IPLab:Lab 6:Multiple Myeloma

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Clinical Summary[edit]

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.

Surgical Pathology Findings[edit]

A thoracotomy was performed after an unsuccessful needle biopsy. At thoracotomy, a 3-cm posterior mediastinal mass was identified that extended to within 1-2 mm of the aorta and into the interspace between the ribs.


Virtual Microscopy[edit]

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Related IPLab Cases[edit]

Malignant bone lesions are part of the differential for increased uptake of isotope during a bone scan.

A normal alk-phos level is 39 to 117 U/L.

A thoracotomy is a surgical procedure in which an opening is made in the chest wall.