A case of multiple myeloma with ascites / 대한내과학회지

Ascites is a rare complication of multiple myeloma. When it develops, it is usually associated with extensive liver infiltration with plasma cells, infectious peritonitis or myelomatous peritoneal infiltration. Ascites caused by peritoneal infiltration is even less frequent than others. The majority of previously reported cases were characterized by an IgA paraprotein and lack of skeletal lesions. This rare extramedullary complication of myeloma has been unresponsive to therapy and rapidly fatal. Therefore, it is important to recognize myeloma as a cause of ascites and the presence of ascites heralds a poor prognosis of myeloma. We recently experienced a case of myeloma with ascites and reviewed the relevant literature of human myeloma presenting with the triad of ascites, relative or absolute sparing of the skeleton, and an IgA paraprotein. A 76-year-old man was presented with ascites early in the course of myeloma. He had no evidence of intra-abdominal plasmacytoma and skeletal lesions. Myelomatous ascites was demonstrated by the monoclonal immunoglobulin of IgA type in ascitic fluid. He was treated by plasmapheresis due to hyperviscosity syndrome and VAD combination chemotherapy. He was discharged with the improved clinical condition.

A Case of Waldenstrom's Macroglobulinemia with Multiple Punched-out, Osteolytic Lesions / 대한혈액학회지

Waldenstr m's macroglobulinemia (WM) is a chronic lymphoproliferative disorder characterized by the association of serum monoclonal IgM and marrow infiltration by lymphoid population. A 69-year-old man was first seen for evaluation of anemia. He had complained of generalized weakness and exertional dyspnea. On physical examination there was generalized lymphadenopathy, palpable liver and spleen. He did not show signs and symptoms of hyperviscosity. Skull X-ray demonstrated multiple punched-out, osteolytic lesions. The total serum protein concentration was 10.6g/dL, with a fast gamma peak accounting for 48.3% of the total. The peak was identified as an IgM of the kappa chain type by immunoelectrophoresis. Bence-Jones protein (kappa type) was found in the urine. A Sia test gave positive result. The patient's serum contained a pyroglobulin. Serum viscosity was 5.3. The bone marrow aspirate and biopsy showed infiltration by atypical lymphocytes (about 90% of all nucleated cells), plasmacytic lymphocytes, and plasma cells. By flow cytometric analysis, these cells expressed CD19 (54%), CD20 (80.5%), and CD38 (92%), but did not express CD3, CD5, and CD10. Biopsy specimen from cervical lymph node demonstrated proliferation of abnormal lymphoid cells, composed of a similar population of cells seen in the bone marrow. He was treated with cyclophosphamide, vincristine, and prednisolone and now he improves slightly in clinical and laboratory aspects.