Pu Zongsheng, Zhan Lujiang, Zha Yimi, Li Yilin, Qiu Shilin, He Yinfu, Yang Yanhong, Feng Zaihui, Zhu Xingxing
Department of Radiology, The Third People's Hospital of Honghe Hani and Yi Autonomous Prefecture, Gejiu, Yunnan, China.
Department of Pathology, The Third People's Hospital of Honghe Hani and Yi Autonomous Prefecture, Gejiu, Yunnan, China.
Front Oncol. 2025 Sep 10;15:1640981. doi: 10.3389/fonc.2025.1640981. eCollection 2025.
Hepatic involvement as the initial manifestation of multiple myeloma (MM) is exceedingly rare and presents significant diagnostic challenges due to its heterogeneous imaging features, which often mimic metastatic liver tumors. We report a case of a 62-year-old man presenting with right upper quadrant discomfort. Imaging revealed a hypoechoic lesion in segment II of the liver on ultrasound, a low-density area with mild enhancement on contrast-enhanced CT, and atypical MRI features including hyperintensity on T1- and T2-weighted images, mild diffusion restriction on diffusion-weighted imaging (DWI), and minimal enhancement post-Gd-DTPA administration. Histopathology demonstrated diffuse infiltration of atypical plasma cells consistent with plasmacytoma, supported by immunohistochemical positivity for CD138, CD38, MUM1, and CD56, and an elevated serum β-microglobulin level, confirming the diagnosis of MM with hepatic involvement. This case underscores the variability of extramedullary myeloma (EM) imaging presentations in the liver and highlights the importance of including EM in the differential diagnosis of atypical hepatic lesions, especially when accompanied by osteolytic bone lesions or abnormal serum markers. Histopathological confirmation remains essential for definitive diagnosis and guiding treatment.
肝脏受累作为多发性骨髓瘤（MM）的初始表现极为罕见，由于其影像学特征异质性，常酷似肝转移瘤，故带来了重大诊断挑战。我们报告一例62岁男性，表现为右上腹不适。影像学检查显示，超声提示肝脏Ⅱ段低回声病变，增强CT显示低密度区伴轻度强化，MRI表现不典型，T1加权像和T2加权像呈高信号，扩散加权成像（DWI）有轻度扩散受限，钆喷酸葡胺（Gd-DTPA）增强后强化轻微。组织病理学显示非典型浆细胞弥漫浸润，符合浆细胞瘤，CD138、CD38、MUM1和CD56免疫组化阳性以及血清β-微球蛋白水平升高支持该诊断，确诊为合并肝脏受累的MM。该病例强调了肝脏髓外骨髓瘤（EM）影像学表现的变异性，并突出了在非典型肝脏病变鉴别诊断中纳入EM的重要性，尤其是伴有溶骨性骨病变或血清标志物异常时。组织病理学确诊对于明确诊断和指导治疗仍然至关重要。
