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Hepatic and renal plasma cell lesions in a patient with multiple myeloma in hematological remission
Zacharoula Galani1, Nora Viniou, Marie-Christine Kyrtsonis
1First Department of Internal Medicine, National and Kapodistrian University of Athens, Laikon General Hospital, Athens, Greece.
Abstract:
Plasma cell myeloma is characterized by plasma cell infiltrations, the presence of paraprotein and mostly skeletal destruction with osteolytic lesions. Liver or kidney infiltration has been described in patients with end stage multiple myeloma (MM), while the features of this malignant dissemination is not clearly understood. An atypical form of MM relapse is presented in a patient being in bone marrow remission, with simultaneous lesions in liver, kidney and suspicion of brain involvement. This case is an interesting model of refractory MM extraosseous involvement, that a clinician should be aware of when carrying out differential diagnosis.
Insights
This case study highlights refractory multiple myeloma (MM) relapse with unusual liver, kidney, and potential brain involvement, even during bone marrow remission. Clinicians must consider these rare extraosseous manifestations in differential diagnoses.
Area of Science:
- Hematology
- Oncology
- Pathology
Background:
- Plasma cell myeloma, a malignancy of plasma cells, typically presents with paraprotein and osteolytic bone lesions.
- Extramedullary involvement, including liver and kidney infiltration, is documented in advanced multiple myeloma (MM).
- The specific mechanisms and clinical presentation of such malignant dissemination remain incompletely understood.
Observation:
- A unique case of multiple myeloma relapse is detailed in a patient achieving bone marrow remission.
- The patient exhibited simultaneous, atypical lesions in the liver and kidney.
- Suspicion of concurrent brain involvement was also noted, indicating widespread disease.
Findings:
- This presentation represents an unusual pattern of refractory multiple myeloma (MM) with significant extraosseous (outside the bone marrow) involvement.
- The simultaneous occurrence of liver, kidney, and suspected brain lesions during bone marrow remission is atypical.
- The case underscores the potential for diverse and unexpected sites of MM relapse.
Implications:
- This case serves as a critical reminder for clinicians regarding the differential diagnosis of unexplained organ dysfunction in myeloma patients.
- Awareness of refractory MM presenting with extraosseous involvement is crucial for timely and accurate diagnosis.
- Further research into the biology and management of such advanced, disseminated disease is warranted.