Multiple myeloma-plasma cell tumor of the antibrachium
Journal Title: Αρχεία Ελληνικής Ιατρικής - Year 2012, Vol 29, Issue 4
Abstract
An 88 year-old Greek male was admitted at the Outpatient of our Institution due to osseous pain. Symptoms began 9 months ago with intense pain at the right proximal antibrachial region. The pain was continuous and aggravated with movements and weight lifting. Four months later, the patient visited an Orthopedic Surgeon who proposed conservative treatment with an antibrachial cast and NSAIDs for three weeks. Despite the immobilization and medical treatment pain was not relieved. Five months later, he was admitted at the Internal Medicine Department of a County Hospital due to fatigue. The patient was submitted to thorough clinical, laboratory, and plain radiographic exams that work up a lesion at the right antibrachium along with highly elevated ESR (115 mm/h), an IgG monoclonal protein and wild renal insufficiency (1.9 mg/dL). Thoracic and abdominal CT scans as well as an MRI of the antibrachium were performed and the patient was referred to our Department. His medical history included an acute myocardial infraction 34 years ago with a preserved EF of 60%, benign prostate hyperplasia under medical treatment and osteoarthritis of the left surgically treated ten years ago. On admission, the patient was asymptomatic and had no abnormal clinical findings, expect of local swelling. During clinical examination, liver and spleen were not palpable. Complete blood counts were as follows: Hb 9.9 g/dL, Ht 30.5%, WBC 6.59×109/L (differential count: neutrophils 89%, lymphocytes 9%, monocytes 2%) and platelets 123×109/L. The erythrocyte sedimentation rate was 100 mm/h. The biochemical profile was as follows: BUN 112 mg/dL, creatinine 1.8 mg/dL, SGOT 11 IU/L, SGPT 6 IU/L, LDH 164 IU/L (upper normal limit 220 IU/L), ALP 72 IU/L, γ-GT 9 IU/L, Na+ 137 mmol/L, K+ 3.8 mmol/L, PO3- 2.9 mg/dL, Mg++ 1.7 mg/dL, Ca++ 8.8 mg/dL, total serum protein 7.8 g/dL, albumin 3.3 g/dL, β2 microglobulin 6.0 mg/L. Serum protein electrophoresis demonstrated a spike at the area of γ-globulins. The immunoelectrophoresis revealed a monoclonal IgGκ peak of of 3320 mg/dL. The 24h total urine protein was 1,052 g. A bone marrow aspirate and biopsy were diagnostic.
Authors and Affiliations
E. KOUTSI, T. VASSILAKOPOULOS, K. PETEVI, G. GAINAROU, A. KANELLOPOULOS, L. PAPEGEORGIOU, P. FLEVARI, V. TELONIS, M. PANOU, J. MELETIS
Keywords
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