Urinary Bence-Jones Protein Research Articles

Parathyroid Carcinoma Mimicking Multiple Myeloma: A Tale of Refractory Hypercalcemia

Primary hyperparathyroidism yields various symptoms, including hypercalcemia, pathological fracture, and renal impairment. Parathyroid carcinoma is the rarest cause of primary hyperparathyroidism, accounting for <1% of the cases. We reported a case of a 46-year-old male with closed fractures at the humerus and femur. Further findings revealed severe refractory hypercalcemia, renal impairment, anemia, and bone lytic lesion (CRAB). No palpable cervical mass was identified. Surprisingly, the serum protein electrophoresis was normal, and urinary Bence-Jones protein was negative along with normal bone marrow aspiration. Hence, multiple myeloma was unlikely. The intact parathyroid hormone level was very high, along with a suspicious nodule on the left thyroid lobe (TIRADS 4). Total thyroidectomy and total parathyroidectomy were performed. The post-surgical pathological examination confirmed the diagnosis of parathyroid carcinoma. After the surgery, the patient was in stable condition with normal intact parathyroid hormone and serum calcium levels. In this case, primary hyperparathyroidism was caused by parathyroid carcinoma with “CRAB” symptoms, mimicking multiple myeloma. Primary hyperparathyroidism should be considered in the patient with refractory hypercalcemia.

Biochemical profile of Bence-Jones type multiple myeloma.

Multiple myeloma (MM) is a malignant tumor occurring from plasma cells that produce an abnormal monoclonal immunoglobulin - a paraprotein. A distinctive feature of Bence-Jones myeloma is the excretion of monoclonal free light chains of immunoglobulins with 24h urine, and the absence of monoclonal intact immunoglobulins secretion. Comprehensive analysis of biochemical parameters in blood serum and 24h urine in patients with Bence-Jones multiple myeloma using electrophoretic and immunoturbidimetric methods to assess their sensitivity as biomarkers. 50 patients with a morphologically confirmed diagnosis of MM of the Bence-Jones immunochemical type were examined. 28 people without oncological diseases were examinedas a control. Detection of monoclonal secretion in blood serum and daily urine was performed by immunofixation electrophoresis on the Hydrasys 2 electrophoretic system (Sebia). The determination of free light chains of immunoglobulins (FLC) was performed by the immunoturbidimetric method (Binding Site) on an Advia 1800 analyzer (Siemens). Analysis of IgG, IgA, IgM, β2-microglobulin and C-reactive protein was performed on Cobas 6000 analyzer (Roche). The median excretion of Bence-Jones protein in 24h urine of MM patients was 0.49 g/24h (0.06-2.45 g/24h). In the blood serum, in 86% of cases, the presence of paraproteinemia, represented by κ and λ type light chains of immunogloublins was detected. At the same time, the frequency of detection of monoclonal secretion in blood serum in Bence-Jones type λ myeloma was 95.7%, which was statistically significantly higher than the frequency of detection of monoclonal secretion of type κ - 77.8%. In patients with identified paraproteinemia, Bence-Jones protein excretion in daily urine (median 0.82 g/day) was statistically significantly higher than in patients without a monoclonal component detected in blood serum (median 0.04 g/24h). The levels of FLC in blood serum obtained by immunoturbidimetry in Bence-Jones myeloma of the corresponding type were higher than the reference levels in 100% of cases. The median level of κ-FLC reached 4358 mg/l, λ-FLC - 2225 mg/l, which was statistically significantly higher than the control levels. The median concentrations of IgG, IgA and IgM in patients with Bence-Jones myeloma were statistically significantly lower than in the control group, while the medians of β2-microglobulin and C-reactive protein were significantly higher than in the control. Our investigation showed high diagnostic efficiency of electrophoretic and immunoturbidimetric analysis of monoclonal secretion in patients with Bence-Jones MM, while FLC analysis demonstrated maximum sensitivity. Bence-Jones MM revealed biochemical signs of secondary immunodeficiency and general inflammatory syndrome.

Effect of MAGE-C1 Gene Expression on Prognosis and Effectiveness of Bortezomib-Containing Courses in Multiple Myeloma

Introduction. The group of genes, encoding cancer-testis antigens is actively studied as a new markers of refractory in some diseases, including multiple myeloma (MM). It is suggested that the MAGE-C1 gene in MM may be considered as an additional marker predicting the effectiveness of therapy.Purpose. Determine of MAGE-C1 gene expression by quantitative real-time polymerase chain reaction (qRT-PCR) in MM patients and assess the correlation of expression with some laboratory parameters and response on bortezomib-containing therapy.Patients and methods. A prospective study from February 2019 to July 2021 included 76 MM patients (43 men and 33 women) aged 35 to 82 years (median 58). The level of MAGE-C1 gene expression by qPCR-PCR in bone marrow samples, enriched with CD138+ cells, was determined for all patients. Quantity of MAGE-C1 expression was calculated with 2ΔCt method relative to housekeeping gene expression. Plasma cell content ranged from 1 to 89% (median 26%), monoclonal paraprotein secretion vary from 2.1 to 82.1 g/l, Bence-Jones protein in urine (from trace values to 12.54 g/day) was determined in 50 patients. High - risk cytogenetic [t(4; 14)(p16; q32), del17p] was documented in 22 patients, bone plasmocytomas - in 36 patients, myeloma nephropathy - in 17. All patients recieved induction with bortezomib - containing courses. Median follow-up duration: 14 months (1-22 months). As a control, similar bone marrow cells of 7 healthy donors were investigated.Results. The average value of MAGE-C1 expression in donors was 0.01 ± 0.007, a range of values vary from 0.0003 to 0.06. Gene expression MAGE-C1 index > 0.06 is accepted as increased expression. High serum lactate dehydrogenase (LDH) level (higher than the upper limit of reference values) was observed in patients with high MAGE-C1 gene expression [median - 0.35], normal LDH-level (≤ 260 U/L) was observed in patients with lower MAGE-C1 gene expression [median - 0.04]; p < 0.0001 (Figure 1). Negative correlation was found between the content of hemoglobin (Hb) and level of MAGE-C1 expression: Hb ≥ 12.0 g/dl was observed in patients with increased MAGE-C1 expression [median - 0.27], and Hb 5.5-11.8 g/dl - in patients with lower expression indices [median 0.1]; p=0,034.Antitumor response was evaluated after induction therapy in 51 patients. In 100% of patients with MAGE-C1 expression of ≤ 0.06 ≥ partial response (PR) was achieved, while in patients with MAGE-C1 expression of 0.07-1.0 ≥ PR was achieved in 84.6% of cases, and in patients with MAGE-C1 expression of > 1.0 - in 58%; p > 0.05. Besides, patients with ≥ PR had a level of MAGE-C1 expression lower than patients with a refractory to bortezomib [median 0.17 vs 1.14]; p = 0.04 (Figure 2).Conclusions. High MAGE-C1 gene expression in MM patients is associated with an increase in LDH, which corresponds to stage III by R-ISS. Probability of achievement of the antitumor response ≥ PR on the bortezomib-containing induction is reliable above at patients with low MAGE-C1 expression while the hyperexpression of this gene is followed by a refractory to a bortezomib therapy. Further study of MAGE-C1 gene expression may promote a personalized approach in the choice of antitumor therapy. [Display omitted] DisclosuresNo relevant conflicts of interest to declare.

Primary Laryngeal Amyloidosis and CO2 Laser as the Treatment Modality

Introduction Amyloidosis is brought about by intracellular and/or extracellular accumulation of insoluble abnormal amyloid fibrils that alters the normal function of the tissues. Localized laryngeal amyloidosis is a rare disease which lacks long-term follow-up studies. It is prone to recurrence; hence meticulous excision is required. We are doing this study to analyse clinical features of primary laryngeal amyloidosis, the subsites commonly found in, and the effectiveness of CO2 laser as treatment modality. Materials and Methods It is a retrospective study of 13 patients diagnosed as Primary Laryngeal Amyloidosis in between 2005 to 2018, where clinical features, histologic and immuno-histochemical patterns of the patients were evaluated. Systemic amyloidosis was ruled out by the non-appearance of Bence-Jones proteins in urine and serum electrophoresis examination. Systemic workups were pursued during the follow-up. The patients were followed up 3 monthly for the first year, then 6 monthly after that, for 3 years. The last patient who underwent the surgery was in the 2018 and had just finished his 2nd follow up, while the rest have been followed up for 3 years. Results Hoarseness was the most common complaint in all the patients. The subsites most common for amyloid deposition were seen in the true vocal cords followed by supraglottis, anterior commissure, ventricle and the subglottis. Microscopically, the amyloid was deposited within the submucosa surrounded by lymphoplamocytic infiltration. All cases were treated with microlaryngoscopic CO2 Laser excision. With the exception of one patient, the rest had no recurrence. Conclusion Primary Laryngeal Amyloidosis is an uncommon benign disease that has a predisposition for recurrence. With use of CO2 laser as the primary treatment modality, the percentage of recurrence has drastically reduced. Systemic involvement should be ruled out. A frequent follow-up of the patients is desirable for early detection of recurrences. Laser is a novel treatment of laryngeal amyloidosis.

Comparison of 24-hour versus random urine samples for determination and quantification of Bence Jones protein in a South African population

BackgroundThe International Myeloma Working Group and College of American Pathologists recommend a 24-h urine collection to determine the Bence Jones protein (BJP) excretion level for monitoring treatment response in patients with multiple myeloma (MM). There are several issues related to sample collection and the method is prone to inaccuracy.ObjectiveThis study compared measured 24-h to random urine collections for the quantitation of BJP in a South African population.MethodsSixty-six patients with MM submitted random urine samples with their routine 24-h urine collection from April 2016 – March 2018. Measured 24-h urine BJP was compared to two estimated 24-h BJP excretions calculated as follows: Estimation 1 (E1): Estimated 24-h BJP (mg/24 h) = Urine BJP/Creatinine ratio (mg/mmol) × 10. Estimation 2 (E2): Estimated 24-h BJP (mg/24 h) = Urine BJP/Creatinine ratio (mg/mmol) × 15 mg/kg for women or × 20 mg/kg for men.ResultsCorrelation of estimation equations E1 and E2 to the measured 24-h urine BJP was 0.893. Patients showed no difference in classification of treatment response using either the E1 or E2 estimation equations when compared to the measured 24-h urine BJP results.ConclusionThis study demonstrates that the estimated 24-h BJP shows a high degree of correlation with the measured 24-h BJP and can likely be used to monitor treatment response in South African patients with MM.

Multiple Myeloma Presenting as Chest Wall Lesion: A Case Report

Multiple myeloma is defined by &gt;10% of clonal plasma cells in bone marrow or biopsy-proven extramedullary plasmacytoma and by the evidence of end-organ damage including bone lesions and renal insufficiency. It usually occurs in the age group of 50-70 years with higher incidence in males. Swelling on the chest wall is an uncommon presentation of multiple myeloma. In this case of 85-year-old male patient, two soft tissue density lesions on the posterolateral and anterior chest wall, multiple punched-out lesions in the skull, diffuse osteopenia and multiple lytic lesions were noted in ribs, sternum and thoracic spine, with evidence of myeloma cells in the bone marrow and bence jones protein in urine. Radiologic imaging plays an important role in providing a provisional diagnosis and thus, helping the clinician in such cases.

Giant Solitary Plasmacytoma of Skull: A Case Report

Plasmacytoma is a tumor arising from plasma cell, which mainly grows within soft tissue or within axial skeleton, when it is present as a discreet solitary mass it is called as solitary plasmacytoma &amp; it is rare, we report a 46 years male, presented to us with the complaints of painless swelling in the left frontoparietal region which is about 8.6x6.5cm in diameter, Magnetic resonance imaging revealed an extra axial mass in fronto parietal region with overlying bone destruction mimicking meningioma with bony erosion, we did frontoparietal craniectomy and complete resection of tumor with bony margin subsequently cranioplasty was also done, histopathology of which revealed plasmacytoma,after that we did urinary bence jones protein which was negative.&#x0D; Bang. J Neurosurgery 2020; 10(1): 106-110

Regression of renal amyloid deposits by VAD therapy plus autologous stem cell transplantation in a patient with primary AL amyloidosis

We report a 58-year-old Japanese woman who presented with nephrotic syndrome. Steroid therapy and cyclosporine A administration were initiated, but hematological remission and renal response were not achieved. Renal biopsy revealed amyloid deposits in the mesangial region and the small arteries. Proteomic analysis based on laser microdissection and mass spectrometry showed that the amyloid deposits were composed of the constant region of the lambda light chain. She received vincristine, adriamycin, and dexamethasone therapy followed by high-dose melphalan and autologous stem cell transplantation, resulting in hematological complete remission and renal response with negative urinary Bence-Jones protein and proteinuria. Renal biopsy was performed four times during follow-up, demonstrating that amyloid deposits decreased gradually, while glomeruli showing global sclerosis increased from 3 to 62%. This case suggests that glomerular amyloid deposits can be cleared via tissue remodeling, if stem cells producing amyloid precursors are completely replaced by unrelated cells after stem cell transplantation.

Difficulties evaluating hematological response in patients with multiple myeloma and dialysis - dependent renal impairment

to determine serum free light chains (FLC) level by patients with multiple myeloma (MM) and dialysis - dependent renal impairment in which the amount Bence Jones (BJ) protein in the urine met the criteria of hematological response. This study included 13 MM with dialysis - dependent renal impairment patients (estimated glomerular filtration rate < 10 ml/min), whose urine BJ protein content was less than 200 mg/day after antimyeloma therapy (including 11 patients whose urine BJ protein content was less than 100 mg/day). The median serum concentration of monoclonal FLC was 608.7 (298-8380) mg/l. Thus, with trace amounts BJ protein in the urine serum content monoclonal FLC varied 28 times with the same degree of severity of renal failure. In patients with oliguria serum SLC content was significantly higher than in normal diuresis (1109 and 307 mg/L; p.

Plasmacytoma of Skull Mimicking Meningioma and Metastasis

Plasmacytoma is a tumor arising from plasma cell, which mainly grows within soft tissue or within axial skeleton. When it is present as a discreet solitary mass it is called as solitary plasmacytoma and it is rare. We report a case of 46 years male presented to us with the complaints of painless swelling in the left front parietal region which is about 8.6x6.5cm in diameter .Magnetic resonance imaging(MRI) revealed an extra axial mass in fronto parietal region with overlying bone destruction mimicking meningioma with bony erosion. We did fronto parietal craniectomy and complete resection of tumor with bone margin subsequent cranioplasty also done.Histopathology of which revealed plasmacytoma. After that we did urinary bence jones protein which was negative.

Plasmacytoma of Skull Mimicking Meningioma and Metastasis

Plasmacytoma is a tumor arising from plasma cell, which mainly grows within soft tissue or within axial skeleton. When it is present as a discreet solitary mass it is called as solitary plasmacytoma and it is rare. We report a case of 46 years male presented to us with the complaints of painless swelling in the left front parietal region which is about 8.6x6.5cm in diameter .Magnetic resonance imaging(MRI) revealed an extra axial mass in fronto parietal region with overlying bone destruction mimicking meningioma with bony erosion. We did fronto parietal craniectomy and complete resection of tumor with bone margin subsequent cranioplasty also done.Histopathology of which revealed plasmacytoma. After that we did urinary bence jones protein which was negative.

Contribution of Bence-Jones proteinuria to the monoclonal gammopathy diagnosis based on serum free light chains

Multiple Myeloma (MM) is the second most common hematological malignancy after non-Hodgkin lymphoma and is manifested by uncontrolled proliferation and accumulation of abnormal plasma cells in the bone marrow (BM). The incidence along with deaths associated with MM is on rise due to lack of an effective diagnosis at an early stage. The identification of MM decades ago marks the adoption of certain conventional markers such as plasma cell percentage in BM, serum protein electrophoresis for M-band and urinary Bence-Jones protein. This was then followed by utilization of β2 microglobulin and serum albumin for determining the staging of MM. The need for a better diagnostic or prognostic marker prompts researchers and hence, certain novel markers have been tested which includes extracellular matrix proteins, angiogenic factors, telomeres and telomerase along with the immune markers. Nowadays, proteomic and genomic studies are being performed to identify novel diagnostic and/or prognostic markers for MM. Followed by this, comes the emerging concept of liquid biopsy which allows easy and non-invasive detection of the disease. The liquid biopsy comprises of circulatory tumor cells along with the nucleic acids (microRNAs and cell-free DNA) released from the tumor cells in peripheral circulation which could be a true representation of BM. This review, hence, summarizes the emerging biomarkers involved in the diagnosis and prognosis of MM.

Nanoporous silica coupled MALDI-TOF MS detection of Bence-Jones proteins in human urine for diagnosis of multiple myeloma

Bence-Jones protein is a biomarker in urine for multiple myeloma. Traditional methods for urine Bence-Jones protein detection are either less-sensitive or laborious. Herein, we describe a new method for the detection of urine Bence-Jones protein using nanoporous materials and matrix-assisted laser desorption/ionization time-of-flight mass spectrometry (MALDI-TOF MS). Macroporous ordered silica foams (MOSF) were used to enrich proteins in urine, and then the materials-proteins composites were analyzed by MALDI-TOF MS. Based on the presence of specific mass spectrometric signals, Bence-Jones protein can be detected for the diagnosis of multiple myeloma. Twenty-one clinical positive and twenty-seven clinical negative urine samples were analyzed by the method. High sensitivity (95.24%, 20/21) and specificity (100%, 27/27) for the diagnosis of multiple myeloma were achieved. Compared to other methods for multiple myeloma diagnosis, e.g. immunofixation electrophoresis and immunonephelometry, our approach is more rapid, economical and convenient, which can be a new choice for the clinical diagnosis of Bence-Jones protein related diseases.

Ultrastructural identification of a proximal tubulopathy without crystals in a relapsed multiple myeloma patient

ABSTRACT A multiple myeloma patient, who had been treated with a hematopoietic stem cell transplant, underwent a renal biopsy for investigation of a possible relapse of disease as indicated by increased serum creatinine and positive urinary Bence-Jones protein containing increased kappa light chain. Paraprotein-related renal disease was not evident by light microscopy or immunofluorescence microscopy however electron microscopy demonstrated a proximal tubulopathy with intracytoplasmic non-crystalline inclusions. The ultrastructural findings suggested possible end-organ involvement by the disease and follow-up studies subsequently revealed a relapsed multiple myeloma in the patient. The case exemplifies the usefulness of electron microscopy in detecting paraproteins that, in some instances, may be difficult to demonstrate by other techniques.

WITHDRAWN: Solitary Skull Base Plasmacytoma with Sella Turcica Extension

Summary A case of 65-year-old female with intrasellar mass was operated on under the diagnosis of pituitary adenoma. The final diagnosis of plasmacytoma was made by immunocytochemical stain of IgG and electron microscopical findings. Postoperatively, the radiological studies of systemic skeletal bone and cytology of bone marrow were normal. However, the serum IgG was high, and the urinary Bence-Jones protein (kappa type) was positive. Although these laboratory data normalized after operation and irradiation, the patient converted to severe multiple myeloma and expired one and half year after operation.

Replacing Acid-Heat Precipitation with Sodium Dodecyl Sulphate Polyacrylamide Gel Electrophoresis Improves Detecting Bence-Jones proteinuria

Background: Detecting Bence-Jones protein in urine is essential for determining plasma cell dyscrasia and multiple myeloma. Conventionally, acid-heat precipitation assay is used for detecting Bence-jones protein in most medical laboratories; however, because of the low accuracy of this test, other more sensitive tests like urine electrophoresis are recommended. Materials and Methods: In this study, the presence of Bence-jones protein in the urine of patients suspected to monoclonal gammopathies were compared using acid-heat precipitation, capillary immunoelectrophoresis and sodium dodecyl sulphate-polyacrylamide gel electrophoresis. Moreover, the subsets of light chain (κ & λ) in capillary immunoelectrophoresis were determined. Results: Our data showed high false negative results (77.7%) using acid-heat precipitation assay in comparison with polyacrylamide gel and capillary immunoelectrophoresis (0%). Conclusion: Collectively, in spite of advantages like easy performance and low cost, acid-heat precipitation assay is not reliable for determining Bence-jones proteinuria in medical laboratories due to its low sensitivity. Therefore, it is recommended to be replaced with more sensitive assays like electrophoresis. K e y w o r ds: Bence-Jones protein, Monoclonal gammopathies, Capillary immuno-electrophoresis, Sodium dodecyl sulphate-polyacrylamide gel electrophoresis

Diagnostic value of 18F-FDG PET/CT for differentiating multiple myeloma from bone metastases with undetermined origin

Objective To investigate the value of 18F-FDG PET/CT for differentiating multiple myeloma from bone metastases with undetermined origin. Methods A retrospective study was performed on patients with multiple bone destructions and without extraosseous primary malignant tumor in 18F-FDG PET/CT imaging. A total of 26 patients (12 males, average age 55.4 years) with multiple myeloma and 20 patients (9 males, average age 50.2 years) with multiple bone metastases confirmed by biopsy or histopathology from January 2011 to December 2013 were included into this study. The characteristics of 18F-FDG PET/CT and urine Bence-Jones protein were used to establish the diagnostic criteria. Myeloma was diagnosed if two or more of the following conditions could be satisfied: more than 10 bone lesions, osteolytic or mixed bone destruction, SUVmax<4.0, and positive urine Bence-Jones protein. Two-sample t test and χ2 test were used. Results The average number of bone lesions in multiple myeloma patients was 15.8, which was more than that (7.8) in patients with bone metastases. About 71.8% (296/412) of bone lesions in multiple myeloma and 28.8% (45/156) of bone metastases were osteolytic. The percentage of osteolytic lesions was significantly higher in multiple myeloma (χ2=87.2, P<0.05). The SUVmax of bone lesions of multiple myeloma and bone metastases were 3.81±2.17 and 5.82±3.44 (t=8.29, P<0.05) respectively. According to the diagnostic criteria, the sensitivity, specificity and accuracy of 18F-FDG PET/CT for the differentiation of myeloma from bone metastases were 88.5%(23/26), 85.0%(17/20) and 87.0%(40/46). Its diagnostic efficiency was higher than urine Bence-Jones protein (sensitivity: 65.4%(17/26); χ2=3.90) and original 18F-FDG PET/CT evaluation (specificity: 10/18, accuracy: 64.1%(25/39); χ2=3.99, 6.12) respectively (all P<0.05). Conclusion Combining the evaluation of structural properties and metabolism on 18F-FDG PET/CT with urine Bence-Jones protein level may provide additional value for the differentiation of multiple myeloma from bone metastases with undetermined origin. Key words: Multiple myeloma; Bone neoplasms; Neoplasm metastasis; Tomography, emission-computed; Tomography, X-ray computed; Deoxyglucose; Bence Jones protein

Urine bence-jones protein analysis – to concentrate or not to concentrate

Urine analysis for Bence-Jones protein (BJP) has been a test for detection of free light chains (FLC) in the urine for over a century. The method, however, is not standardised. Urine from the same patient is sometimes concentrated by 10–50 fold and sometimes not prior to analysis. Aim To assess whether BJP analysed in neat and concentrated urine provides concordant results. Method Immunofixation for IgG, IgM, IgA, free kappa (fK) and free lamda (fL) was performed in neat and concentrated (by 10-fold) urines from 44 patients using Hydrogel 9IF, Sebia. Results FLC was not detected in both neat and concentrated urines in 36 (86%) patients. The remaining six patients had trace FLC detected only in the concentrated but not the neat urine. Serum FLC results were available from five patients: three had raised fK with abnormal ratios and two raised FLC with normal ratio due to impaired kidney function. The remaining one without serum FLC but had no proteinuria. Discussion The findings of this study raise the question whether it is necessary to concentrate the urine for BJP analysis. If this is still required, magnitude of concentrating the urine and how to report the result need to be standardised.

Solitary extramedullary plasmacytoma of mesentery: A rare presentation

A case of extramedullary plasmacytoma of mesentery is being reported due to its rarity. To date only six cases have been reported in the literature out of which only one is from India. Subsequent investigations for myeloma like urinary Bence-Jones proteins, serum electrophoresis, radiological skeletal examination, bone marrow biopsy were negative. The diagnosis of plasmacytoma was confirmed by pathological and immunohistochemical studies. Surgical excision of the mass was done.

A case of bilateral pleural effusion as the first sign of multiple myeloma

Multiple myeloma (MM) is a type of hematological malignancy that can affect all types of tissues in human. However, it is extremely rare that pleural effusion presents as the first sign in MM patients. A 54-year-old male patient attended our department of respiratory medicine complaining of shortness of breath for the past 3 months. A chest computer tomography (CT) radiograph revealed a bilateral pleural effusion, which was further assessed as exudative type. Sinus spiral CT scan demonstrated diffuse bone destruction of craniofacial bone. A broad reduction of the lumbar bone signal was confirmed by MRI. Furthermore, pleural biopsy showed abnormal proliferation of plasmocytes whereas bone marrow biopsy showed active hyperplasia of plasmacytoid cells. Interestingly, Bence-Jones protein in urine and serum protein electrophoresis was negative. The patient was diagnosed as non-secretory MM. He then underwent chemotherapy with vincristine, adriamycin and dexamethasone. Partial regression of the pleural effusion was achieved after two rounds of chemotherapy, and the patient has been followed for more than one year.