Massive hepatomegaly: a presenting manifestation of multiple myeloma

We report a 50-year-old woman presenting with isolated massive hepatomegaly. Liver histology showed dilated sinusoids within which some atypical cells, probably of hematopoeitic origin, were identified. Bone marrow was densely packed with similar atypical cells with high nucleo-cytoplasmic ratio, which tested positive for plasma cell markers. Plasma protein electrophoresis showed a distinct M spike in the gamma globulin fraction and skeletal survey revealed multiple lytic lesions in the skull and pelvic bones. Thus, a final diagnosis of multiple myeloma was made. The patient has received six cycles of chemotherapy and is doing well.