scholarly journals Myelomatous pleural effusion as an initial presenting sign in a case of multiple myeloma

2020 ◽  
Vol 8 (2) ◽  
pp. 777
Author(s):  
Dinesh Chandra Sharma ◽  
Deepanjali Sharma
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Pleural Effusion ◽  
Pleural Fluid ◽  
Plasma Cells ◽  
Late Complication ◽  
Neoplastic Disease ◽  
High Cellularity ◽  
Initial Sign ◽  
The Right

Multiple Myeloma (MM) is a neoplastic disease which mainly affects bone marrow but rarely may infiltrate extramedullary tissues as well. Myelomatous pleural effusions (MPE) develop due to extension of plasmacytoid cell lesions of thoracic bones into pleural tissue and directly presenting as an initial sign in a case of MM is exceedingly rare. It indicates poor prognosis, resistance to treatment and more chance of relapse in spite of aggressive chemo-radiotherapy. The effusions of serous cavities in MM generally develop as a late complication of the disease like heart failure, renal failure, pneumonia and amyloidosis. We are reporting a rare case of IgG subtype myelomatous pleural effusion demonstrating abundance of plasmacytoid cells in pleural fluid. Bone marrow smear examination favoured the diagnosis of multiple myeloma with the presence of predominant population of plasma cells with high cellularity. There were also presence of a heterogenous myelomatous mass lesion in the right infratemporal fossae, multiple erosive lesions in ribs, vertebral bodies, skull and pelvic bones. Pleural fluid and serum protein electrophoresis demonstrated the presence of gamma monoclonal protein peaks confirming the diagnosis.

scholarly journals A hematologic condition expressed as a lung disease

F1000Research ◽  
2012 ◽  
Vol 1 ◽  
pp. 28 ◽  
Author(s):  
Mónica Egozcue-Dionisi ◽  
José Nieves-Nieves ◽  
Ricardo Fernández-Gonzalez ◽  
Rosángela Fernández-Medero ◽  
Raúl Reyes-Sosa ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Pleural Effusion ◽  
Plasma Cells ◽  
Rare Complication ◽  
Disease Stage ◽  
Fluid Analysis ◽  
Progressive Dyspnea ◽  
Breath Sounds ◽  
The Right ◽  
Pleural Involvement

Pleural involvement secondary to Multiple Myeloma is considered a very rare complication. According to the literature only 1% of these patients develop a myelomatous pleural effusion. We present a case of a 39 year old man with multiple myeloma diagnosed six years prior to our evaluation, which developed progressive dyspnea, dry cough and right pleuritic chest pain two weeks prior to admission. On physical examination the patient had decreased breath sounds over the right posterior hemithorax accompanied by dullness to percussion. The chest radiogram was consistent with a right sided pleural effusion. Pleural fluid analysis revealed the presence of abundant abnormal plasma cells. The patient died four weeks after hospitalization. The presence of myelomatous pleural effusion is considered to be a poor prognostic finding, no matter at what disease stage it develops. So far no definite treatment has been shown to improve survival.

scholarly journals Multiple myeloma associated with IgA lambda gammopathy and multiple myeloma oncogene 1 in a Yorkshire terrier

2018 ◽  
Vol 63 (No. 4) ◽  
pp. 187-192
Author(s):  
S. Kim ◽  
E. Son ◽  
S. Lee ◽  
S. Lee ◽  
H. Kim ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Plasma Cells ◽  
Weight Bearing ◽  
Serum Biochemistry ◽  
First Case ◽  
History Of ◽  
Immunofixation Electrophoresis ◽  
The Right ◽  
Yorkshire Terrier

An eight-year-old spayed female Yorkshire terrier was presented with a one-month history of conspicuous weight-bearing lameness in the right hindlimb, mild anorexia, intermittent vomiting and marked polydipsia and polyuria. Radiographs revealed circular radiolucent foci of variable size in the skeleton. Haematological and serum biochemistry examination revealed mild leucopoenia with severe neutropaenia, mild non-regenerative anaemia, moderate thrombocytopoenia, moderate hyperglobulinaemia, mild hypoalbuminaemia, mild azotaemia and moderate hypercalcaemia. Quantification of serum immunoglobulins revealed elevated IgA and IgG. Serum protein electrophoresis showed a broad appearance with a β-region spike. Plasma cells accounted for 7.6% of the cells in the bone marrow. Serum immunofixation electrophoresis (IFE) revealed IgA lambda gammopathy. Immunohistochemistry in the bone marrow was diffusely positive for multiple myeloma oncogene 1 (MUM-1) and CD20. To our knowledge, this is first case report of multiple myeloma associated with IgA lambda gammopathy confirmed via IFE and immunohistochemical expression of MUM-1 in a dog.

Biologic variations of plasma cells in the bone marrow of smoldering multiple myeloma (SMM) and multiple myeloma (MM) patients: Multiple biopsies in the same patient.

2013 ◽  
Vol 31 (15_suppl) ◽  
pp. e19506-e19506
Author(s):  
Elisabet E. Manasanch ◽  
Neha Korde ◽  
Constance Yuan ◽  
Mary Kwok ◽  
Nishant Tageja ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Plasma Cells ◽  
Ethylenediaminetetraacetic Acid ◽  
Rank Test ◽  
Phenotypic Analysis ◽  
Multiple Biopsies ◽  
Treatment Naïve ◽  
The Right ◽  
Cd Markers

e19506 Background: The European Myeloma Network has reported that plasma cell (PC) enumeration by flow cytometry (FC) varies depending on quality of aspirate pull and field biopsied. We conducted a prospective study to evaluate PC site variation content in the core biopsy (CB), PC viability (V) and proportion of monoclonal PCs based on immunophenotypic characteristics, anticoagulant use, and aspirate (A) pull sequence in SMM and MM treatment-naïve patients. Methods: Untreated SMM (n=5) and MM (n=5) patients underwent bilateral bone marrow (BM) A and CB. Bilateral first-pull A were anticoagulated with ethylenediaminetetraacetic acid (EDTA). The second-pull A were anticoagulated with heparin. CB were performed after obtaining all A. The first pull A was sent for morphology and FC evaluation, and the second-pull for FC. CB infiltration by PC was assessed by CD138 immunohistochemistry (IHC). Analysis of PC by FC used CD markers: 19, 45, 20, 38, 138, 27, 28, 19, 81, 126, 200 and 117. V was measured by FC using 7-amino-actinomycin D exclusion. We used the two-tailed Wilcoxon signed rank test to determine the significance of the difference between paired values. Results: The mean difference in estimated percentage of PC infiltration between the right and left CB was 0.033 +/- 0.017 (p=0.25). Phenotypic analysis of PCs by FC showed similar expression of CD markers. PC V was significantly lower in samples anticoagulated with EDTA when compared to heparin (p<0.005), suggesting that the latter is superior for PC analysis. Of importance, the fraction of abnormal PCs determined by FC did not differ significantly between the two sides, use of EDTA/heparin or order of A pull (p>0.05). Conclusions: Based on IHC and FC, our results suggest that in untreated patients with SMM or MM there are no major differences in the estimated number or immunophenotypic characteristics and distribution of PC in marrow samples obtained from two distant bone sites. These observations have implications for current diagnostic and treatment of MM and its precursor disease. More advanced molecular profiling may find biological variation in bone marrow tumor PC extracted from different locations.

scholarly journals Dyspnea, Massive Effusion and Lytic Rib Lesion as Initial Presentation of Multiple Myeloma in a Young Man

2013 ◽  
Vol 20 (4) ◽  
pp. 253-255 ◽  
Author(s):  
Mohammed H AlShati ◽  
Ramesh Kumar ◽  
Shreeram Kannan
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Pleural Effusion ◽  
Elderly Patients ◽  
Plasma Cells ◽  
Young Age ◽  
Initial Presentation ◽  
Chest Imaging ◽  
Spontaneous Hemothorax ◽  
Plain Chest

Multiple myeloma, a disorder commonly encountered in elderly patients, represents a malignant proliferation of plasma cells that primarily affects bone marrow. Pleural effusion as the presenting manifestation of the disease is uncommon. The authors report a case of multiple myeloma with unusual features presenting at a relatively young age with massive spontaneous hemothorax and multiple thoracic masses completely obscuring rib shadow on plain chest imaging. The patient demonstrated a good response to melphalan chemotherapy without recurrence of effusion or the need for additional chemical or surgical pleural interventions.

scholarly journals Multiple Myeloma in a Dog

2016 ◽  
Vol 44 (1) ◽  
pp. 5
Author(s):  
Claudine Botelho De Abreu ◽  
Rodrigo Bernardes Nogueira ◽  
Luiz Eduardo Duarte De Oliveira ◽  
Flávia Dada Paiva ◽  
Antônio Carlos Cunha Lacreta Junior ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Plasma Cells ◽  
Final Diagnosis ◽  
Initial Assessment ◽  
Radiographic Examination ◽  
Cardiac Murmur ◽  
Left Femur ◽  
The Right ◽  
Bence Jones Proteinuria

Background: The multiple myeloma is a neoplasia characterized by the uncontrolled proliferation of plasma cells (plasmacytes) in the bone marrow and in other tissues. The infiltration of the neoplasia cells associated to the high level of anomalous immunoglobulin production (M protein) results in a variety of clinic-pathologic anomalies. It is a rare disease in dogs, corresponding to 0.3% of all malignant neoplasia and 2% of the hematopoietic, with few literature descriptions. So, the present paper aims at properly report a multiple myeloma in a dog of non-defined breed, emphasizing the clinic, laboratorial, radiographic and pathologic aspects.Case: In a Veterinary Teaching Hospital, an 11-year-old dog of non-defined breed was admitted, weighing 10.8 kg of body mass. The clinic history was claudication of the right thoracic member, hyporexia and lethargy in the past 20 days. The main abnormalities in the physical examination were holosystolic cardiac murmur III/VI on mitral focus, and high sensibility to touch in the right humerus. Laboratory tests showed pancytopenia, serum hypercalcemia and Bence-Jones proteinuria. Radiographic examination confirmed polyostotic punctate osteolysis on the right humerus; pelvic, femurs and vertebrae bones from L2 to L7, on generalized condition. Cytology by aspiration puncture from the left femur marrow bone did not confirm neoplasia cells. The clinic condition of the referred animal was progressively getting worse and euthanasia was performed. At the dog’s necropsy it was spotted tumor infiltrations on the femur, the humerus and the vertebrae canal. Histopathological exam of the bone marrow revealed diffuse occupation by distinguished plasmacytes, in some áreas reaching around 100% of cell population. Metastases on the primary tumor were found on the liver, kidney and spleen.Discussion: The diagnosis of multiple myeloma in this dog was confirmed by bone marrow histopathological exam. It is confirmed when there is more than 20% of plasmacytes in the examined structure. In this report, certain areas were spotted with 100% occupation of neoplasia cells. On the other hand, the first cytological assess did not reveal any abnormalities, suggesting that the place which received the puncture (aspiration) was not infiltrated by tumor cells. It is described that in the bone marrow may occur grouping of plasmacytes, as it was observed the animal’s necropsy of this report. This aspect point out that the diagnosis cannot be discarded only with a negative cytological exam from the bone marrow; especially if there are clinic, laboratorial and radiographic signs compatible to the illness. The spotted clinic signs by this patient are frequent in dogs with multiple myeloma, as well as the laboratory results, except to the monoclonal gammopathy. Due to a no realization of electrophoresis, this abnormality cannot be confirmed. At the initial assessment of the disease, the radiographic exam is considered golden standard as it was observed in this dog. The radiographic abnormalities were determinant, once they conducted the diagnosis towards the suspected neoplasia. According to current diagnosis criteria, on this present case, the pancytopenia, serum hypercalcemia and Bence-Jones proteinuria also helped towards the suspicion of multiple myeloma. However, the evaluation of the bone marrow was decisive to the final diagnosis; and a special attention was given to puncture more than one place in the bone marrow, which improved/enhanced the diagnosis possibility in this patient.Keywords: plasma cells, bone marrow, pancytopenia, osteolysis, radiography.

scholarly journals An Uncommon Presentation of Multiple Myeloma

2014 ◽  
Vol 14 (2) ◽  
pp. 189-191 ◽  
Author(s):  
Chayan Kumar Singha ◽  
Eshita Biswas ◽  
Md. Tanvir Islam ◽  
Ferdous Jahan ◽  
MA Jalil Chowdhury ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Weight Loss ◽  
Plasma Cells ◽  
Protein Electrophoresis ◽  
Hip Pain ◽  
Significant Weight Loss ◽  
Uncommon Presentation ◽  
Radiotherapy Department ◽  
The Right

Multiple myeloma can sometimes manifest only with fracture. We report the case of an individual who presented with a progressive right sided localized hip pain that made him difficulty in walking and also significant weight loss. Investigations revealed anaemia with markedly raised ESR, fracture in the right neck of the femur, monoclonal gamopathy on protein electrophoresis and 70% atypical plasma cells in the bone marrow. Subsequently he was managed in haematology and radiotherapy department accordingly.DOI: http://dx.doi.org/10.3329/jom.v14i2.19673 J Medicine 2013, 14(2): 189-191

scholarly journals Flow Cytometry Method as a Diagnostic Tool for Pleural Fluid Involvement in a Patient with Multiple Myeloma

2012 ◽  
Vol 4 (1) ◽  
pp. e2012063 ◽  
Author(s):  
Muzaffer Keklik ◽  
Serdar Sivgin ◽  
Cigdem Pala ◽  
Celalettin Eroglu ◽  
Gulsah Akyol ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Flow Cytometry ◽  
Back Pain ◽  
Pleural Fluid ◽  
Diagnostic Tool ◽  
Plasma Cells ◽  
Pleural Effusions ◽  
Left Hemithorax ◽  
Simple Method

Multiple myeloma is a malignant proliferation of plasma cells that mainly affects bone marrow. Pleural effusions secondary to pleural myelomatous involvement have rarely been reported in the literature. As it is rarely detected, we aimed to report a case in which pleural effusion of a multiple myeloma was confirmed as true myelomatous involvement by flow cytometry method. A 52-years old man presented to our clinic with chest and back pain lasting for 3 months. On the chest radiography, pleural fluid was detected in left hemithorax. Pleural fluid flow cytometry was performed. In the flow cytometry, CD56, CD38 and CD138 found to be positive, while CD19 was negative. True myelomatous pleural effusions are very uncommon, with fewer than 100 cases reported worldwide. Flow cytometry is a potentially useful diagnostic tool for clinical practice. We presented our case; as it has been rarely reported, although flow cytometer is a simple method for detection of pleural fluid involvement in multiple myeloma.

Bone disease as the first manifestation of systemic AL-amyloidosis

2020 ◽  
Vol 92 (7) ◽  
pp. 85-89
Author(s):  
L. P. Mendeleeva ◽  
I. G. Rekhtina ◽  
A. M. Kovrigina ◽  
I. E. Kostina ◽  
V. A. Khyshova ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Disease ◽  
Plasma Cells ◽  
Interventricular Septum ◽  
Bone Destruction ◽  
Amyloid Deposition ◽  
Bone Lesions ◽  
Al Amyloidosis ◽  
Linear Type

Our case demonstrates severe bone disease in primary AL-amyloidosis without concomitant multiple myeloma. A 30-year-old man had spontaneous vertebral fracture Th8. A computed tomography scan suggested multiple foci of lesions in all the bones. In bone marrow and resected rib werent detected any tumor cells. After 15 years from the beginning of the disease, nephrotic syndrome developed. Based on the kidney biopsy, AL-amyloidosis was confirmed. Amyloid was also detected in the bowel and bone marrow. On the indirect signs (thickening of the interventricular septum 16 mm and increased NT-proBNP 2200 pg/ml), a cardial involvement was confirmed. In the bone marrow (from three sites) was found 2.85% clonal plasma cells with immunophenotype СD138+, СD38dim, СD19-, СD117+, СD81-, СD27-, СD56-. FISH method revealed polysomy 5,9,15 in 3% of the nuclei. Serum free light chain Kappa 575 mg/l (/44.9) was detected. Multiple foci of destruction with increased metabolic activity (SUVmax 3.6) were visualized on PET-CT, and an surgical intervention biopsy was performed from two foci. The number of plasma cells from the destruction foci was 2.5%, and massive amyloid deposition was detected. On CT scan foci of lesions differed from bone lesions at multiple myeloma. Bone fragments of point and linear type (button sequestration) were visualized in most of the destruction foci. The content of the lesion was low density. There was no extraossal spread from large zones of destruction. There was also spontaneous scarring of the some lesions (without therapy). Thus, the diagnosis of multiple myeloma was excluded on the basis based on x-ray signs, of the duration of osteodestructive syndrome (15 years), the absence of plasma infiltration in the bone marrow, including from foci of bone destruction by open biopsy. This observation proves the possibility of damage to the skeleton due to amyloid deposition and justifies the need to include AL-amyloidosis in the spectrum of differential diagnosis of diseases that occur with osteodestructive syndrome.

Sign in / Sign up

Export Citation Format

Share Document