Abdominal Manifestations of Extraosseous Myeloma

Abstract

Extraosseous myeloma, defined as the myelomatous involvement outside the skeleton system, is rare and often associated with advanced multiple myeloma. There has been a recent increase in the clinicoradiological incidence of this entity, possibly secondary to increased survival of patients and frequent use of imaging. This has led to the development of new clinical staging guidelines for multiple myeloma, which include the use of imaging modalities positron emission tomography/computed tomography and magnetic resonance imaging for accurate detection and optimal management. The aims of this review were to discuss the significance of identification of extraosseous disease, to describe the spectrum and common sites of extraosseous involvement in the abdomen, and to review the imaging findings of extraosseous myeloma in the abdomen.

Central Nervous System Myeloma and Unusual Extramedullary Localizations: Real Life Practical Guidance

“…Regarding gastrointestinal localizations, the most frequent is small bowel followed by stomach, colon and esophagus (61). Lesions appear as large masses with mural infiltration, mimicking lymphoma (16). Testicular and ovarian involvement is quite rare, presenting as diffuse enlargement or solid mass (62).…”

“…Authors argue that these locations represent a sanctuary not successfully treated by stem cell transplantation ( 17 ). EMM is usually associated with shorter overall and progression free survival, and resistance to conventional therapies ( 16 ). These lesions may potentially involve any organ and consist either of plasma cells proliferation or amyloid deposition ( 18 ).…”

“…Plasma cell leukemia (PCL) can be considered an extreme variant of aggressive EMM characterized by rapid progression, drug resistance and short survival (13)(14)(15), nevertheless some authors reason that PCL is a well-defined pathologic entity and should be excluded from the EMM spectrum, although PCL fulfills the definition of EMM (10). Longer patient survival, due to more efficient drugs and the following development of resistance to these therapies may engenders clones of plasm cells with unpredictable pattern of relapse (16). Authors argue that these locations represent a sanctuary not successfully treated by stem cell transplantation (17).…”

Extraosseous myeloma of liver mimicking multifocal hepatocellular carcinoma where a distinction has to be made: two case reports

“…Second, only one single large lesion was initially seen in our first case on multiphasic CT. This was in concordance with multiple previous studies that reported cases of EM of liver where lesions are more conspicuous on ultrasound than on CT. 3 Regarding the hepatic lesions on CT from our cases, they were most conspicuous on the arterial phase, while the smaller ones may be isoattenuating or minimally hypo-enhancing on portovenous or delayed phases. In addition, most lesions had a subcapsular location in the liver, an important area to review.…”

“…On magnetic resonance imaging, focal lesions may be hyper-or hypo-intense on T1weighted images and hyperintense on T2-weighted images with minimal gadolinium enhancement. 2,3 Scarce literature has documented hypervascular enhancement patterns with washout on multiphasic CT or magnetic resonance imaging, and only few case reports have reported only a solitary focal mass. [4][5][6] The multinodular form with hypervascular enhancement pattern has not been reported before.…”