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Year : 2013  |  Volume : 56  |  Issue : 2  |  Page : 178-179
Disappearing bone in multiple myeloma


Department of Hematology, NRS Medical College and Hospital, Kolkata, West Bengal, India

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Date of Web Publication23-Sep-2013
 

How to cite this article:
Dolai TK, Dutta S, Mandal PK. Disappearing bone in multiple myeloma. Indian J Pathol Microbiol 2013;56:178-9

How to cite this URL:
Dolai TK, Dutta S, Mandal PK. Disappearing bone in multiple myeloma. Indian J Pathol Microbiol [serial online] 2013 [cited 2020 Feb 26];56:178-9. Available from: http://www.ijpmonline.org/text.asp?2013/56/2/178/118693


At the time of diagnosis of multiple myeloma (MM) nearly 80% had bone disease; [1] however, vanishing bone like presentation is very uncommon. Here we discuss a case which was clinically resemble as "Vanishing bone syndrome (Gorham's disease)."

A 55-year-old lady presented with swelling in middle third of left arm for 3 months. She had pallor, generalized bony tenderness on examination. Complete hemogram showed hemoglobin 5.7 g/dl and normal white cell count and platelets. Erythrocyte sedimentation rate was 130 mm at 1 h. Plain radiograph of left arm showed gross bony destruction of mid shaft humerus with soft-tissue swelling. The lesion appeared to originate from intramedullary region. Image [Figure 1] was akin to "Vanishing bone syndrome (Gorham's disease)." [2] Her further evaluation revealed monoclonal M band (84.7 g/l) of immunoglobulin G (IgG) kappa variety, osteolytic lesions in skull vault. Fine needle aspiration cytology and immunohistochemistry from biopsy, evaluation from left humerus lesion showed [Figure 2] predominantly a typical plasma cells having bi or tri nucleus. She was treated with Velcade, thalidomide and dexamethasone [3] (Bortezomib, thalidomide and dexamethasone) regimen, zolindronic acid and cast immobilization with which his pain subsided and she undergone follow-up with remarkable reduction of swelling of left arm. Later amputation was done and followed with thalidomide maintenance. [4]
Figure 1: Plainradiograph of left arm showed gross bony destruction of midshaft humer us with soft tissues welling and osteolytic lesion sinbones

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Figure 2: Fine needle aspiration cytology from left humer us lesion showed atypical plasma cells

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Bone destruction in MM can involve any bone. In a study [5] of over 250 myeloma patients, bones most likely to be involved included the spine (49%), skull (35%), pelvis (34%), ribs (33%), humeri (22%), femora (13%) and mandible (10%). The most common radiographic findings of bone involvement included osteolysis, osteopenia, pathological fractures, or a combination of the above. Here the patient presented with gross bony destruction of mid shaft of left humerus with soft-tissue swelling resemble disappearing bone along with osteolytic lesions and diagnosed as IgG Kappa MM which was not documented in literature. On chemotherapy, patient was doing well with regular follow-up with thalidomide.

 
   References Top

1.Kyle RA, Gertz MA, Witzig TE, Lust JA, Lacy MQ, Dispenzieri A, et al. Review of 1027 patients with newly diagnosed MM. Mayo Clin Proc 2003;78:21-33.  Back to cited text no. 1
    
2.Poirier H. Massive osteolysis of the humerus treated by resection and prosthetic replacement. J Bone Joint Surg Br 1968;50:158-60.  Back to cited text no. 2
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3.Rosiñol L, Oriol A, Teruel AI, Hernández D, López-Jiménez J, de la Rubia J, et al. Superiority of bortezomib, thalidomide, and dexamethasone (VTD) as induction pretransplantation therapy in multiple myeloma: A randomized phase 3 PETHEMA/GEM study. Blood 2012;120:1589-96.  Back to cited text no. 3
    
4.Attal M, Harousseau JL, Leyvraz S, Doyen C, Hulin C, Benboubker L, et al. Maintenance therapy with thalidomide improves survival in patients with multiple myeloma. Blood 2006;108:3289-94.  Back to cited text no. 4
[PUBMED]    
5.Kyle RA, Therneau TM, Rajkumar SV, Larson DR, Plevak MF, Melton LJ 3rd. Incidence of multiple myeloma in Olmsted County, Minnesota: Trend over 6 decades. Cancer 2004;101:2667-74.  Back to cited text no. 5
    

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Correspondence Address:
Tuphan Kanti Dolai
Department of Hematology, NRS Medical College and Hospital, 138, AJC Bose Road, Kolkata - 700 014, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0377-4929.118693

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    Figures

  [Figure 1], [Figure 2]

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