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Oligosecretory myeloma with gastrointestinal tract involvement: an unusual presentation and literature review
  1. Victor Yu Han Ling,
  2. Sreekanth Reddivari,
  3. Angel Mary Joseph and
  4. Rosie Cox
  1. Haematology Department, Wrightington Wigan and Leigh NHS Foundation Trust, Wigan, UK
  1. Correspondence to Dr Victor Yu Han Ling; victorlyh2004{at}gmail.com

Abstract

A woman in her 70s with vague gastrointestinal (GI) symptoms and unintentional weight loss was referred to endoscopy clinic for investigation and consideration of GI malignancy. CT of the thorax, abdomen and pelvis showed a suspicious mass in the oesophago-gastric junction with a lytic lesion on S1–S2 sacrum. A subsequent upper GI endoscopy revealed two raised, ulcerated tumours on the lesser curvature of the stomach. By the time an MRI of the whole spine was done which revealed multiple metastases involving thoracic, lumbar and sacral skeleton, she had developed leg weakness and paraesthesias, consistent with the imaging findings. A positron emission tomography/CT scan further confirmed the above findings. The initial working diagnosis was primary GI tumour with bony metastases. However, she was later referred to the haematology team after the immunohistochemistry of the tumour showed that it was of a plasma cell origin (CD138 positive) associated with lambda light chain deposits. Serum-free light chain showed a raised lambda light chain of 272 mg/L and kappa light chain of 11.3 mg/L and involved/uninvolved light chain ratio of 24. Bone marrow biopsy confirmed a plasma cell myeloma with moderate disease burden. Monoclonal lambda chains were demonstrated on immunofixation but negative on serum protein electrophoresis and hence a diagnosis of oligosecretory myeloma with GI involvement was made. Subsequent management involved physiotherapy, pain management and chemotherapy, where this woman was commenced on Velcade (generically known as bortezomib), thalidomide and dexamethasone and she continued to experience clinical and biochemical improvement.

  • Haematology (incl blood transfusion)
  • Malignant and Benign haematology
  • Stomach wall

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Footnotes

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  • Contributors VYHL was mainly responsible for information selection, organising and outlining of content, researching the disease and drafting the case report. Scientific research was conducted by all authors after joint discussion. AMJ was specifically in charge of editing manuscript. RC contributed specifically to liaising with patient throughout, getting patient’s perspective, acquisition of data and coordination with laboratory. SR oversaw the whole process and gave valuable opinions and suggestions and contributed in giving a framework/structure for the case report. Patient’s follow up and clinical information acquisition was the responsibility of all coauthors with SR as the treating consultant. All authors were in charge in assuring scientific correction. All authors have revised and accepted the final manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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