60-year-old patient:
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- With AML and multiple myeloma, AML induction therapy started two months ago
- High-resolution CT to rule out fungal pneumonia raised suspicion for small liver lesions, follow- up MRI was performed (largest liver lesion depicted)
- Concomitant enlarging lesion of the left ninth rib with soft tissue mass
- Histopathological confirmation was obtained
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What is the correct diagnosis?
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- Progress of multiple myeloma with hepatic manifestations/infiltrations
Explanation:
Extraosseous myelomatous masses are rare and found in less than 5% of patients with multiple myeloma. Although hepatic involvement in multiple myeloma has been described at autopsy in up to 30% of patients, clinical diagnosis is significantly less common. Diffuse and nodular patterns of plasma cell infiltration have been reported. Most often, focal liver lesions have been observed as non- or mildly enhancing on CT scan and as moderate or minimally enhancing on MRI
References:
– Patlas M, Khalili K, Dill-Macky MJ, Wilson SR. Spectrum of imaging findings in abdominal extraosseous myeloma. AJR Am J Roentgenol. 2004 Oct;183(4):929-32. doi: 10.2214/ajr.183.4.1830929. PMID: 15385283.
– Marcon M, Cereser L, Girometti R, Cataldi P, Volpetti S, Bazzocchi M. Liver involvement by multiple myeloma presenting as hypervascular focal lesions in a patient with chronic hepatitis B infection. BJR Case Rep. 2016 May 8;2(3):20150013. doi: 10.1259/bjrcr.20150013. PMID: 30459962; PMCID: PMC6243346.