[IgD (lambda) multiple myeloma associated with myelofibrosis: an isolated case of nuclear physicist]

A new case of IgD (lambda) multiple myeloma associated with myelofibrosis is described and four from the literature are reviewed. A 66-year-old nuclear physicist who had been diagnosed of having multiple myeloma in 1992 was admitted to the hospital in 1995 because of pancytopenia. A bone marrow biopsy specimen showed nests of myeloma cells with marked fibrotic background. The association of IgD (lambda) multiple myeloma with myelofibrosis was characterized by marked marrow fibrosis and myeloma cell proliferation, without typical features of extramedullary hematopoiesis. Some increase in the bone marrow fibrous tissue is not uncommon in hematologic disorders in which there is a rapid proliferation of marrow cells. What distinguishes these five patients is that their marrow fibrosis was an order of magnitude more extensive. These patients were generally severely anemic and commonly leukopenic and thrombocytopenic. Radiation has been reported as a causal factor in multiple myeloma. In the present case, radiation exposure during his study may have been related to the development of his disease. The correct diagnosis in the case of Dr. Torahiko Terada (1878-1935; physicist, essayist) who died of disseminated bone tumor seems to be multiple myeloma.