IPLab:Lab 6:Multiple Myeloma
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
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.
AL - Immunocyte dyscrasias - primary amyloidosis.
Immunoglobulin light chains, usually lambda.
Heart, gastrointestinal tract, peripheral nerves, skin, and tongue.
- Rodon P, Linassier C, Gauvain JB, Benboubker L, Goupille P, Maigre M, Luthier F, Dugay J, Lucas V, Colombat P. Multiple myeloma in elderly patients: presenting features and outcome. Eur J Haematol 2001 Jan;66(1):11-7.
- PEIR Digital Library: Multiple Myeloma Images
- PEIR Digital Library: Amyloidosis Images
- WebPath: Myeloma
Related IPLab Cases
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.