Multiple Myeloma Case Studies

Decent Essays
Multiple myeloma (MM) is characterized by neoplastic proliferation of immunoglobulin-producing plasma cells. Many malignancies can mimic MM, however the concomitant existence of another primary malignancy alongside MM is exceedingly rare. We report the first case wherein MM and esophageal adenocarcinoma manifest concomitantly. A 58 year old male with a history of prostatic adenocarcinoma, in remission post chemo-radiation therapy, presented with a six month history of worsening intermittent dysphagia to soft and solid food, low back and right rib pain, and a weight loss of 50 lbs. He had a 30 pack year smoking history. Clinical exam revealed an emaciated gentleman with conjunctival pallor and diffuse tenderness over his low back and over his…show more content…
Labs were significant for macrocytic anemia, hypoalbuminemia, hyperglobulinemia, hypercalcemia (corrected Ca 11.5 mg/dl), normal intact PTH, normal PSA profile, elevated creatinine (2.9 mg/dl) and eGFR of 44 ml/min/1.73 m2. Urinalysis revealed moderate proteinuria. SPEP and UPEP detected a monoclonal IgA Kappa spike. Serum IgA levels were significantly elevated, with reduction in serum IgG and IgM levels. Free Kappa-Lambda ratio was significantly high at 8.6. Peripheral smear revealed macrocytosis with rouleaux formation, with absence of circulating plasma cells. CT chest revealed a 5 X 4 X 10 mass at the GE junction and expansile osteolytic lesions over the posterior right rib. Subsequent EGD revealed a non-occluding 10 cm mass in the distal esophagus, which was consistent with poorly differentiated esophageal adenocarcinoma (signet ring variety) on biopsy. CT and MRI images of his spine revealed multiple osteolytic lesions and compression fractures involving his lower thoracic vertebrae, especially affecting T11 vertebra. Biopsy of T11 and right rib lesions’ were consistent with MM; with no evidence of esophageal adenocarcinoma metastasis. Bone marrow biopsy with flow cytometry; CD56 and CD138 IHC stains revealed 40% plasma cell population, confirming MM. PET scan revealed
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