Multiple Myeloma in a Cadaver: A Case Report

Date

2023

Authors

Kalman, Kyra
Judd, Dallin
Hochberg, Dovey
Johnson, Darrian
Jewell, Lauren

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Abstract

Introduction: Multiple Myeloma (MM) is a malignant neoplasm characterized by the abnormal proliferation of monoclonal immunoglobulin producing plasma cells within the bone marrow. The risk of developing MM is 0.76%; however, risk factors include age, BMI, gender, and race. Common complications include destructive bony lesions and renal insufficiency. Extraosseous myelomatous masses are a rare finding, identified in less than 5% of patients with MM, and its presence is associated with more aggressive, advanced stage disease and poor prognosis. These masses can impact many organ systems but most commonly involve the spleen, lymph nodes, liver, and kidneys. Pancreatic involvement, however, is extremely rare. Infiltration of the pancreas by myeloma cells has an incidence of 2.3% based on autopsy studies. Case Information: A medical dissection of a 58 year old woman was performed in the UNTHSC Center for Anatomical Sciences. The donor was 5’4”, 114 pounds, with a BMI of 22.3. The donor presented with a history of chronic tobacco use at 2 packs/day, unspecified broken bones, MM, and chemotherapy. The examination of the cadaveric specimen yielded insight into the systemic ramifications of MM, uncovering various pathological deviations. The donor's lung tissue exhibited signs consistent with prolonged usage of tobacco, as evidenced by the presence of discoloration and mottling. The kidneys displayed extensive scarring and a significant presence of adipose tissue. Most significantly, a large pancreatic tumor measuring 17 x 5.8 x 4 cm and weighing 167.65 g was found encasing the splenic artery. The sectioned tissue sample looked uniformly tan-white, firm, and mottled. Further dissection revealed an additional neoplastic growth on the posterolateral wall of the pelvic cavity. This tumor was situated anterior to a bony lesion on the sacrum and was found to be impinging upon the surrounding neurovasculature. Conclusion: This case exemplifies the complexities and nuances of Multiple Myeloma, highlighting the systemic nature of the disease and the need for a comprehensive understanding of its potential complications. Identification of scarring in the cadaver's kidney indicated that the patient's MM had caused the congregation of monoclonal immunoglobulins in the renal tissue, triggering profibrotic mechanisms and impaired renal function. The sacral bony lesion is a characteristic MM manifestation of heightened bone reabsorption and elevated osteoclast activity. Furthermore, this may have also led to the donor’s history of unspecified fractures in the arm and leg. The discovery of a large pancreatic neoplasm in this case is an extremely rare complication of MM, with an incidence of only 2.3%. Metastatic pancreatic involvement is not normally diagnosed as an aspect of the clinical progressive course of MM and is associated with poorer prognoses. Therefore, this case serves as a call to action for the medical community to continue to explore and understand the underlying mechanisms of extraosseous myelomatous masses and their presentation to improve the diagnosis and treatment of patients with MM. It is a testament to the ongoing need for research, education, and awareness in the fight against this debilitating disease.

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