Coexistent polycythemia vera and smoldering multiple myeloma: report of a case and review of the literature

RESUMO

Polycythemia vera is a myeloproliferative disorder rarely associated with other hematologic malignancies be sides leukemia. Very seldon, an immunoglobulin abnormality may be seen without clinical evidence of a coexistent plasma cell disorder. The association of polycytemia vera and multiple myeloma is extremely rare and in only six of the previously reported cases, both diagnoses were made simultaneously. We report the case of an asymptomatic 58 years old hipertensive male patient who during a routine lalboratory evaluation was found to have thrombocytosis (931,000/mm3) and mild leukocytosis (14,300/mm3). Bone marrow aspiration revealed an increased number of immature plasma cells with absent iron stores. Further laboratory studies were as follows hemoglobin level 19.6gm/dl; white blood count 19,200/mm3 and platelet count 486,000/mm3. The total serum proteins were 9.1 gm/dl with a serum protein electrophoresis showing hyper gamma-globulinemia (3.2 gm/dl). Immunoglobulin quantitation showed an IgA of 3 gm/dl. The total red cell mass was 38.6cc/Kg and the arterial oxygen saturation was 93%. The leucocyte alkaline phosphatase test score was 271. These studies suggested the coexistence of two diseases polycythemia vera and multiple mueloma. A detailed description of the clincial manifestations and the laboratory studies of this case as well as a reviwe of the pertinent literature form the basis of this report