Extraosseous manifestation of multiple myeloma with unusual appearance in computed tomography--case report

Extramedullary Localizations at diagnosis or during the course of multiple myeloma are rare. We report on a 70 year old patient, presenting multiple hypoechoic liver lesions during an ultrasound examination. The following contrast-enhanced computed tomography demonstrated hypodense liver Lesions with slight contrast enhancement and hyperdense polypoid masses in the wall of the gall bladder as well as a small pericostal tumor. A punch biopsy of the liver and immunohistochemical studies confirmed the diagnosis of extramedullary multiple myeloma. In a follow-up CT five weeks later the liver lesions and the pericostal tumor clearly showed progress, the masses in the gall bladder had developed into a concentric wall-thickening. Additionally, polypoid contrast-enhancing masses in the gastric wall became apparent as well as a hypodense lesion in the spleen. Radiologists should be aware that multiple myeloma can on rare occasions present as hypodense nodules in the liver or new masses in other organs in CT. Because of the morphologic similarity to metastatic disease, a biopsy may be necessary for definitive diagnosis.