|IMAGES IN CLINICAL ONCOLOGY
|Year : 2008 | Volume
| Issue : 3 | Page : 27
Systemic amyloidosis associated with myeloma
Aarti Gupta1, Saurabh Radhakrishnan1, Prasenjit Das2
1 Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi-110029, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi-110029, India
|Date of Web Publication||30-May-2009|
Department of Medical Oncology, All India Institute of Medical Sciences, New Delhi-110029
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Gupta A, Radhakrishnan S, Das P. Systemic amyloidosis associated with myeloma. Indian J Med Paediatr Oncol 2008;29:27
Mr. SS, 60 years old male presented with purpuras, petechiae, ecchymotic patches [Figure 1],[Figure 2],[Figure 3] over the face, chest, shoulders and back since one and half years along with history of swelling of limbs and breathlessness. Clinical examination revealed ECOG performance status of 3, skin lesions, hepatomegaly and pedal oedema. Investigations showed grade 1 anaemia, normal renal and liver functions tests. Bone marrow aspirate was suggestive of 18% plasma cells. Skeletal survey revealed multiple lytic lesions in skull and mandible. Protein electrophoresis (SPE) showed sharp and dense M band (2.1g/dl) in serum and narrow M band in urine. Abdominal fat biopsy showed normal blood vessels with no amyloid deposits. Skin biopsy [Figure 4] showed amyloid deposits in dermis and vessels which showed apple green birefringence on Congo Red stain under polarized light features compatible with amyloidosis. Echocardiography showed thickened interventricular septum (22mm) with concentric left ventricular hypertrophy. He was diagnosed as myeloma associated with systemic amyloidosis of skin and heart and is currently on treatment with melphalan and dexamethasone.
Concurrent amyloid deposits with myeloma can be identified either at presentation or during course of myleoma in 10-15% patients. Myeloma associated amyloidosis especially with cardiac involvement represents poor prognosis with very limited treatment options.
[Figure 1], [Figure 2], [Figure 3], [Figure 4]