Harris Jacob T, Viniotis Alexa, Bibb John
Internal Medicine, HonorHealth, Scottsdale, USA.
Hematology/Oncology, HonorHealth, Scottsdale, USA.
Cureus. 2025 May 8;17(5):e83759. doi: 10.7759/cureus.83759. eCollection 2025 May.
Multiple myeloma (MM) is a rare blood cancer. Non-measurable MM (NMMM) is a category designation consisting of both non-secretory MM (NSMM) and oligo-secretory MM (OSMM), both of which have negative findings on serum protein electrophoresis and urine protein electrophoresis testing. NSMM and OSMM are infrequent subtypes. This report describes the case of a 67-year-old female patient without significant past medical history who presented with back pain, nausea, fatigue, and mild confusion. Labs were significant for severe hypercalcemia. Imaging demonstrated osteopenia and multiple lytic lesions throughout her spine. Serum protein electrophoresis and immunofixation by electrophoresis were obtained but were inconclusive. Bone marrow biopsy was therefore obtained to help clarify the diagnosis. Workup ultimately revealed a new diagnosis of kappa light chain-restricted NSMM. It is beneficial for the clinician to review the classic features of general MM in such a case, and they are also worth reviewing, as it may be better characterized as OSMM. Recognizing the rare features of NSMM and OSMM is relevant since these are entities not commonly encountered and can appear as classic MM in the initial workup. The care of patients will continue to improve as the medical community continues to recognize the rare malignancy of MM and its variant forms of NMMM, specifically NSMM and OSMM.
多发性骨髓瘤（MM）是一种罕见的血液癌症。不可测量性MM（NMMM）是一个类别名称，包括非分泌性MM（NSMM）和寡分泌性MM（OSMM），这两种类型在血清蛋白电泳和尿蛋白电泳检测中均呈阴性结果。NSMM和OSMM是罕见的亚型。本报告描述了一名67岁女性患者的病例，该患者既往无重大病史，出现背痛、恶心、疲劳和轻度意识模糊。实验室检查显示严重高钙血症。影像学检查显示骨质疏松以及整个脊柱多处溶骨性病变。进行了血清蛋白电泳和免疫固定电泳，但结果不明确。因此进行了骨髓活检以帮助明确诊断。检查最终确诊为κ轻链限制性NSMM。在这种情况下，临床医生回顾一般MM的典型特征是有益的，它们也值得回顾，因为它可能更好地被归类为OSMM。认识到NSMM和OSMM的罕见特征很重要，因为这些是不常见的实体，在初始检查中可能表现为典型的MM。随着医学界继续认识到MM及其NMMM的变异形式，特别是NSMM和OSMM的罕见恶性肿瘤，患者的护理将不断改善。
