Kaushik Himanshi, Manuja Nishtha, Devde Kanchan D, Dongre Amol
Department of Medical Oncology, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND.
Department of Medicine, Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Wardha, IND.
Cureus. 2024 Jul 20;16(7):e65004. doi: 10.7759/cureus.65004. eCollection 2024 Jul.
The diagnosis of multiple myeloma (MM) is made based on the presence of either marrow clonal plasma cells > 10% or an extramedullary or bony plasmacytoma confirmed by biopsy. Additionally, at least one of the SLiM (sixty years, light chain ratio, magnetic resonance imaging)-CRAB (calcium elevation, renal insufficiency, anemia, and bone lesions) myeloma-defining events must be present. MM typically presents with symptoms such as fatigue due to anemia, kidney failure, hypercalcemia, and bone pain. It is uncommon, though, for MM to manifest as a single bone mass. We report the case of a 65-year-old male who did not fit the criteria for solitary bone plasmacytoma and presented with an unusual sternal tumor. The patient was diagnosed with MM despite not having any of the traditional symptoms such as low back pain, weight loss, anemia, or hypercalcemia. The diagnosis was based on a bone marrow examination, which showed 50% plasma cells. Radiation therapy and systemic chemotherapy were then used to treat him. The patient's symptoms, radiological findings, and biopsy results are described in detail, emphasizing the difficulty and intricacy of correctly diagnosing this uncommon manifestation of MM. This case highlights the need for a comprehensive and multidisciplinary strategy to diagnose and treat atypical presentations of MM, making sure that all possible diagnostic pathways are investigated in order to achieve accurate and timely diagnosis and treatment.
多发性骨髓瘤(MM)的诊断基于骨髓中克隆性浆细胞>10%,或经活检证实的髓外或骨浆细胞瘤的存在。此外,必须至少出现一项SLiM(年龄≥60岁、轻链比例、磁共振成像)-CRAB(血钙升高、肾功能不全、贫血和骨病变)骨髓瘤定义事件。MM通常表现为因贫血、肾衰竭、高钙血症和骨痛等症状导致的疲劳。不过,MM表现为单一骨肿块并不常见。我们报告一例65岁男性病例,该患者不符合孤立性骨浆细胞瘤的标准,表现为不寻常的胸骨肿瘤。尽管该患者没有任何传统症状,如腰痛、体重减轻、贫血或高钙血症,但仍被诊断为MM。诊断基于骨髓检查,结果显示浆细胞占50%。随后对其进行了放射治疗和全身化疗。详细描述了患者的症状、影像学检查结果和活检结果,强调了正确诊断MM这种罕见表现形式的难度和复杂性。该病例突出了采用全面且多学科策略来诊断和治疗MM非典型表现的必要性,确保对所有可能的诊断途径进行调查,以实现准确、及时的诊断和治疗。