J Hematol Mult Myeloma | Volume 3, Issue 1 | Case Report | Open Access

Peritoneal Metastasis as Extramedullary Myeloma

Wael Toama^1*, George Ansstas² and Keith Stockerl-Goldstein²

¹Department of Medicine, Washington University School of Medicine, USA
²Department of Hematology and Oncology, Washington University School of Medicine, USA

^*Correspondance to: Wael Toama 

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Abstract

A 71 year old woman with a prolonged history of cured breast cancer after lumpectomy and radiation in 1991. She presented with unspecific symptoms of fatigue, increased abdominal size. Her labs showed acute renal failure and the imaging demonstrated innumerable deposits on omentum, serosa of intestine, pleura and pericardium. Tumor markers of the gynecologic and mammary malignancies were high [CA-125 of 94 units/ml (0-35) and CA15-3 of 788.6 units/ ml (1-30)]. Cytology of the ascetic fluid is suspicious for carcinoma but not definitive. Omental biopsy demonstrates poorly differentiated malignant cells; however immunostaining indicates diffuse positivity for CD138 with restricted kappa light chains the marker of plasma cells disorders. Bone marrow is involved with plasma cells in 5% and Multiple Myeloma (MM) profile was positive to monoclonal IgG Kappa. Patient initiated treatment with Velcade, Cyclophosphamide and Dexamethasone (CyBorD). Resultantly, FISH showed Del 17p (TP53) in 49% and repeat CT scan showed progressing disease after the first cycle of CyBorD. Treatment was switched to Daratumumab, Velcade and Dexamethasone. The patient’s nutrition continued to be poor and her breathing worsened due to pleural effusion. Finally, palliative care was consulted and hospice was chosen.

Citation:

Toama W, Ansstas G, StockerlGoldstein K. Peritoneal Metastasis as Extramedullary Myeloma. J Hematol Mult Myeloma. 2018;3(1):1013.