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→Surgical Pathology Findings
This 63-year-old female presented with the complaint of left chest pain of approximately 4 months duration. Physical examination revealed that the pain was along the distribution of the left sixth intercostal nerve. Chest film showed a posterior mediastinal mass with partial collapse of T6. A lytic lesion of the right distal clavicle was noted on subsequent radiological examination. A bone scan revealed increased uptake in thoracic vertebrae. Serum alkaline phosphatase was elevated slightly (143 U/L). Serum protein electrophoresis was normal, while urine protein electrophoresis showed a monoclonal spike in the Gamma region. A bone marrow study was non-diagnostic.
== Images ==
File:IPLab6MM4.jpg|This is a photograph of the vertebral column from this patient at autopsy. Notice the collapsed vertebra (1). There are multiple variably-sized white nodules (2) within the bone marrow. These are accumulations of malignant plasma cells in this case of multiple myeloma.
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== Virtual Microscopy ==
<peir-vm>IPLab6MM</peir-vm>
== Study Questions ==
* <spoiler text="What class of amyloid is this?">AL - Immunocyte dyscrasias - primary amyloidosis.</spoiler>
* <spoiler text="What is the chemical nature of this type of amyloid?">Immunoglobulin light chains, usually lambda.</spoiler>
* <spoiler text="What is the usual organ distribution of amyloid in this class of amyloidosis?">Heart, gastrointestinal tract, peripheral nerves, skin, and tongue.</spoiler>
== Additional Resources ==
=== Reference ===
* [http://emedicine.medscape.com/article/204369-overview eMedicine Medical Library: Multiple Myeloma]
* [http://www.merckmanuals.com/professional/hematology_and_oncology/plasma_cell_disorders/multiple_myeloma.html Merck Manual: Multiple Myeloma]
=== Journal Articles ===
* Rodon P, Linassier C, Gauvain JB, Benboubker L, Goupille P, Maigre M, Luthier F, Dugay J, Lucas V, Colombat P. [http://www.ncbi.nlm.nih.gov/pubmed/11168502 Multiple myeloma in elderly patients: presenting features and outcome]. ''Eur J Haematol'' 2001 Jan;66(1):11-7.
=== Images ===
* [{{SERVER}}/library/index.php?/tags/327-multiple_myeloma PEIR Digital Library: Multiple Myeloma Images]
* [{{SERVER}}/library/index.php?/tags/65-amyloidosis PEIR Digital Library: Amyloidosis Images]
* [http://library.med.utah.edu/WebPath/HEMEHTML/HEMEIDX.html#6 WebPath: Myeloma]
== Related IPLab Cases ==
* [[IPLab:Lab 6:Amyloidosis|Lab 6: Liver: Amyloidosis]]
* [[IPLab:Lab 6:Senile Amyloidosis|Lab 6: Heart: Senile Amyloidosis]]
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[[Category: IPLab:Lab 6]]