Multiple myeloma presenting at unusual sites

ABSTRACT

To report unusual presentations of multiple myeloma and to highlight that early detection of these unusual features will encourage early investigation, diagnosis and appropriate management and consequently better prognosis of this difficult disease. Three consecutive cases of plasmacytoma reported at histopathology department of Foundation University Medical College which were later on diagnosed as multiple myeloma are presented. The clinical features and lab investigations were extracted from the patients' files. The hematoxylin and eosin stained slides were retrieved and reviewed. Three cases comprising a surgically excised chest wall mass [presternal], trucut biopsy of a mediastinal mass and a surgically excised extra dural mass along D7-D8 vertebrae were received in histopathology lab. All the patients were females. The ages of the patients were 63, 55 and 47 years respectively. On initial view of slides the diagnosis of plasma cell tumor, plasmacytoma and non-Hodgkin's lymphoma [lymphoplasmacytic type] was made respectively although the differential of large cell lymphoma with plasmacytic differentiation was also kepi in mind. Surprisingly all three cases turned out to be multiple myeloma after bone marrow aspiration, serum protein electrophoresis and skeletal x- rays. Plasmacytoma with coexistent multiple myeloma must be kept in the differential of mediastinal and vertebral masses and further lab and radiologic assessment must be done before starting the treatment.