Multiple Myeloma Presenting in Unusual Extramedullary Sites in a 62 Year Old Female from Kigali, Rwanda: Case Report
Etienne Amendezo
Department of Internal Medicine, OSHEN_King Faisal Hospital, Kigali, Rwanda.
Patrick Kavabushi
Department of Internal Medicine, OSHEN_King Faisal Hospital, Kigali, Rwanda.
Theoneste Nizeyimana
Anatomical Pathology Resident, College of Medicine and Health Sciences, University of Rwanda, Rwanda.
Issa Ngabonziza
Internal Medicine Resident, College of Medicine and Health Sciences, University of Rwanda, Rwanda.
Patrick Niyongabo
Radiology Resident, College of Medicine and Health Sciences, University of Rwanda, Rwanda.
Kingsley Tobi
Department of Anaesthesia, OSHEN_King Faisal Hospital, Kigali, Rwanda.
Julienne Imuragire
Laboratory Histotechnologist, Pathology Laboratory Services, OSHEN_King Faisal Hospital, Kigali, Rwanda.
Jean Jacques Nshizirungu
Department of Radiology, OSHEN_King Faisal Hospital, Kigali, Rwanda.
Lynnette Kyokunda-Tumwine *
Department of Pathology Laboratory Services, OSHEN_King Faisal Hospital, Kigali, Rwanda.
*Author to whom correspondence should be addressed.
Abstract
Introduction: Multiple myeloma (MM) is a malignant hematological tumor that mainly manifests as osseous lesions in the bone marrow and skeletal bones. It rarely presents in extramedullary sites. Patients with extramedullary disease have been noted to have advanced stage disease with poor prognosis. We describe the clinical, radiological and pathological manifestations of a 62 year old Rwandan female who presented with extramedullary plasmacytoma involving multiple sites including the pleura, pancreas and gall bladder.
Case Presentation: A 62 year old Rwandan female presented with a three week history of intractable post-prandial vomiting, nausea, progressive weight loss, generalized body pain and limb weakness. Our diagnostic work-up showed soft tissue tumors involving multiple organs particularly pleura, pancreas and gall bladder along with diffuse lytic bone lesions in the ribs, spine and pelvis. Laboratory tests showed increased serum amylase, lipase, calcium, lactate dehydrogenase and CA125. Histopathology of the core biopsy of the pleura showed infiltration of monotonous atypical plasma cells. A diagnosis of MM with multiple extramedullary lesions was made. The patient initially improved and reached a partial response on bortezomib, dexamethasone and lenalidomide. However, five months after the initial diagnosis, she died from complications of the disease.
Conclusion: MM may be challenging to diagnose when it presents in unusual sites as extramedullary plasmacytomas.
Keywords: Multiple myeloma, extramedullary plasmacytoma, Rwanda.