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Hepatic failure caused by plasma cell infiltration in multiple myeloma  [cached]
Fadi E Rahhal, Robert R Schade, Asha Nayak, Teresa A Coleman
World Journal of Gastroenterology , 2009,
Abstract: Although plasma cell infiltration is not rare in autopsy of patients with multiple myeloma (MM), it is very rarely detected in living patients. This is because MM rarely causes significant liver dysfunction that requires further evaluation. A 49-year-old man presented with acute renal failure and was diagnosed with kappa light chain MM stage IIB. Thalidomide and dexamethasone were initiated. The patient developed a continuous increase in bilirubin that led to severe cholestasis. A liver biopsy revealed plasma cell infiltration. He then rapidly progressed to liver failure and died. Treatment options are limited in MM with significant liver dysfunction. Despite new drug therapies in MM, those patients with rapidly progressive liver failure appear to have a dismal outcome.
A case of refractory multiple myeloma  [cached]
Ritesh Vekariya,Vishal Satadiya,Manish Bavaliya,Shyam Shah
International Journal of Basic & Clinical Pharmacology , 2012, DOI: 10.5455/2319-2003.ijbcp001112
Abstract: Multiple myeloma is a plasma cell cancer in which antibody-producing plasma cells grow in an uncontrolled and invasive way. The known incidence of multiple myeloma in India ranges from 0.5 to 1.2 per 100,000 & is a rare in India. It usually occurs in persons older than 55 years and the ratio of men: women is 3:2. Multiple myeloma affects the bones, immune system, kidneys and red blood cell count. We report a case of refractory multiple myeloma. [Int J Basic Clin Pharmacol 2012; 1(1.000): 41-42]
Bortezomib Resistance Can Be Reversed by Induced Expression of Plasma Cell Maturation Markers in a Mouse In Vitro Model of Multiple Myeloma  [PDF]
Holly A. F. Stessman, Aatif Mansoor, Fenghuang Zhan, Michael A. Linden, Brian Van Ness, Linda B. Baughn
PLOS ONE , 2013, DOI: 10.1371/journal.pone.0077608
Abstract: Multiple myeloma (MM), the second most common hematopoietic malignancy, remains an incurable plasma cell (PC) neoplasm. While the proteasome inhibitor, bortezomib (Bz) has increased patient survival, resistance represents a major treatment obstacle as most patients ultimately relapse becoming refractory to additional Bz therapy. Current tests fail to detect emerging resistance; by the time patients acquire resistance, their prognosis is often poor. To establish immunophenotypic signatures that predict Bz sensitivity, we utilized Bz-sensitive and -resistant cell lines derived from tumors of the Bcl-XL/Myc mouse model of PC malignancy. We identified significantly reduced expression of two markers (CD93, CD69) in “acquired” (Bz-selected) resistant cells. Using this phenotypic signature, we isolated a subpopulation of cells from a drug-na?ve, Bz-sensitive culture that displayed “innate” resistance to Bz. Although these genes were identified as biomarkers, they may indicate a mechanism for Bz-resistance through the loss of PC maturation which may be induced and/or selected by Bz. Significantly, induction of PC maturation in both “acquired” and “innate” resistant cells restored Bz sensitivity suggesting a novel therapeutic approach for reversing Bz resistance in refractory MM.
Multiple myeloma presenting as dysphagia
Ameen Z. Alherabi,Ali M. Khan,Osama A. Marglani,Tariq A. Abdulfattah
Saudi Medical Journal , 2013,
Abstract: Plasmacytoma is a discrete solitary mass of neoplastic monoclonal plasma cells in either bone marrow or soft tissue sites. Extramedullary plasmacytoma or multiple myeloma of the larynx is extremely a rare condition. We report a 77-year-old male patient diagnosed with multiple myeloma and presented with dysphagia. The rarity of the disease incidence and difficulty of the diagnosis of this disease is discussed. We present this case to increase the awareness of the Otolaryngologists of this rare disease to expedite its diagnosis and management.
Laryngeal Involvement of Multiple Myeloma
Ariel B. Grobman,Richard J. Vivero,German Campuzano-Zuluaga,Parvin Ganjei-Azar,David E. Rosow
Case Reports in Oncological Medicine , 2012, DOI: 10.1155/2012/257814
Abstract: The objectives of this paper are to discuss a rare cause of laryngeal multiple myeloma, to review unique pathologic findings associated with plasma cell neoplasms, to discuss epidemiology, differential diagnosis, and treatment options for plasma cell neoplasms of the larynx. Laryngeal multiple myeloma, also noted in the literature as “metastatic” multiple myeloma, presenting as a de novo laryngeal mass is extremely rare with few reported cases. Laryngeal involvement of extramedullary tumors is reported to be between 6% and 18% with the epiglottis, glottis, false vocal folds, aryepiglottic folds, and subglottis involved in decreasing the order of frequency. We present the case of a 58-year-old male with a history of IgA smoldering myeloma who presented to a tertiary care laryngological practice with a two-month history of dysphonia, which was found to be laryngeal involvement of multiple myeloma. We review the classification of and differentiation between different plasma cell neoplasms, disease workups, pathologic findings, and treatment options.
The Effects of Arsenic Trioxide and Zoledronic Acid on Malignant Plasma Cells Derived from Bone Marrow Cells of Multiple Myeloma Patients
AH Emami,M Yousefi,A Mirshafiey,M Momeny
Iranian Journal of Public Health , 2009,
Abstract: "nBackground: Multiple myeloma (MM) is a disease of plasma cells that has fatal consequences. New agents associated with mo-lecular targets have prompted clinical investigators to design new treatment strategies initially for advanced MM and later for newly diagnosed MM, with encouraging preliminary results. We devised a project to assess the mechanisms of ac-tion of two drugs, Ar-senic trioxide (ATO) and Zoledronic acid (Zometa) on Bone marrow mononuclear cells (BMMCs) de-rived from patients."nMethods: Bone marrow samples were collected from 10 patients after receipt of formal consent. BMMCs were collected from samples. In two parallel sets of experiments, BMMCs were treated with 0.5, 2, 6 μM ATO and 0.1, 10, 100 μM Zo-meta, for 72 h. The following analyses were then performed on treated cells as compared to untreated cells (assumed as con-trol): cytotoxicity using Micro culture tetrazolium test (MTT assay); matrix metalloproteinase-2 zymography; comparative gene expression analysis of IL-6, vascular endothelial growth factor (VEGF) and intercellular adhesion molecule-1 (ICAM-l)."nResults: MTT assay showed significant proliferation inhibition in ATO high dose treatment (6 uM). However, no signifi-cant in-hibitory effect of Zometa was seen. Zymography analyses showed significant decrease in gelatinolytic activity in treated cells. Analyses of gene expression using Real-Time RT-PCR methodology showed significant decrease in IL-6, ICAM-1, and VEGF genes as normalized against Hypoxanthine phosphoribosyltransferase normalizer and as compared with untreated cells."nConclusion: Both ATO and Zometa could significantly decrease MM cells critical phenotype and genotype. This finding could support the hypothesis that ATO or Zometa could inhibit growth and metastasis of malignant cells.
Nonsecretory multiple myeloma  [cached]
Middela Seshikanth,Kanse Prakash
Indian Journal of Orthopaedics , 2009,
Abstract: Multiple myeloma is characterized by clonal proliferation of plasma cells usually of the B cell type.The skeletal manifestations are usually osteolytic lesions whose differential diagnosis includes primary and secondary bone tumor. This tumor is characterized by the presence of abnormal paraprotein 8 in blood and urine. However, one to five per cent of the cases do not have any protein. Hence they are termed nonsecretory. It often poses a diagnostic dilemma when it is presented to orthopedic surgeons with no clear features of the disease. Our case report exemplifies such a diagnostic dilemma. A high index of suspicion must be borne in mind when excluding multiple myeloma as a cause of pain, pathological fracture or lytic lesion.
Multiple myeloma/hypercalcemia
Babatunde O Oyajobi
Arthritis Research & Therapy , 2007, DOI: 10.1186/ar2168
Abstract: Multiple myeloma, a clonal neoplasm of plasma cells, is the second most common adult hematologic malignancy, and it is the most common cancer with skeleton as its primary site. Multiple myeloma, which affects 70,000 people in the USA, with 15,000 new cases accruing yearly, accounts for 1% to 2% of cancer-related deaths. Myeloma is unique in its propensity to cause osteolysis, with 80% of patients suffering from devastating and progressive bone destruction; this results in the complications that are responsible for the high morbidity and mortality rates associated with the disease. These complications, which include severe and unremitting bone pain, pathologic fractures (Figure 1), spinal cord compression, and hypercalcemia, are a significant clinical problem for which there is no effective cure. Hypercalcemia, which can range in presentation from mild to severe and life threatening, is the most common metabolic complication of myeloma and occurs in approximately one-third of patients.In myeloma patients, the primary cause of the hypercalcemia is widespread tumor-induced bone destruction. This is primarily due to increased osteoclastic bone resorption caused by potent cytokines expressed or secreted locally by the myeloma cells (receptor activator of nuclear factor-κB ligand [RANKL], macrophage inflammatory protein [MIP]-1α, and tumor necrosis factors [TNFs]; see below) or over-expressed by other cells in the local microenvironment [1]. This bone resorption in turn leads to efflux of calcium into the extracellular fluid. However, the pathogenesis of hypercalcemia in myeloma is probably more complex than this because not all patients with significant myeloma bone disease develop hypercalcemia and, even in the patients who do develop it, hypercalcemia is often a prominent feature only late in the course of disease.Hypercalcemia is most common in those myeloma patients who have the greatest tumor volume, irrespective of serum parathyroid hormone-related protein (PTHrP)
Mandibular Swelling as the First Manifestation of Multiple Myeloma
Maryam Amirchaghmaghi,Atessa Pakfetrat,Pegah Mosannen Mozafari,Shadi Saghafi
Iranian Journal of Medical Sciences , 2010,
Abstract: Multiple myeloma is a monoclonal malignant proliferationof plasma cells. The disease is more frequent in men, andthe average age of patients at the time of diagnosis of thedisease is about 60 years. Solitary myeloma may be the firstmanifestation of the disseminated form of multiple myeloma,which is characterized by multiple skeletal lesions,general metabolic alterations, impairment of renal functionand eventually death.The findings in regards to the present case suggest that oralmanifestations may be the first sign of multiple myeloma. Thismight highlight the important role that a dentist can have inthe early diagnosis of the disease.Iran J Med Sci 2010; 35(4): 331-334.
Laryngeal Involvement of Multiple Myeloma  [PDF]
Ariel B. Grobman,Richard J. Vivero,German Campuzano-Zuluaga,Parvin Ganjei-Azar,David E. Rosow
Case Reports in Oncological Medicine , 2012, DOI: 10.1155/2012/257814
Abstract: The objectives of this paper are to discuss a rare cause of laryngeal multiple myeloma, to review unique pathologic findings associated with plasma cell neoplasms, to discuss epidemiology, differential diagnosis, and treatment options for plasma cell neoplasms of the larynx. Laryngeal multiple myeloma, also noted in the literature as “metastatic” multiple myeloma, presenting as a de novo laryngeal mass is extremely rare with few reported cases. Laryngeal involvement of extramedullary tumors is reported to be between 6% and 18% with the epiglottis, glottis, false vocal folds, aryepiglottic folds, and subglottis involved in decreasing the order of frequency. We present the case of a 58-year-old male with a history of IgA smoldering myeloma who presented to a tertiary care laryngological practice with a two-month history of dysphonia, which was found to be laryngeal involvement of multiple myeloma. We review the classification of and differentiation between different plasma cell neoplasms, disease workups, pathologic findings, and treatment options. 1. Introduction A 58-year-old male presented with a two-month history of dysphonia. The physical exam demonstrated an asymmetric thyroid cartilage with a left-sided 2.5?cm firm, mobile, and nontender mass. Ten years prior, he was treated with radiotherapy for IgA myeloma involving the right acromion and lower extremity with complete resolution. Laboratory results were remarkable for serum IgA of 474?mg/dL, free kappa light chains of 7.92?mg/L, free lambda light chains of 1.96?mg/dL, a free kappa/lambda ratio of 4.04, and β2-microglobulin of 2.31?mg/L. Videostroboscopy revealed a large submucosal mass effacing the left ventricle (Figure 1). The vocal cords appeared normal and mobile bilaterally. The position emission tomography/computerized tomography (PET/CT) revealed a hypermetabolic 3.5 × 4?cm lesion involving the left thyroid cartilage and lytic lesions in the left coracoid process and right tibia. The peripheral blood smear and bone marrow flow cytometry were unremarkable. Bone marrow failed to demonstrate abnormal populations of plasma cells or lymphocytes. Figure 1: Videostroboscopic image revealing an erythematous, submucosal mass arising from and effacing the left ventricle, representing extension of the mass into the laryngeal introitus. A fine needle aspiration of the mass (Figure 2) showed abundant atypical plasma cells with marked pleomorphism, increased nuclear-to-cytoplasmic ratio, binucleation, nuclear convolution, lobation, and nuclear inclusions. A CD138 immunostain confirmed laryngeal
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