TY - JOUR T1 - Limitations of routine skeletal survey: detection of critical but asymptomatic cervical spine lesion in multiple myeloma JF - BMJ Case Reports DO - 10.1136/bcr-2017-221231 VL - 2017 SP - bcr-2017-221231 AU - Syeda Sabeeka Batool AU - Ahmad Iftikhar AU - Aamir Nafees Ahmad AU - Faiz Anwer Y1 - 2017/07/04 UR - http://casereports.bmj.com/content/2017/bcr-2017-221231.abstract N2 - 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 … ER -