Korean J Hematol.  2005 Dec;40(4):261-265. 10.5045/kjh.2005.40.4.261.

A Case of Multiple Myeloma Presenting as Non-obstructive Jaundice Due to Plasma Cell Infiltration of the Liver

• Yu MH
• Kim HW
• Yeo YS
• Lim JW
• Jeong WJ
• Han EM
• Seo CW
• Kim SB
• Park SK
• Lee SK

• KMID: 2083464
• DOI: http://doi.org/10.5045/kjh.2005.40.4.261

Abstract

Extraosseous manifestations are found in less than 5% of the patients with multiple myeloma. We reported here on a rare case of multiple myeloma presenting as non-obstructive jaundice due to diffuse plasma cell infiltration of the liver. A 70-year-old man was referred to our hospital because of general weakness, weight loss, jaundice, anemia and proteinuria. The laboratory studies showed: hemoglobin 8.5g/dL, calcium 10.3mg/dL, creatinine 1.3mg/dL, AST 41IU/L, ALT 26IU/L, alkaline phosphatase 304IU/L, total bilirubin 4.0mg/dL, direct bilirubin 2.3mg/dL and 24 hour urinary protein 1,120mg. The serologic tests for hepatitis B and C virus were negative. The abdominal CT scans were normal. The urinary protein studies revealed a M component of the lamda type light chain. The bone marrow biopsy showed atypical plasma cells, and the liver biopsy showed a diffuse sinusoidal infiltration of plasma cells.

Keyword

Multiple myeloma; Plasma cell infiltration; Jaundice; Liver

MeSH Terms

Aged
Alkaline Phosphatase
Anemia
Bilirubin
Biopsy
Bone Marrow
Calcium
Creatinine
Hepatitis B
Humans
Jaundice*
Liver*
Multiple Myeloma*
Plasma Cells*
Plasma*
Proteinuria
Serologic Tests
Tomography, X-Ray Computed
Weight Loss
Alkaline Phosphatase
Bilirubin
Calcium
Creatinine

Figure

• 

  Fig. 1. Neoplastic plasma cells (in bone marrow) show abundant deep-blue cytoplasm with perinuclear halo (Wright-Giemsa stain, ×1,000).

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  Fig. 2. The infiltrated myeloma cells are seen in dilated sinusoids (H & E stain, ×400).

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  Fig. 3. The immunostains for CD 138, myeloma cells show intense cytoplasmic reactivity, but surrounding hepatocytes does not (×400).

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