Korean J Hematol.  2009 Sep;44(3):188-192. 10.5045/kjh.2009.44.3.188.

A Case of Multiple Myeloma Associated with Multifocal Osteosclerosis (Multiple Myeloma with Osteosclerosis)

• Jin SA
• Baek SW
• Song IC
• Yun GW
• Yang YJ
• Lee HJ
• Yun HJ
• Kim JM
• Jo DY
• Kim S

• KMID: 2252141
• DOI: http://doi.org/10.5045/kjh.2009.44.3.188

Abstract

Osteosclerotic myeloma is a rare entity, characterized by single or multiple osteosclerotic bone lesions and usually accompanied by a polyneuropathy syndrome (POEMS). Multiple myeloma with osteosclerotic lesions without polyneuropathy is exceedingly rare. We report a case of multiple myeloma associated with multifocal osteosclerotic lesions without any evidence of POEMS. A 48-year-old woman presented with incidentally found osteosclerosis of 8th thoracic vertebra on a plain chest film. Bone survey, CT scan, MR scan, and radioisotope scintigraphy revealed multiple localized osteoclerosis; serum protein immunofixation showed IgG, lambda monoclonal gammopathy. A biopsy of T8 vertebral body disclosed plasma cell myeloma. Given that there was no organ or tissue damage other than multifocal osteosclerosis, the patient was placed on close observation with regular examination. This case indicates that although rare, multiple myeloma should be included in the differential diagnosis of sclerotic bone lesions.

Keyword

Multiple myeloma; Osteosclerosis; Polyneuropathy syndrome; POEMS

MeSH Terms

Biopsy
Diagnosis, Differential
Female
Humans
Immunoglobulin G
Middle Aged
Multiple Myeloma
Osteosclerosis
Paraproteinemias
Polyneuropathies
Spine
Thorax
Immunoglobulin G

Figure

• 

  Fig. 1. Plain images show multifocal bony sclerosis. (A) A thoracic spine image shows sclerotic changes in vertebral bodies (T8, L1) and coracoid process of left scapula (arrows). (B) A lumbar spine image shows osteosclerotic lesions in pelvic bone and femur (arrows).

• 

  Fig. 2. An abdomen CT scan image shows focal bony sclerosis in a vertebral body (arrow).

• 

  Fig. 3. T1-weighted MR images show osteoblastic low signal intensity lesions in the bodies of T8–10, L1, L2 and L5 vertebrae.

• 

  Fig. 4. Biopsy of T8 vertebral body shows focal infiltration of CD138-positive atypical plasmacytoid cells, which is consistent with plasma cell myeloma (A) HE stain, ×200. (B) Immunohistochemical stain for CD138, ×400.

Reference

References

1. Barlogie B, Shaughnessy J, Espstein J, et al. Plasma cell myeloma. Lichtman MA, Beutler E, Kipps TJ, editors. Williams Hematology. 7th ed.New York: USA, McGraw-Hill Medical;2006. p. 1501–33.

2. Schey S. Osteosclerotic myeloma and ‘POEMS'syndrome. Blood Rev. 1996; 10:75–80.

3. Dispenzieri A. POEMS syndrome. Hematology Am Soc Hematol Educ Program. 2006. 360–7.

4. Sharnoff JG, Belsky H, Melton J. Plasma cell leukemia or multiple myeloma with osteosclerosis. Am J Med. 1954; 17:582–4.

5. Hall FM, Gore SM. Osteoslcerotic myeloma variants. Skeletal Radiol. 1998; 17:101–5.

6. Lacy MQ, Gertz MA, Hanson CA, Inwards DJ, Kyle RA. Multiple myeloma associated with diffuse osteosclerotic bone lesions: a clinical entity distinct from osteosclerotic myeloma (POEMS syndrome). Am J Hematol. 1997; 56:288–93.

7. Mulleman D, Gaxatte C, Guillerm G, et al. Multiple myeloma presenting with widespread osteosclerotic lesions. Joint Bone Spine. 2004; 71:79–83.

8. The International Myeloma Working Group. Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group. Br J Haematol. 2003; 121:749–57.

9. Park SY, Lee JS, Lee KS, et al. A case of multiple myeloma with sclerosis and cryoglobulinemia. Korean J Hematol. 1985; 20:103–8.

10. Lee CK, Kim HK, Lee DN. A case of multiple myeloma sssociated with osteosclerosis. Korean J Clin Pathol. 1991; 11:103–8.

11. Brown TS, Paterson CR. Osteosclerosis in myeloma. J Bone Joint Surg Br. 1973; 55:621–3.

12. Mundy GR, Raisz LG, Cooper RA, Schechter G, Salmon SE. Evidence for the secretion of an osteoclast stimulating factor in myeloma. N Engl J Med. 1974; 291:1041–6.

13. Bataille R, Chappard D, Klein B. Mechanisms of bone lesions in multiple myeloma. Hematol Oncol Clin North Am. 1992; 6:285–95.