Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

A case of cerebral astrocytoma associated with a systematic multiple myeloma is reported. A 76-year-old man was admitted to our hospital because of left hemiparesis. The CT scan revealed a cystic tumor at the right parietal lobe. A serum protein electrophoresis showed a monoclonal peak in the region of gamma-globulin, and examination of bone marrow revealed 15% of atypical plasma cells. After irradiation and chemotherapy, the patient suffered from DIC syndrome and died. Autopsy findings revealed a cerebral astrocytoma and bone marrow infiltration by myeloma cells in the sternum, vertebrae, costae, pelvis, and so on. So we finally diagnosed this case a cerebral astrocytoma with systematic multiple myeloma. In spite of the fact that systematic multiple myeloma is frequently accompanied with cancers at other sites (so called multiple primary cancers), the coexistence of a cerebral astrocytoma and systematic multiple myeloma is extremely rare. Complications of multiple myeloma with other tumors are reviewed.
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PMID:[An autopsy case of cerebral astrocytoma associated with multiple myeloma]. 279 75

A patient presented with right hemiparesis, dysphasia and a large, palpable, left frontoparietal mass arising from the calvarial diploe. A diagnosis of multiple myeloma was made on radiological and biochemical grounds, together with bone marrow examination. Few cases of cerebral compression by a massive plasmacytoma have been reported, but in some surgical management produced clinical deterioration. The present case was treated with radiotherapy and chemotherapy, with satisfactory results.
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PMID:Cerebral compression by myeloma. 731 Apr 24

Rapid growth of a glioblastoma during therapy for multiple myeloma is reported. A 53-year-old man was admitted to our hospital with a right costal tumor, which was resected. The diagnosis was plasmocytoma. Urine protein electrophoresis showed a monoclonal peak in the region of gamma-globulin, and examination of the bone marrow revealed 17.8% of atypical plasma cells. Brain magnetic resonance (MR) imaging detected two small lesions, but these could not be identified as brain tumor. He received chemotherapy (melphalan 10 mg/day and predonin 30 mg/day for 4 days) and was discharged. Two weeks after discharge, he was readmitted because of left hemiparesis. T1-weighted MR imaging showed two large hypointense lesions in the right frontal lobe, with ring-like enhancement following Gd-DTPA infusion. 1H-MR spectroscopy showed typical findings of tumor with increased choline and lactic acid peaks. 201Tl SPECT revealed high accumulation in both early and delayed images. Right carotid angiography showed a hypervascular tumor with venous filling and mass effect. The lesions were resected via right frontal craniotomy, followed by intraoperative radiation and placement of an Ommaya reservoir. Histological examination showed the tumors were glioblastoma. The brain between the tumors also showed the typical appearance of glioblastoma, suggesting that the lesions were continuous. Postoperatively, the patient's left hemiparesis disappeared. He received local irradiation and chemotherapy and was then discharged. Coexistence of glioblastoma and multiple myeloma is rare. The cause may be genetic abnormality, but immunodeficiency due to multiple myeloma, surgical damage, or chemotherapy may have contributed to the rapid growth of the glioblastoma.
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PMID:[Rapid growth of glioblastoma during therapy for multiple myeloma: case report]. 974 4

A 54-year-old man diagnosed with IgD myeloma (stage IIIA) in complete remission (CR) received peripheral blood stem cell transplantation (PBSCT) twice with an interval of 4 months using high-dose melphalan 200mg/m2. However 9 months after the second PBSCT, he was readmitted because of lumbago, lower left hemiparesis, speech disturbance and left facial nerve palsy. A lumbar puncture revealed myeloma cells in the cerebrospinal fluid (CSF). The patient did not respond to any salvage chemotherapy and died of sepsis 27 months after the initial diagnosis. The findings in this patient suggest that another treatment modality including prophylactic intrathecal injection of an anti-cancer drug as well as allogeneic cell therapy is probably necessary in patients with high-risk IgD myeloma.
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PMID:Meningeal relapse after double peripheral blood stem cell transplantation in IgD myeloma. 1200 72

Multiple myeloma (MM) is a plasma cell malignancy characterized by infiltration of bone marrow, bone destruction, infiltration of soft tissues with plasma cells, and suppression of normal hematopoiesis. The production of monoclonal immunoglobulins with or without light chains is a major feature of the disease. Full spectrum of plasma cell dyscrasias include monoclonal gammapathy of undetermined significance, smouldering myeloma, indolent multiple myeloma, and fully developed, symptomatic multiple myeloma. The usual presenting features of MM include bone pain, weakness, fatigue, fever and infection. Neurologic symptoms are less common but one must not forget that MM may present with a neurologic disease. Careful neurologic history and examination are mandatory in patients with MM. Neurologic symptoms may be a direct manifestation of MM or may be due to the immune effect of monoclonal proteins directed against different neural structures. Finally, metabolic consequences (uremia, hypercalcemia, hyperviscosity) of MM may produce a broad spectrum of different neurologic symptoms including headache, blurring of vision, drowsiness, precoma, coma, vertigo, ataxia, hemiparesis and epileptiform seizures. The most common location of bone changes in MM is the thoracic spine, where it causes osteolytic changes with consequent compressive fractures. The most disastrous sequel is paraplegia. Multiple vertebral involvement with the evidence of osteolytic changes in other bones is usual, but solitary vertebral myeloma may occur. Myeloma usually involves the bone of the vertebral body and then spreads into the extradural space. However, patients with solitary extradural myeloma have been reported. Skull myeloma is frequently asymptomatic. It may grow externally or, rarely, there is intracranial expansion. Involvement of the cranial nerves is not rare, with II, V, VI, VII and VIII cranial nerves being most often affected. Isolated intracerebral plasmacytomas are extremely rare. Diagnostic approach includes plain X-rays of the skeleton, which was found to be the method of choice for demonstration of osteolytic changes, whereas magnetic resonance with gadolinium enhancement most reliably displays the degree of vertebral involvement and demonstrates any associated soft tissue mass. Current treatment of osteolytic changes in multiple myeloma include chemotherapy, radiotherapy in combination with dexamethasone, monthly infusions of bisphosphonates, surgical decompression, and kyphoplasty. Therapeutic approach is dictated by the presenting symptoms. In case of pain as the predominant symptom, treatment with chemotherapy and radiotherapy may be appropriate. Compressive symptoms are relieved with dexamethasone followed by radiotherapy and chemotherapy. Surgical decompression is used in patients with vertebral collapse and vertebral instability. Kyphoplasty is a new method used in the treatment of osteolytic changes of vertebral bodies. A viscous cement is injected into the cavity by a balloon-like inflatable bone tampon. It has been successfully employed to improve the quality of life, to reduce pain, and to increase overall functioning in patients with vertebral compression fractures by restoring most of the original height of the vertebral body. Bisphosphonates reduce pain associated with osteolytic changes in multiple myeloma, but also significantly reduce skeletal events (pathologic fracture, spinal cord compression, surgery or irradiation of bone) via unknown mechanism. It seems that bisphosphonates, by inhibiting bone resorption, alter the microenvironment in which the MM cells grow.
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PMID:[Neurologic sequelae of bone changes in multiple myeloma and its therapy]. 1263 Mar 41

A 55-year-old male was admitted to our hospital because of confusion and mild weakness of his left arm and leg. His condition had taken a gradual turn for the worse for several months. Computed tomography (CT) demonstrated a mixed density mass with multiple cysts and massive perifocal edema. Magnetic resonance imaging (MRI) demonstrated an irregular-shaped mass with multiple cysts sized 6 x 4 x 6 cm in the temporal lobe, which manifested mixed signal intensity on both the T1 weighted image and the T2 weighted image. MRI also revealed massive perifocal edema and marked midline shift. Gd-DTPA study showed ring-like enhancement. Angiography showed no tumor stain and a suppressed right posterior cerebral artery. A right extended temporo-occipital craniotomy was performed to extirpate the abscess subtotally. The histological examination showed brain abscess and Gram stain of the pus revealed the presence of gram-positive bacilli. The gram-positive bacillus, Corynebacterium only was subsequently cultured from the pus. After the operation his hemiparesis seemed to disappear. In spite of the treatment with multiple intravenous antibiotics, his hemiparesis worsened again. CT and MRI demonstrated recurrence of the brain abscess in the occipital lobe and marked perifocal edema. The second operation was performed and removed all the infected brain tissue with abscess. After the second operation, otorhinological and cardiovascular examinations were carried out, but no causal disease was found. Immunoelectrophoresis (total protein 12.2 g/d/) revealed the peak of M protein. Bone marrow revealed dysplasia of the plasma cell and he was diagnosed as having multiple myeloma that had made him an immunocompromised host.
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PMID:[A case of brain abscess associated with asymptomatic multiple myeloma]. 1471 44

A halo orthosis is often used to immobilize the cervical spine after severe injury in patients who cannot tolerate surgery. Although complications such as pin loosening or brain abscess have been reported, there are no reported cases of hemiparesis following pneumocephalus associated with halo use. The authors report the case of a 77-year-old man with multiple myeloma who, after undergoing halo vest therapy and chemotherapy, suddenly developed hemiparesis and speech disturbance. Diagnostic neuroimaging demonstrated penetration of the inner table at the right posterior pin site and intracerebral pneumocephalus at the parietal lobe. Intraoperative inspection revealed only air and no purulent materials or cerebrospinal fluid in the cystic lesion. When a halo device is used, attention to detail in pin application, maintenance, and proper pin-site care must be undertaken to minimize complications. The tightening of the pin in cases in which late-onset loosening has occurred should not be performed. Additionally, because late loosening of the pin and pin-site infection increase the risks of complications, a halo vest should be used only as a short-term treatment, and the clinician should be aware of the possible increased risk of serious complications such as pneumocephalus or subdural abscess formation.
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PMID:Intracerebral pneumocephalus and hemiparesis as a complication of a halo vest in a patient with multiple myeloma. Case report. 1507 Jan 46

A 92-year-old female was admitted to our hospital with 2-months history of rapidly enlarging subcutaneous masses in the multiple skull's regions. Neurological examination in the admission showed slightly right hemiparesis. Skull X-P showed multiple osteolytic lesions, and CT showed high density masses. MRI revealed iso-intensity masses on both T1 and T2-weighted images. Gd-DTPA enhanced T1-weighted image showed masses with marked homogeneous enhancement like the dural tail sign in the dura adjacent to the tumors. The tumor in the right frontal subcutaneous region was partialy removed; this mass was diagnosed as multiple myeloma. Because the prognosis of such a case was very poor and she was older, we thought her quality of life (QOL) and she was conservatively treated. A case of multiple myeloma having plasmacytoma in multiple skull's regions was reported. Although 30 cases in the literature of multiple myeloma forming cranial or intracranial plasmacytoma were briefly reviewed, multiple lesion was not reported and we thought it as a very rare case. And if such a case was performed to remove all masses, we believed that three dimensional computed tomography images to distinguish the tumors from skull and skin (Perspective 3D-CT; SIEMES's Somatom Emotion 6 and Syngo) was very valuable for the preoperative evaluation of a surgical approach.
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PMID:[Multiple myeloma presenting with multiple subcutaneous masses]. 1567 53

The authors describe the case of a 72-year-old woman with dural plasmacytoma revealing an immunoglobulin (Ig) G-kappa multiple myeloma (MM). She presented with headaches and left hemiparesis. Magnetic resonance imaging demonstrated a right frontal extraaxial lesion arising from the dura mater, and biological studies revealed hypercalcemia, hyperproteinemia, and a serum gamma globulin peak. A diagnosis of IgG-kappa MM was based on microscopic examination and immunohistochemical analysis of the dural plasmacytoma as well as on signs of systemic myeloma after surgery. The patient died 3 years after the first symptoms of MM despite systemic chemotherapy and no recurrence of the dural plasmacytoma. Myelomatous involvement of the dura mater is a rare occurrence given that only three cases have been reported to date. Nevertheless, this pathological entity should be differentiated from solitary dural plasmacytoma (SDP) because the prognosis is radically different. Progression seems to be correlated with systemic disease in contrast to the long-term survival associated with SDP. Careful systemic evaluation should be made in such a presentation to rule out MM, which would require different management and has a different prognosis.
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PMID:Dural plasmacytoma revealing multiple myeloma. Case report. 1661 66

We report a possible case of progressive multifocal leukoencephalopathy (PML) that was attempted to evaluate the pathogenesis by a novel brain MRI techniques. A 72-year-old woman had developed subacute visual disturbance, right hemiparesis and sensory disturbance. Laboratory examinations revealed liver dysfunction and pancytopenia due to liver cirrhosis (type C) and preclinical status of multiple myeloma. Thus, this patient had these two underlying diseases, while anti-HIV antibody was negative. She was suspected with PML by detection of JCV-DNA in cerebrospinal fluid using with PCR. MRI showed multifocal T2-high signals in the bilateral parieto-occipital deep white matter, basal ganglia and right cerebellar hemisphere. No gadolinium enhancement was found. On FLAIR and diffusion weighted images (DWI), the lesion showed hyperintensity. The hyperintense areas on DWI showed various pattern on apparent diffusion coefficient (ADC) and fractional anisotropy (FA). In particular white matter changes, the course of FA reflected the clinical course more than ADC. Proton magnetic resonance spectroscopy (1H-MRS) in deep brain white matter showed ratios of reduced N-acetyl aspartate (NAA) and increased choline (Cho) to creatine. 1H-MRS by chemical shift imaging were undergone three times between 4 and 6 months after the onset. The change of these chemical markers correlated with her clinical course. We conclude that the approach of diffusion tensor imaging (DTI) and 1H-MRS are useful for evaluating neuropathologic observations and clinical course.
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PMID:[Neuroradiological study of a possible progressive multifocal leukoencephalopathy using diffusion tensor imaging and proton magnetic resonance spectroscopy]. 1715 35


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