Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma
Multiple myeloma is a malignant clonal proliferation of plasma cells in the bone marrow preceded by monoclonal gammopathy of undetermined significance. Initial presentation of multiple myeloma as extramedullary spread in soft tissues particularly in the liver is uncommon. We report a case of a 74-ye...
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| Format: | Article |
| Language: | English |
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Wiley
2018-01-01
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| Series: | Case Reports in Hematology |
| Online Access: | http://dx.doi.org/10.1155/2018/7954816 |
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| author | Andrew C. Tiu Rashmika Potdar Vivian Arguello-Gerra Mark Morginstin |
| author_facet | Andrew C. Tiu Rashmika Potdar Vivian Arguello-Gerra Mark Morginstin |
| author_sort | Andrew C. Tiu |
| collection | DOAJ |
| description | Multiple myeloma is a malignant clonal proliferation of plasma cells in the bone marrow preceded by monoclonal gammopathy of undetermined significance. Initial presentation of multiple myeloma as extramedullary spread in soft tissues particularly in the liver is uncommon. We report a case of a 74-year-old African American female who presented with epigastric pain, hematemesis, elevated alkaline phosphatase, and gamma-glutamyl transferase. Initial impression was peptic ulcer disease; however, ultrasound and CT scan of the abdomen showed multiple liver nodules and perihepatic lymphadenopathy suggestive of metastatic disease. Biopsy of the liver nodules showed CD138 and kappa light chain-restricted positive cells consistent with extramedullary spread of multiple myeloma to the liver. The patient achieved partial response after 6 months of treatment with Velcade, cyclophosphamide, and dexamethasone (VCD). Due to severe neutropenia from cyclophosphamide, regimen was switched to Velcade, Revlimid, and dexamethasone (VRD) which resulted to very good partial response in 1 year which eventually persisted after 4 years. No controlled prospective studies have defined the standard treatment for multiple myeloma with extramedullary spread particularly to the liver. Treatment of multiple myeloma with extramedullary disease follows guidelines for multiple myeloma. |
| format | Article |
| id | doaj-art-58ff87bdcc1546e08a1e4821bcb8fecb |
| institution | Kabale University |
| issn | 2090-6560 2090-6579 |
| language | English |
| publishDate | 2018-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Hematology |
| spelling | doaj-art-58ff87bdcc1546e08a1e4821bcb8fecb2025-08-20T03:34:58ZengWileyCase Reports in Hematology2090-65602090-65792018-01-01201810.1155/2018/79548167954816Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple MyelomaAndrew C. Tiu0Rashmika Potdar1Vivian Arguello-Gerra2Mark Morginstin3Department of Medicine, Einstein Medical Center, Philadelphia, PA, USADivision of Hematology and Medical Oncology, Einstein Medical Center, Philadelphia, PA, USADepartment of Pathology and Laboratory Medicine, Einstein Medical Center, Philadelphia, PA, USADivision of Hematology and Medical Oncology, Einstein Medical Center, Philadelphia, PA, USAMultiple myeloma is a malignant clonal proliferation of plasma cells in the bone marrow preceded by monoclonal gammopathy of undetermined significance. Initial presentation of multiple myeloma as extramedullary spread in soft tissues particularly in the liver is uncommon. We report a case of a 74-year-old African American female who presented with epigastric pain, hematemesis, elevated alkaline phosphatase, and gamma-glutamyl transferase. Initial impression was peptic ulcer disease; however, ultrasound and CT scan of the abdomen showed multiple liver nodules and perihepatic lymphadenopathy suggestive of metastatic disease. Biopsy of the liver nodules showed CD138 and kappa light chain-restricted positive cells consistent with extramedullary spread of multiple myeloma to the liver. The patient achieved partial response after 6 months of treatment with Velcade, cyclophosphamide, and dexamethasone (VCD). Due to severe neutropenia from cyclophosphamide, regimen was switched to Velcade, Revlimid, and dexamethasone (VRD) which resulted to very good partial response in 1 year which eventually persisted after 4 years. No controlled prospective studies have defined the standard treatment for multiple myeloma with extramedullary spread particularly to the liver. Treatment of multiple myeloma with extramedullary disease follows guidelines for multiple myeloma.http://dx.doi.org/10.1155/2018/7954816 |
| spellingShingle | Andrew C. Tiu Rashmika Potdar Vivian Arguello-Gerra Mark Morginstin Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma Case Reports in Hematology |
| title | Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma |
| title_full | Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma |
| title_fullStr | Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma |
| title_full_unstemmed | Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma |
| title_short | Multiple Liver Nodules Mimicking Metastatic Disease as Initial Presentation of Multiple Myeloma |
| title_sort | multiple liver nodules mimicking metastatic disease as initial presentation of multiple myeloma |
| url | http://dx.doi.org/10.1155/2018/7954816 |
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