

A Case of Multiple Myeloma Presenting with High-Output Heart Failure That Improved with Anti-angiogenesis Therapy.

A Case of Multiple Myeloma Presenting with High-Output Heart Failure That Improved with Anti-angiogenesis Therapy.

1434 A Rare Case of Multiple Myeloma Presenting as Pancreatic Plasmacytoma Causing Obstructive Jaundice

INTRODUCTION: Extramedullary plasmacytomas represent a rare type of plasma cell tumors which can present outside of the bone marrow. Although extremely uncommon, they should be considered in the differential diagnosis when it comes to obstructive jaundice and pancreatic malignancy. Here, I present a case of obstructive jaundice caused by extramedullary plasmacytoma mimicking an adenocarcinoma, diagnosed by endoscopic ultrasonography-guided fine needle aspiration (EUS-FNA). CASE DESCRIPTION/METHODS: A 72-year-old Caucasian male patient presented to our hospital with complaints of fatigue and painless jaundice. On admission, his liver biochemistries were abnormal with ALT 417, AST 414, ALP 1309, T bili 15.9, D bili 13.4, with normal lipase, amylase and WBC. CT abdomen was significant for a large mass adjacent to the pancreatic head along with multiple retroperitoneal and intra-abdominal nodules. Subsequently, patient underwent EUS with FNA of the pancreatic lesion. Tissue biopsy was positive for plasmacytoma. Follow up ERCP was unsuccessful as CBD could not be cannulated due to bulging papilla. As such, IR guided biliary drainage was placed with successful decompression of the biliary tree and corresponding improvement in liver biochemistries. Further workup showed evidence of widespread plasmacytomas including involvement of heart and bone. DISCUSSION: Pancreatic plasmacytomas remain a rare entity, with only five percent of all plasma cell tumors occurring outside of the bone marrow. This case documents a rare occurrence of visceral involvement of multiple myeloma, brought to clinical attention by atypical involvement of pancreatic head and body. Gastrointestinal plasmacytomas are usually limited to the liver and stomach, with only a limited amount of cases describing pancreatic involvement. Most reported cases describe microscopic plasma cell infiltration of the pancreas, making this presentation of a well-formed mass unusual. Availability of EUS and FNA sampling has made it easier for clinicians to diagnose plasmacytomas, as radiological differentiation of these tumors from other pancreatic malignancy is difficult. Furthermore, it is imperative to make the correct tissue diagnosis as prognosis and management differs from other pancreatic malignancy. This case highlights the importance of keeping a broad differential when suspecting a pancreatic malignancy in a patient with obstructive jaundice and those with history of plasma cell disorders.

A case of multiple myeloma presenting with uric acid kidney stones

Kidney disease is common in patients with multiple myeloma. Patients often present with acute kidney failure most commonly the result of light chain cast nephropathy. Presentation can also be in the form of nephrotic syndrome associated with immunoglobulin light chain amyloidosis or monoclonal immunoglobulin deposition disease and tubulopathy as in acquired light chain Fanconi syndrome. We present a case of a 56-year-old male with multiple myeloma who presented with chronic kidney disease and uric acid stones. Chemical analysis of the nephrolithiasis showed it to be entirely composed of uric acid. Fractional excretion of uric acid was elevated at 35.9%. Kidney biopsy was consistent with light chain proximal tubulopathy. Bone marrow biopsy showed 30% kappa light chain–restricted plasma cells. Genetic sequencing identified the light chain to be from the Vk1-33 subgroup. The patient was treated with bortezomib, cyclophosphamide, and dexamethasone, with improvement of his kidney function. This case illustrates a rare presentation of multiple myeloma.

Lung and Liver Plasmacytoma With Multiple Myeloma

SESSION TITLE: Pulmonary Manifestations of Systemic Disease 3 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Multiple Myeloma is a neoplasm characterized by clonal expansion of plasma cells.This case shows an atypical and aggressive presentation of multiple myeloma with metastasis to bone, lungs and liver. CASE PRESENTATION: 46 y/o AAM presented with diffuse body pain, pathologic fracture of humerus and lytic bone lesions. CT chest and abdomen revealed multiple nodules in liver and lungs. SPEP, UPEP and Immunofixation were done with results positive for light chains consistent with multiple myeloma. Bone marrow biopsy showed necrosis and highly anaplastic plasma cell dyscrasia. CT guided liver biopsy of the nodule revealed plasma cells, consistent with plasmacytoma confirming metastasis to liver and lungs. Patient rapidly deteriorated, developing cord compression and respiratory failure secondary requiring mechanical ventilation. Due to the poor prognosis and rapid deterioration, the patient did not qualify for chemotherapy or surgical interventions. DISCUSSION: Multiple Myeloma accounts for 10% of hematologic cancers. Presentation is usually seen at age of 65 with only 2% of patients presenting between 40 and 49. 30% of patients are diagnosed incidentally and another 30% are diagnosed after pathologic fractures or history of bone pain.Besides the bone pain (58%) and pathologic fractures, other modes of presentation are infection, weight loss (24%), anemia (73%), hypercalcemia (28%), spinal cord compression or renal failure (48%).Extramedullary presentation is seen in less than 7% of patients, usually as solitary extramedullary plasmacytomas in the head and neck.A few cases of multiple myeloma presenting as nodular hepatic lesions have been reported, however they usually present as a solitary lesions.Rarity of our case is highlighted by the multiple plasmacytomas in the liver and lung. Commonly used, first line treatment regimens for multiple myeloma include a steroid backbone, proteasome inhibitor and Lenalidomide. Eligibility for bone marrow transplant should be individualized and depends on several factors. CONCLUSIONS: Even though literature emphasizes the classic presentation of Multiple Myeloma as bone pain, hypercalcemia, anemia and renal disease, this clonal oncotic disease can also present with multiple plasmacytomas. With such a presentation multiple myeloma tends to behave aggressively and appropriate palliative intervention should be considered. Reference #1: Multiple myeloma with lung plasmacytoma Rajendra Prasad;Sanjay Kumar Verma;Rakhi Sodhi Lung India2011 Reference #2: Multiple myeloma in young patients:clinical presentation and treatment Bladé J,Kyle RA;Leuk Lymphoma1998 Reference #3: Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Soutar R,Lucraft H,Jackson G,Reece A, Bird J,Low E,Samson D;Br J Haema2004 DISCLOSURE: The following authors have nothing to disclose: Theo Trandafirescu, Vansha Singh, Ana Ventura No Product/Research Disclosure Information

A case of multiple myeloma presenting as multiple arthralgia

A case of multiple myeloma presenting as multiple arthralgia

17P deleted multiple myeloma presenting with intracranial disease: durable remission after tailored management

In multiple myeloma (MM), del(17p) is associated with a poor outcome if present in greater than half the tumour cells. Similarly, intracranial involvement, often seen in the context of advanced disease, also heralds short survival. We present a rare case of MM presenting with intracranial disease and carrying del(17p) in 100% of tumour cells. This patient was successfully treated with combination chemotherapy employing central nervous system directed agents and bortezomib, followed by autologous stem cell transplant and consolidation with radiotherapy, bortezomib and thalidomide. We also present the outcomes of our single-centre experience of MM patients presenting with del(17p) disease. Copyright © 2015 John Wiley & Sons, Ltd.

A Case of Multiple Myeloma Presenting with Plasmacytoma of Body of Sphenoid Bone: A Case Report

A Case of Multiple Myeloma Presenting with Plasmacytoma of Body of Sphenoid Bone: A Case Report Plasmacytoma (plasma cell neoplasm) presented as multiple myeloma, solitary plasmacytoma of bone (SBP) and extramedullary plasmacytoma (EMP). Types of plasmacytoma vary from one another in terms of clinical findings, treatment options and survival. Intracranial involvement of multiple myeloma is extremely rare event and rarely the first presentation of Multiple myeloma. A case of 58 years old patient reported with an unusual clinical presentation and behaviour of multiple myeloma where intracranial lesion arising from body of sphenoid. Initial biopsy proved plasmacytoma and later confirmed the case as multiple myeloma. Patient received palliative radiation and planned to receive chemotherapy. Hence, in any skull based lesion, multiple myeloma should be kept in the differential diagnosis.

Pancytopenia in Multiple Myeloma- An Enigma: Our Experience from Tertiary Care Hospital.

Multiple myeloma is a plasma cell neoplasm that is characterized by clonal proliferation of malignant plasma cell in the bone marrow along with M-protein in the serum and/or urine. Pancytopenia as a initial presentation of multiple myeloma is quite unusual. We are presenting a case series having pancytopenia as the presenting complaint. A retrospective study was conducted for a period of 30 months, wherein all the cases of multiple myeloma presenting with pancytopenia were included. The complete blood picture, peripheral smear examination, bone marrow aspirate & protein electrophoresis of all the cases were reviewed & analysed. During the study period, 10 cases presented with pancytopenia with a mean age of 66.3 years (range: 59-72 years) at presentation with male: female ratio being 8:2. Fatigue and weakness was the most common symptom (100%) & average ESR was 104 mm/hour. High-resolution serum electrophoresis, showed a dense, sharp to wide M band in the gamma globulin region. Bone marrow plasma cell percentage was increased with an average of 63.1%. Bone marrow biopsy correlation was obtained in 100% cases. Diagnosing multiple myeloma, presenting as pancytopenia requires a high degree of suspicion to avoid delay in initiation of treatment.

A case of multiple myeloma presenting as scalp swelling with intracranial extension

Multiple myeloma is a malignant neoplasm of bone marrow affecting plasma cells. It is usually detected in skull bone with characteristic features of multiple punched-out lesions. Its presentation as a solitary scalp swelling with underlying skull bone erosion and intracranial extension is very rare. A 35-year-old female presented to us with complains of rapidly growing left-side scalp swelling with right-side paresis and simple partial seizure of right upper limb. Local examination, X-ray skull, CT scan, and MRI of brain were suggestive of a malignant lesion. Near total excision of lesion was done. Histopathological study was suggestive of plasmacytoma of skull. Bone marrow study further confirmed it as a case of multiple myeloma. Cases presenting with solitary osteolytic skull lesions, possibility of plasmacytoma, or multiple myeloma should be kept in mind.

Isolated Abducens Nerve Palsy in Multiple Myeloma With Hyperviscosity of the Serum

A 40-year-old woman without contributory medical history was diagnosed as having IgA type multiple myeloma, based on the immunological and pathological investigation. Blood pathology demonstrated the rouleaux formation. Then, sudden onset of left-sided complete abducens nerve palsy (6NP) without pain was preceded to initiation of chemotherapy. Cranial and orbital magnetic resonance imaging, and cerebrospinal fluid examination demonstrated no abnormalities. Under chemotherapy, 6NP was resolved within 5 weeks. This is a first reported case of multiple myeloma presenting with 6NP without intracranial lesion. We speculated that 6NP might be caused by peripheral ischemia due to hyperviscosity of the serum. J Med Cases. 2012;3(6):373-374 doi: https://doi.org/10.4021/jmc855w

Pneumococcal native aortic valve endocarditis with mycotic abdominal aortic aneurysm, paraspinal and iliopsoas abscesses and pneumonia revealing a multiple myeloma

We report a rare case of multiple myeloma presenting with native aortic valve endocarditis with secondary embolic mycotic abdominal aortic aneurysm, contiguous paraspinal and iliopsoas abscesses, and pneumonia due to Streptococcus pneumoniae in a Chinese man. He was treated with aortic valve replacement, endovascular stenting of aneurysm, image-guided drainage of abscesses, and a 6-week course of endocarditic antibiotic therapy followed by chronic suppressive antibiotic therapy. Cases of multiple myeloma presenting with invasive pneumococcal infection were reviewed.

Multiple myeloma presenting as solitary mass in the posterior fossa

Intracranial plasma cell tumors are extremely rare and can either be solitary lesions or part of systemic multiple myeloma. We report a 42-year-old woman who presented with a posterior fossa mass and successfully underwent surgical resection, leading to the diagnosis of multiple myeloma. To our knowledge, this is the first reported case of multiple myeloma presenting as a posterior fossa mass lesion. This report highlights the importance of maintaining plasma cell tumor in the differential of intracranial mass with bony involvement. Furthermore, once the diagnosis is established, further work up is critical to evaluate for systemic disease.