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• W2766901410 abstract "SESSION TITLE: Pulmonary Manifestations of Systemic Disease 3 SESSION TYPE: Affiliate Case Report Poster PRESENTED ON: Tuesday, October 31, 2017 at 01:30 PM - 02:30 PM INTRODUCTION: Multiple Myeloma is a neoplasm characterized by clonal expansion of plasma cells.This case shows an atypical and aggressive presentation of multiple myeloma with metastasis to bone, lungs and liver. CASE PRESENTATION: 46 y/o AAM presented with diffuse body pain, pathologic fracture of humerus and lytic bone lesions. CT chest and abdomen revealed multiple nodules in liver and lungs. SPEP, UPEP and Immunofixation were done with results positive for light chains consistent with multiple myeloma. Bone marrow biopsy showed necrosis and highly anaplastic plasma cell dyscrasia. CT guided liver biopsy of the nodule revealed plasma cells, consistent with plasmacytoma confirming metastasis to liver and lungs. Patient rapidly deteriorated, developing cord compression and respiratory failure secondary requiring mechanical ventilation. Due to the poor prognosis and rapid deterioration, the patient did not qualify for chemotherapy or surgical interventions. DISCUSSION: Multiple Myeloma accounts for 10% of hematologic cancers. Presentation is usually seen at age of 65 with only 2% of patients presenting between 40 and 49. 30% of patients are diagnosed incidentally and another 30% are diagnosed after pathologic fractures or history of bone pain.Besides the bone pain (58%) and pathologic fractures, other modes of presentation are infection, weight loss (24%), anemia (73%), hypercalcemia (28%), spinal cord compression or renal failure (48%).Extramedullary presentation is seen in less than 7% of patients, usually as solitary extramedullary plasmacytomas in the head and neck.A few cases of multiple myeloma presenting as nodular hepatic lesions have been reported, however they usually present as a solitary lesions.Rarity of our case is highlighted by the multiple plasmacytomas in the liver and lung. Commonly used, first line treatment regimens for multiple myeloma include a steroid backbone, proteasome inhibitor and Lenalidomide. Eligibility for bone marrow transplant should be individualized and depends on several factors. CONCLUSIONS: Even though literature emphasizes the classic presentation of Multiple Myeloma as bone pain, hypercalcemia, anemia and renal disease, this clonal oncotic disease can also present with multiple plasmacytomas. With such a presentation multiple myeloma tends to behave aggressively and appropriate palliative intervention should be considered. Reference #1: Multiple myeloma with lung plasmacytoma Rajendra Prasad;Sanjay Kumar Verma;Rakhi Sodhi Lung India2011 Reference #2: Multiple myeloma in young patients:clinical presentation and treatment Bladé J,Kyle RA;Leuk Lymphoma1998 Reference #3: Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Soutar R,Lucraft H,Jackson G,Reece A, Bird J,Low E,Samson D;Br J Haema2004 DISCLOSURE: The following authors have nothing to disclose: Theo Trandafirescu, Vansha Singh, Ana Ventura No Product/Research Disclosure Information" @default.
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• W2766901410 date "2017-10-01" @default.
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• W2766901410 title "Lung and Liver Plasmacytoma With Multiple Myeloma" @default.
• W2766901410 doi "https://doi.org/10.1016/j.chest.2017.08.962" @default.
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