Immunoglobulin D-Lambda Type Multiple Myeloma Presenting with FDG-PET/CT Negative Bone Marrow Involvement

Abstract

We here report a rare case of a patient with IgD-lambda-positive multiple myeloma presenting with FDG-PET/CT negative bone marrow involvement. A 72-year-old man was admitted to our hospital for evaluation of a paravertebral tumor of the chest. Thoracotomy was performed and a histopathological evaluation of resected intrathoracic tumor demonstrated a plasmacytic neoplasma. Initially we thought that this case was a solitary plasmacytoma because there were no positive findings on postoperative FDG-PET/CT. However, bone marrow aspiration study demonstrated massive infiltration of myeloma cells (72%). It is necessary to recognize that IgD-lambda type myeloma cells may not be sufficiently metabolically active to form high uptake on FDG-PET/CT.

18F-fluorocholine versus 18F-fluorodeoxyglucose for PET/CT imaging in patients with suspected relapsing or progressive multiple myeloma: a pilot study

“…According to Machida et al [37], FDG does not accumulate in bone marrow lesions of IgD-λ type MM, whereas Nakamoto et al [23] observed non-FDG avid myelomas other than IgD-λ type MM. Our study found no relationship between MM type and number of visible lesions regardless of which tracer was used.…”

Mieloma de células plasmáticas secretor de IgD, un reto diagnóstico. Reporte de un caso

“…En relación con las anormalidades citogenéticas, éstas son variables (3,11,13) y algunos de los pacientes pueden tener un cariotipo normal (8,13), aunque no se ha descrito el efecto que tienen en el pronóstico de los pacientes con mieloma secretor de IgD.…”