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Multiple myeloma in a patient with acromegaly.

Kang YM, Choi JH, Lee MJ, Ahn A, Park CJ, Chang K, Seo S, Hong SI, Kim MS - Endocrinol Metab (Seoul) (2014)

Bottom Line: Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH), generally caused by a GH-secreting pituitary adenoma.Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis.Multiple myeloma (MM) is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH), generally caused by a GH-secreting pituitary adenoma. Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis. Multiple myeloma (MM) is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM. However, no cases of acromegaly accompanied with MM have been reported in Asia to date. We here report the case of a 58-year-old woman with acromegaly accompanied with MM who presented with longstanding acromegalic manifestations resulting from a GH-secreting pituitary adenoma and also exhibited anemia, a reversed albumin/globulin ratio, and plasmacytosis on bone marrow examination. Because IGF-1 has been suggested to play an important role in the development and progression of MM, the patient promptly underwent surgical removal of the pituitary adenoma via a transsphenoidal approach. Since there is currently no consensus on therapeutic guidelines and suggested prognosis for MM with acromegaly, long-term follow-up of such cases is needed.

No MeSH data available.


Related in: MedlinePlus

(A) Neoplastic plasma cells in the bone marrow aspirate specimen (Wright stain, ×1,000). (B) Numerous clustered neoplastic plasma cells on a bone marrow touchprint slide. (C) Packed neoplastic plasma cells were prominent in a bone marrow biopsy specimen stained with H&E (×400). (D) CD138-positive neoplastic plasma cells in an immunohistochemically stained bone marrow biopsy specimen (×400). In an immunohistochemically stained bone marrow biopsy specimen, neoplastic cells were positive for λ light chain (E, ×400) and negative for κ light chain (F, ×400).
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Figure 4: (A) Neoplastic plasma cells in the bone marrow aspirate specimen (Wright stain, ×1,000). (B) Numerous clustered neoplastic plasma cells on a bone marrow touchprint slide. (C) Packed neoplastic plasma cells were prominent in a bone marrow biopsy specimen stained with H&E (×400). (D) CD138-positive neoplastic plasma cells in an immunohistochemically stained bone marrow biopsy specimen (×400). In an immunohistochemically stained bone marrow biopsy specimen, neoplastic cells were positive for λ light chain (E, ×400) and negative for κ light chain (F, ×400).

Mentions: The markedly reversed A/G ratio and anemia led us to suspect a monoclonal gammopathy such as MM. A peripheral blood smear revealed a red blood cell rouleux formation (Fig. 3). Protein electrophoresis (PEP) and immunofixation electrophoresis (IFE) of serum samples revealed a monoclonal gammopathy (M peak 4.9 g/dL) of immunoglobulin G (IgG)-λ type; PEP and IFE of urine samples were inadequate because of low urinary protein. The patient's serum IgG level was elevated to 5,860.0 mg/dL, and the κ and lambda free light chain ratios were 7.16 and 34.50 mg/L, respectively. To confirm the diagnosis of MM, we performed bone marrow aspiration and biopsy with plasma cell phenotyping. Neoplastic plasma cells were observed on bone marrow aspirate and touchprint slides (Fig. 4A, B), and packed bone marrow with neoplastic plasma cells (35.6% of the clonal plasma cells) was observed in the bone marrow biopsy specimen (Fig. 4C-F). In an attempt to find myeloma-related organ damage, we took simple X-rays of the entire body, and they did not reveal any osteolytic lesions. According to the diagnostic criteria for symptomatic MM, one should exhibit more than one of the parameters reflecting myeloma-related organ dysfunction (Table 3). Because the M peak was >3 g/dL and the proportion of monoclonal plasma cells in the bone marrow was >10% without myeloma-related orgam damages, the patient was diagnosed with asymptomatic (smoldering) MM. However, it is of note that her serum hemoglobin level was at the cutoff value for diagnosis of symptomatic MM and that her serum calcium level was slightly below the cutoff (Table 3). In accordance with the treatment guidelines for asymptomatic MM, we planned close follow-up, with deferral of chemotherapy until the disease became symptomatic.


Multiple myeloma in a patient with acromegaly.

Kang YM, Choi JH, Lee MJ, Ahn A, Park CJ, Chang K, Seo S, Hong SI, Kim MS - Endocrinol Metab (Seoul) (2014)

(A) Neoplastic plasma cells in the bone marrow aspirate specimen (Wright stain, ×1,000). (B) Numerous clustered neoplastic plasma cells on a bone marrow touchprint slide. (C) Packed neoplastic plasma cells were prominent in a bone marrow biopsy specimen stained with H&E (×400). (D) CD138-positive neoplastic plasma cells in an immunohistochemically stained bone marrow biopsy specimen (×400). In an immunohistochemically stained bone marrow biopsy specimen, neoplastic cells were positive for λ light chain (E, ×400) and negative for κ light chain (F, ×400).
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4384674&req=5

Figure 4: (A) Neoplastic plasma cells in the bone marrow aspirate specimen (Wright stain, ×1,000). (B) Numerous clustered neoplastic plasma cells on a bone marrow touchprint slide. (C) Packed neoplastic plasma cells were prominent in a bone marrow biopsy specimen stained with H&E (×400). (D) CD138-positive neoplastic plasma cells in an immunohistochemically stained bone marrow biopsy specimen (×400). In an immunohistochemically stained bone marrow biopsy specimen, neoplastic cells were positive for λ light chain (E, ×400) and negative for κ light chain (F, ×400).
Mentions: The markedly reversed A/G ratio and anemia led us to suspect a monoclonal gammopathy such as MM. A peripheral blood smear revealed a red blood cell rouleux formation (Fig. 3). Protein electrophoresis (PEP) and immunofixation electrophoresis (IFE) of serum samples revealed a monoclonal gammopathy (M peak 4.9 g/dL) of immunoglobulin G (IgG)-λ type; PEP and IFE of urine samples were inadequate because of low urinary protein. The patient's serum IgG level was elevated to 5,860.0 mg/dL, and the κ and lambda free light chain ratios were 7.16 and 34.50 mg/L, respectively. To confirm the diagnosis of MM, we performed bone marrow aspiration and biopsy with plasma cell phenotyping. Neoplastic plasma cells were observed on bone marrow aspirate and touchprint slides (Fig. 4A, B), and packed bone marrow with neoplastic plasma cells (35.6% of the clonal plasma cells) was observed in the bone marrow biopsy specimen (Fig. 4C-F). In an attempt to find myeloma-related organ damage, we took simple X-rays of the entire body, and they did not reveal any osteolytic lesions. According to the diagnostic criteria for symptomatic MM, one should exhibit more than one of the parameters reflecting myeloma-related organ dysfunction (Table 3). Because the M peak was >3 g/dL and the proportion of monoclonal plasma cells in the bone marrow was >10% without myeloma-related orgam damages, the patient was diagnosed with asymptomatic (smoldering) MM. However, it is of note that her serum hemoglobin level was at the cutoff value for diagnosis of symptomatic MM and that her serum calcium level was slightly below the cutoff (Table 3). In accordance with the treatment guidelines for asymptomatic MM, we planned close follow-up, with deferral of chemotherapy until the disease became symptomatic.

Bottom Line: Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH), generally caused by a GH-secreting pituitary adenoma.Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis.Multiple myeloma (MM) is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM.

View Article: PubMed Central - PubMed

Affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

ABSTRACT
Acromegaly is a slowly progressing condition resulting from excess growth hormone (GH), generally caused by a GH-secreting pituitary adenoma. Cancer is the third most common cause of mortality in patients with acromegaly, and insulin-like growth factor 1 (IGF-1) is known to influence tumor formation by increasing cell proliferation and inhibiting apoptosis. Multiple myeloma (MM) is a plasma cell neoplasm, and previous studies have suggested the possible role of IGF-1 in its development of MM. However, no cases of acromegaly accompanied with MM have been reported in Asia to date. We here report the case of a 58-year-old woman with acromegaly accompanied with MM who presented with longstanding acromegalic manifestations resulting from a GH-secreting pituitary adenoma and also exhibited anemia, a reversed albumin/globulin ratio, and plasmacytosis on bone marrow examination. Because IGF-1 has been suggested to play an important role in the development and progression of MM, the patient promptly underwent surgical removal of the pituitary adenoma via a transsphenoidal approach. Since there is currently no consensus on therapeutic guidelines and suggested prognosis for MM with acromegaly, long-term follow-up of such cases is needed.

No MeSH data available.


Related in: MedlinePlus