Indian Journal of Pathology and Microbiology

: 2013  |  Volume : 56  |  Issue : 2  |  Page : 178--179

Disappearing bone in multiple myeloma

Tuphan Kanti Dolai, Shyamali Dutta, Prakas Kumar Mandal 
 Department of Hematology, NRS Medical College and Hospital, Kolkata, West Bengal, India

Correspondence Address:
Tuphan Kanti Dolai
Department of Hematology, NRS Medical College and Hospital, 138, AJC Bose Road, Kolkata - 700 014, West Bengal

How to cite this article:
Dolai TK, Dutta S, Mandal PK. Disappearing bone in multiple myeloma.Indian J Pathol Microbiol 2013;56:178-179

How to cite this URL:
Dolai TK, Dutta S, Mandal PK. Disappearing bone in multiple myeloma. Indian J Pathol Microbiol [serial online] 2013 [cited 2021 Jun 20 ];56:178-179
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Full Text

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}{Figure 2}

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.


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