DIAGNOSTIC CHALLENGE: COEXISTING MULTIPLE MYELOMA AND EXTRAMEDULLARY PLASMACYTOMA WITH RENAL AND HEPATIC INVOLVEMENT.

Q4 Medicine
Georgian medical news Pub Date : 2025-01-01
K Tsanava, L Khurtsia, E Shengelia, G Qvariani, L Dangadze
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Abstract

Background: Both plasmacytoma and multiple myeloma (MM) are plasma cell dyscrasias, though their concurrence, especially with the unusual extramedullary presentation of plasmacytoma, is exceedingly rare. Distinguishing between them is crucial for management, especially in the presence of atypical findings that complicate the diagnosis.

Case report: Herein, we describe a rare instance of synchronous plasmacytoma and multiple myeloma (MM) in a 65-year-old woman. The patient did not have any preceding symptoms or complaints and was living her life with no limitations until the day she fell and fractured. Preoperative examinations by a traumatologist demonstrated anemia, increased rates of nitrogen metabolism, and a mass in the right kidney. The above findings led to the cancellation of the surgery and encouraged our team to go into more detail. Computed tomography (CT) scans showed a renal mass and liver lesions. During the diagnostic procedure, special attention was given to the acutely high level of total protein in the blood plasma, for which investigations were directed in another avenue. Electrophoresis of blood and urine and bone marrow biopsy established the diagnosis of MM, although the typical CRAB criteria were absent. Laboratory findings present conflicting evidence, with some results suggesting MM and others suggesting plasmacytoma. Clarification was especially important since the renal mass was initially thought to be renal cell carcinoma and needed to be distinguished carefully. Due to the uncommon coexistence of these diseases, we examined both literature and clinical cases in order to investigate their simultaneous occurrence.

Conclusions: This case illustrates the diagnostic dilemma of simultaneous MM and plasmacytoma, highlighting the importance of thorough assessment, including histology and modern imaging. The fact that there are hepatic metastases also points to the aggressive nature of this unusual disease presentation.

诊断挑战:多发性骨髓瘤和髓外浆细胞瘤共存,累及肾脏和肝脏。
背景:浆细胞瘤和多发性骨髓瘤(MM)都是浆细胞增生,尽管它们同时发生,尤其是髓外浆细胞瘤的罕见表现。区分它们对于治疗是至关重要的,特别是在出现使诊断复杂化的非典型表现时。病例报告:在此,我们报告一例罕见的同步浆细胞瘤和多发性骨髓瘤(MM),患者为65岁女性。患者之前没有任何症状或主诉,直到她摔倒并骨折的那一天,她的生活没有任何限制。术前检查显示贫血,氮代谢率增加,右肾有肿块。上述发现导致手术取消,并鼓励我们的团队进行更详细的研究。计算机断层扫描(CT)显示肾脏肿块和肝脏病变。在诊断过程中,特别注意血浆中总蛋白的急剧高水平,因此在另一途径进行调查。血尿电泳和骨髓活检确定了MM的诊断,尽管没有典型的螃蟹标准。实验室结果提供了相互矛盾的证据,一些结果提示MM而另一些结果提示浆细胞瘤。澄清是特别重要的,因为肾脏肿块最初被认为是肾细胞癌,需要仔细区分。由于这些疾病的罕见共存,我们查阅了文献和临床病例,以调查它们的同时发生。结论:该病例说明了同时发生MM和浆细胞瘤的诊断困境,强调了全面评估的重要性,包括组织学和现代影像学。肝转移的事实也表明这种不寻常的疾病表现具有侵袭性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
Georgian medical news
Georgian medical news Medicine-Medicine (all)
CiteScore
0.60
自引率
0.00%
发文量
207
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