World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access
Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc
Journal website https://www.wjon.org

Case Report

Volume 13, Number 5, October 2022, pages 311-319

Extramedullary Multiple Myeloma: A Patient-Focused Review of the Pathogenesis of Bone Marrow Escape

Figures

Figure 1.
Figure 1. Positron emission tomography scan showing progression of disease following initial chemotherapy.
Figure 2.
Figure 2. Positron emission tomography scan at the time of relapse showing extraosseous and extramedullary involvement.
Figure 3.
Figure 3. Positron emission tomography scan at the time of relapse showing liver involvement.
Figure 4.
Figure 4. Liver biopsy with CD138 immunostaining showing plasmacytoid cells strongly immunopositive for CD138 at × 30 (a) and × 50 (b) power.
Figure 5.
Figure 5. Liver biopsy with kappa in-situ hybridization at × 20 (a) and lambda in-situ hybridization at × 40 (b). The plasmacytoid cells show a kappa restriction. This immuno-histopathological presentation is consistent with kappa-restricted multiple myeloma.

Table

Table 1. Staging and Response to Treatment
 
StageDateIgG (mg/dL)K/L ratioKappa light chains (mg/L)Serum M protein (g/dL)Urine M protein (mg/24 h)Aspartate aminotransferase (U/L)Alanine aminotransferase (U/L)Alkaline phosphatase (U/L)Creatinine (mg/dL)
DiagnosisAugust 23, 2017534116.962,00001115290.98
Started carfilzomib, lenalidomide and dexamethasone on September 7, 2017September 28, 2017614538.019,2000.23,8811321345
Started bortezomib, daratumumab and dexamethasone on October 17, 2017November 21, 201754318.50279.3741015861.4
February 2, 2018487207.51,66081467
Started cyclophosphamide, pomalidomide, and dexamethasone on February 7, 2018February 27, 201846013.941980.167431.45
April 13, 201836528.832050.158106991.12
Started elotuzumab, lenalidomide and dexamethasoneApril 30, 2018308124744.20.135066461.05