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Limitations of routine skeletal survey: detection of critical but asymptomatic cervical spine lesion in multiple myeloma
  1. Syeda Sabeeka Batool1,
  2. Ahmad Iftikhar2,
  3. Aamir Nafees Ahmad3,
  4. Faiz Anwer2
  1. 1Department of Medicine, Services Institute of Medical Sciences, Lahore, Punjab, Pakistan
  2. 2Department of Medicine, Division of Hematology and Oncology, University of Arizona Cancer Center, Tucson, Arizona, USA
  3. 3Department of Medicine, College of Medicine - Tucson, University of Arizona, Tucson, Arizona, USA
  1. Correspondence to Dr Faiz Anwer, anwerf{at}

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A 67-year-old asymptomatic man was found to have a total plasma protein level of 10.2 mg/dL on routine work-up. Serum protein electrophoresis (SPEP) revealed an M spike of 4 g/L and an elevated IgG level of 4759, and free kappa chain of 170.72 (H), free lambda chain of 3.15 (L) and kappa:lambda ratio of 54.20. Bone marrow biopsy showed a kappa light chain restricted plasma cell neoplasm involving 20%–30% of marrow cellularity. Fluorescence in situ hybridisation (FISH) test demonstrated polysomy of chromosome 9 in 70%, trisomy 11 in 57% and trisomy 7 in 50.5% of cells. Skeletal survey showed generalised mild osteopaenia …

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