Multiple Myeloma With Mixed Lytic and Blastic Bone Lesions With Lymphadenopathy: Rare Manifestation of a Common Disease-Case Presentation and Literature Review

Abstract

Multiple myeloma - a neoplastic proliferation of plasma cell is the second most common blood cancer. Multiple myeloma is characterized by neoplastic proliferation of the plasma cells. These cells infiltrate variety of organs. Infiltration by immature neoplastic cells and overproduction of monoclonal immunoglobulin chain is responsible for clinical manifestations of multiple myeloma. The most common clinical presentation of multiple myeloma is an asymptomatic person having anemia and elevated globulin in laboratory testing. Multiple myeloma is diagnosed by triad of > 10% marrow infiltration by plasma cells, serum/urine monoclonal protein and end organ damages. One of the common end organ damage is lytic bone lesions resulting from imbalance between osteolytic and osteoblastic activities. Lymphadenopathy and osteoblastic lesions are rare presentations of multiple myeloma - lymphadenopathy in 1% of cases with IgA subtype and osteoblastic lesions in IgE myeloma and lambda light chains. Osteoblastic multiple myeloma is a distinct entity from POEMS syndrome. IgG myeloma with kappa chain predominance is not described yet with osteoblastic lesions and lymphadenopathy. We present a rare case of IgG myeloma with kappa chain predominance that had both lymphadenopathy and osteoblastic lesions.

Synchronous Bone Metastasis From Multiple Myeloma and Prostate Adenocarcinoma as Initial Presentation of Coexistent Malignancies

“…Variable or mixed radiographic patterns are well documented with certain malignancies like breast, bladder, or gastrointestinal tumors ( 2 , 10 ), but our patient exhibited atypical imaging inconsistent with his cancer diagnosis. As such, the sclerotic changes seen on imaging were not in line with the initial diagnosis of multiple myeloma given that osteoblastic lesions are extremely unusual in this condition with only a few reported cases ( 11 ), as would be expected due to the underlying osteoclast activation which drives skeletal metastasis in multiple myeloma. Similarly, even though metastasis mechanisms in prostate cancer include local, hematogenous, and lymphatic spread which can lead to atypical presentations ( 12 ), osteolytic lesions occur in less than 5% of metastatic prostate cancer ( 3 ), and a large destructive lesions with cortical involvement which was not consistent with a diagnosis of prostate adenocarcinoma.…”

Rectal carcinoma revealed by isolated mixed bone metastases

“…Besides, metastatic mixed lesions have been reported in POEMs syndrome and one case of multiple myeloma. 10 , 11 …”

“…9 Besides, metastatic mixed lesions have been reported in POEMs syndrome and one case of multiple myeloma. 10,11 This mixed radiographic appearance can be seen rarely in patients with benign bone dystrophy, such as Paget's disease of bone, typically in the intermediate phase of the disorder. 12 Bone metastases usually affect the spine and pelvis.…”

Case of lymphadenopathy with lytic bone lesions

“…Lymph node enlargement is also relatively uncommon manifestation of myeloma and is reported only in 1% of the cases 5. It is commonly associated with IgA myeloma 6. Biclonal gammopathy is also extremely uncommon and is only seen in 1% of cases of myeloma 7…”