Cases reported "Multiple Myeloma"

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1/133. lymphomatoid granulomatosis following autologous stem cell transplantation.

    lymphomatoid granulomatosis (LYG) is a rare angio-destructive lymphoproliferative disorder (LPD) of uncertain etiology, with prominent pulmonary involvement. Recent studies indicate that LYG is an Epstein-Barr virus (EBV)-associated B cell LPD with large numbers of background reactive T lymphocytes (T cell-rich B cell lymphoma). Although the disease frequently, but not exclusively, occurs in various immunodeficiency states, it has not been reported in association with the transient immunosuppression following autologous bone marrow/peripheral stem cell transplantation (ABM/PSCT). We describe a patient who developed lymphomatoid granulomatosis of the lung approximately 2 weeks after high-dose chemotherapy and autologous peripheral stem cell transplantation for multiple myeloma. Although molecular studies showed no evidence of EBV genome in the biopsy material, the serologic profile with high IgM titers was suggestive of primary EBV infection. Complete radiologic remission occurred following reconstitution of the patient's immune response after a 2-week course of ganciclovir treatment. Despite the apparently low frequency of LPD (both LYG and EBV-associated post-transplant lymphoma) in the ABMT setting, we believe that it should be considered in the differential diagnosis of patients whose clinical course following ABMT is complicated by fevers, in the absence of an identifiable infectious process.
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2/133. Subglottic plasmacytoma: the use of jet ventilation and contact Nd:YAG laser for tissue diagnosis.

    Extramedullary plasmacytomas (EMP) constitute only 1% of all head and neck malignancies, with the vast majority occurring in the upper respiratory tract. The diagnosis of laryngeal EMP can be difficult since the symptoms are non-specific and the tumor usually mucosally covered. This paper discusses the successful combination of jet Venturi ventilation technique with suspension microlaryngoscopy and contact Nd:YAG laser for tissue diagnosis in a patient presenting with a large subglottic mass. Previous attempts using standard endotracheal intubation and forceps technique for biopsy failed to reach the diagnosis and resulted in significant bleeding from the biopsy site. A review of the disease and technique is presented.
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keywords = upper
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3/133. multiple myeloma preceding the development of chronic myelogenous leukemia.

    A case of a 70-year-old man who first developed multiple myeloma and then chronic myelogenous leukemia (CML) within a 3-year period is documented. The patient, with monoclonal hypergammopathy, was diagnosed with smoldering myeloma with IgG-kappa and bence jones protein kappa paraproteinemia. No chemotherapy was given for the myeloma until progressive leukocytosis developed after approximately 3 years. This was found to be due to philadelphia chromosome positive CML. A reverse transcription-polymerase chain reaction assay did not reveal BCR/ABL mRNAs when the myeloma was first diagnosed. The occurrence of 2 distinct hematologic malignancies in the same patient suggests either a different clonal evolution from a common pluripotent malignant stem cell since the CML stem cell also involves the B-lymphoid lineage, a coincident complication of the 2 hematological malignancies, or the coexistence of 2 distinct malignancies due to the same genetic background and/or exposure to similar carcinogenic agents. The literature provides support for the existence of a relationship between multiple myelomas and CML.
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4/133. Sternal splitting approach to upper thoracic lesions located anterior to the spinal cord.

    The sternal splitting approach for upper thoracic lesions located anterior to the spinal cord is described. The sternal splitting approach can be effectively applied to lesions from the T-1 to T-3 levels. The aortic arch prevents procedures below this level. The approach is straight toward the T1-3 vertebral bodies and provides good surgical orientation. The sternal splitting approach was applied to five patients with metastatic spinal tumors at the C7-T3 levels and three patients with ossification of the posterior longitudinal ligament at the T1-3 levels. No postoperative neurological deterioration occurred. Two patients had postoperative hoarseness. The sternal splitting approach to the upper thoracic spine is recommended for hard lesions, extensive lesions requiring radical resection, and lesions requiring postoperative stabilization with spinal instrumentation.
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5/133. multiple myeloma presenting as acute pancreatitis.

    Acute pancreatitis is a very uncommon presenting feature of multiple myeloma. We report an elderly non-alcoholic man presenting with acute abdominal pain and rapidly progressing renal failure. Investigations revealed lytic lesions in the vertebrae and skull, M band on urine electrophoresis, and radiological and biochemical evidence of acute pancreatitis. The patient died despite conservative management of the pancreatitis.
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keywords = abdominal pain
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6/133. plasmacytoma and upper airway obstruction.

    Extramedullary plasmacytomas are hematologic malignancies that occur primarily in the head and neck region. They usually involve the submucosal lymphoid tissue of the nasopharynx or paranasal sinuses and present as soft tissue masses, but have not been previously reported to cause airway obstruction. In general, detection of plasmacytoma antedates the eventual development of the systemic hematologic malignancy, multiple myeloma, by months or years. We describe a unique case of acute upper respiratory tract obstruction secondary to compression by an extramedullary plasmacytoma occurring in the neck of a patient with history of long-standing multiple myeloma. Upper airway obstruction may be a manifestation of untreated plasmacytoma. It is imperative for otolaryngologists and head and neck surgeons to be familiar with this entity because total excision, as well as radiation therapy, for plasmacytomas can be curative in patients without underlying overt plasma cell dyscrasias.
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ranking = 0.8796226978302
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7/133. multiple myeloma presenting with a paraspinal tumor and malignant effusion: case report.

    We describe a patient with multiple myeloma which presented as a thoracic paraspinal tumor and myelomatous pleural effusion. He had manifested a gradual onset of upper back pain with radiation to the left chest wall for 3 months. A radiographic examination showed left pleural effusion and a paraspinal tumor with rib destruction at the--left T5-6 level. Laboratory data showed anemia and a reversed serum albumin to globulin ratio. Protein electrophoresis and immunoelectrophoresis showed a monoclonal IgG-lambda chain component in the serum, urine, and pleural effusion fluid. Ultrasound-guided transthoracic mass biopsy and thoracentesis were performed for diagnosis. biopsy of the thoracic tumor showed a solid mass composed of immature plasma cells. The pleural effusion fluid contained numerous immature plasma cells. An immunophenotype study of the pleural effusion fluid revealed monoclonal plasma cells, compatible with malignant pleural effusion. A specimen of bone marrow was interpreted as typical for plasma cell myeloma. Local radiotherapy and chemotherapy with melphalan and prednisolone resulted in good partial remission with a stable condition. Later, however, the disease flared up and hyperviscosity syndrome developed with epistaxis and retinal hemorrhage. He died of sepsis about 15 months after the initial diagnosis.
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keywords = back pain, back, chest, upper
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8/133. multiple myeloma and chronic lymphatic leukemia in the same patient.

    A patient with both chronic lymphatic leukemia and multiple myeloma is presented. Characterisation of the leukemic cells showed them to possess Fc receptors but to lack SmlG and C3 receptors. Intracellular immunoglobulin was not detected within the leukemic cells. The multiple myeloma presented as a soft tissue mass on the chest wall and produced an IgGK paraprotein. The possible relationship of the two disorders is discussed.
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keywords = chest
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9/133. Epstein-Barr virus-associated high-grade anaplastic plasmacytoma in a renal transplant patient.

    Allograft transplant patients have an increased risk of developing polyclonal or monoclonal lymphoproliferative disorders, but high-grade anaplastic plasmacytomas are extremely rare in these patients. We present a renal transplant patient who developed multiple extramedullary high-grade anaplastic plasmacytomas in the oral cavity, the left maxillary antrum, the scalp, the thigh and the upper abdominal wall with no evidence of diffuse bone marrow infiltration. Epstein-Barr virus (EBV) mRNA transcripts were detected within the myeloma cells by in situ hybridization using EBER1-2 probes. Following discontinuation of immunosuppression applied, the patient was treated with a cyclophosphamide-prednisone regimen followed by local irradiation, and a complete remission was achieved within four weeks. We concluded that EBV-associated high-grade anaplastic plasmacytomas constitute one more type of post-transplant lymphoproliferative disorder, and that despite their characterization as highly malignant neoplasms, their clinical behavior is not always aggressive.
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10/133. Germline CDKN2A mutation implicated in predisposition to multiple myeloma.

    Germline mutations of the CDKN2A (p16(INK4A)) tumor suppressor gene predispose patients to melanoma and pancreatic carcinoma. In contrast, mutations of the murine CDKN2A gene predispose BALB/c mice to pristane-induced plasmacytoma. We describe here a family in which a germline mutation of CDKN2A is present in 4 individuals who developed melanoma as well as in a fifth family member who is suffering from multiple myeloma. To determine whether the CDKN2A mutation predisposed the myeloma patient to her disease, we carried out loss of heterozygosity studies on sorted bone marrow from this individual and observed loss of the wild type CDKN2A allele in the malignant plasma cells. We suggest that germline mutations of CDKN2A may predispose individuals to a wider variety of malignancy than has been hitherto reported, but that the expression of these cancers may depend heavily on the genetic background of the patient. (blood. 2000;95:1869-1871)
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