J Korean Soc Radiol.  2019 Sep;80(5):997-1002. 10.3348/jksr.2019.80.5.997.

A Case Report of Extramedullary Myeloma Mimicking Lymphoma with Extensive Abdominal Involvement

• Moon J
• Hwang JA
• Shin HC
• Kim SS
• Lee JH
• Lee JE
• Choi SY
• Lee MY

• KMID: 2459028
• DOI: http://doi.org/10.3348/jksr.2019.80.5.997

Abstract

Extramedullary myeloma refers to the presence of myeloma deposits outside the skeletal system and typically indicates a poor prognosis associated with shorter overall survival and progression- free survival. We report a case of extramedullary myeloma with extensive, abdominal multi-organ involvement mimicking lymphoma at initial diagnosis. Bulky retroperitoneal masses with severe diffusion restriction and patency of encased vessels can be MR findings of both myeloma and lymphoma. Radiologic findings such as arterial hyperenhancement, obstructive uropathy, and the lack of associated lymphadenopathy may favor a diagnosis of myeloma over lymphoma.

MeSH Terms

Diagnosis
Diffusion
Lymphatic Diseases
Lymphoma*
Magnetic Resonance Imaging
Multiple Myeloma
Prognosis
Sarcoma, Myeloid

Figure

• 

  Fig. 1 A 58-year-old man with extensive extramedullary myeloma in abdomen mimicking lymphoma. A. An arterial-phase dynamic contrast-enhanced magnetic resonance image revealing a highly enhancing right perirenal mass (arrow) with IVC encasement. The pancreatic mass (black arrow) shows hyperenhancement compared with the uninvolved pancreatic parenchyma (not shown). A hyperenhancing mass in the gallbladder fundus (arrowhead) is also shown. B. A T2-weighted image showing masses encased in the IVC (white arrow) and two right renal arteries (arrowheads). The vessels show only mild narrowing and maintain their patency. Only mild right hydronephrosis is indicated (black arrow). C. Magnetic resonance cholangiopancreatography image showing the cut-off of the pancreatic duct at the body (arrow). No substantial upstream ductal dilatation is observed. Furthermore, the bile duct is not dilated. D. Masses involving the right perirenal area (arrow), pancreas (black arrow), and gallbladder (arrowhead) showing severe diffusion restriction compared to the spleen (asterix) on diffusion-weighted imaging. IVC = inferior vena cava E. An 18F-fluorodeoxyglucose PET-CT image showing multiple hypermetabolic skeletal lesions and a huge abdominal hypermetabolic mass. F. A photomicrograph of tissue obtained using ultrasound-guided percutaneous gun biopsy of the perirenal mass showing a sheet of small cell infiltration. A high-power view (hematoxylin and eosin, × 400) showing abundant plasma cells containing eccentric abundant basophilic cytoplasm, eccentric round-to-oval nuclei, and fine to coarsely clumped chromatin (left). Tumor cells are positive for CD138 (a marker of plasma cell differentiation, × 40, middle) and κ light chain restriction (× 40, right) showing strong, diffuse, brown staining.

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