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Plasma cell tumors with calcified amyloid mimicking chondrosarcoma
European Journal of Radiology Extra 59 (2006) 131–132
Plasma cell tumors with calcified amyloid mimicking chondrosarcoma Hiralal a , Shivanand Gamanagatti b,∗ , Sahibinder Bhatti c a
b
CGHS, Kanpur, India Department of Radio diagnosis, All India Institute of Medical Sciences, New Delhi 110029, India c Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India Received 21 March 2006; received in revised form 6 May 2006; accepted 16 May 2006
Abstract We report a case of amyloidoma of iliac bone, mimicking chondrosarcoma radiologically, associated with multiple myeloma in a 52-year-old man. This patient in addition had myeloma deposit in the nasal cavity. © 2006 Published by Elsevier Ireland Ltd. Keywords: Multiple myeloma; Amyloidoma; Bone; Chondrosarcoma
Multiple myeloma is a malignant plasma cell disorder characterized by monoclonal immunoglobulin production with a peak incidence in the seventh decade of life. Most of these patients have bone pain, renal insufficiency, or anemia. About 10–15% of myeloma patients have extracellular deposition of amyloid in tissues resulting in amyloidoma [1]. Amyloid deposition in solid organs such as liver, kidney and heart is well known [2]. Bone amyloidomas are very rare and are frequently misinterpreted as chondrosarcomas [3,4]. Typical radiographic appearance of plasma cell related tumor is that of well defined lytic lesion. Occasionally these lesions may contain foci calcifications within their matrix causing them to simulate chondrosarcoma. We describe a case report of amyloidoma of iliac bone mimicking chondrosarcoma in an elderly patient with light chain multiple myeloma.
obstruction of recent onset, otherwise patient had no other complaints. Physical examination revealed mass in the left nasal cavity on anterior rhinoscopy. Incidentally a calcified mass overlapping right iliac bone and sacrum was detected on routine skeletal survey (Fig. 1). Computed tomography (CT) of paranasal sinuses revealed soft tissue with destruction of middle turbinate, completely occluding the left nasal cavity. CT scan of pelvis showed large soft tissue mass associated with punctate calcified matrix involving right iliac bone and right hemi sacrum (Fig. 2). The matrix of soft tissue also showed calcified matrix. Appearance of iliac fossa lesion radiologically was consistent with chondrosarcoma. Biopsy from nasal fossa mass showed mature plasma cells consistent with myeloma deposit. Biopsy from right iliac bone lesion demonstrated intrasseous amyloid, which was positive for beta2 -microglobulin. There were no symptoms referable to right iliac bone lesion.
2. Case report
3. Discussion
A 52-year-old man was bone marrow biopsy proven case of light chain multiple myeloma, presented with nasal
Amyloidosis occurs in approximately 10–15% of cases of myeloma [5]. There are sporadic case reports of calcifications in plasma cell tumors that simulate chondrosarcoma [3,4,6]. There are several causes of calcification arising in plasma cell tumors. These include (1) metastatic tissue calcification in which serum calcium–phosphrous product is raised, (2) dys-
1. Introduction
∗ Corresponding author at: C/o Vijay Kumar Uppal, 198/58, East of Kailash, Uppal’s House, Ramesh Market, New Delhi 110065, India. Tel.: +91 11 26864851x4889/26412131; fax: +91 11 26862663. E-mail address: [email protected] (S. Gamanagatti).
1571-4675/$ – see front matter © 2006 Published by Elsevier Ireland Ltd. doi:10.1016/j.ejrex.2006.05.001
132
Hiralal et al. / European Journal of Radiology Extra 59 (2006) 131–132
Fig. 1. Plain radiograph of pelvis showing calcified mass overlapping right iliac bone and sacrum.
Typically, these calcifications are amorphous or punctate and not of the typical “O” or “C” or punctate types associated with chondrosarcoma. In our case, possible cause of deposition is metastatic deposition of calcium on amyloid. There are several case reports of soft tissue calcifications associated with plasma cell dyscrasias without associated amyloid deposition [7,8]. Soft tissue calcification can occur in association with both primary and secondary amyloidosis. Amyloid is frequently associated with chain than with k chain plasma cell dyscrasias. Bone amyloidomas are very rare, only few cases have been reported in radiology literature [3,4,8]. Detailed radiologic findings are very scarce. On plain radiographs they appear as well defined lytic lesions that may cause cortical destruction. Occasionally their matrix may calcify and simulate typical chondrosarcoma. CT may be better for evaluating the degree of bone involvement and cortical destruction and can be used as an adjunct to percutaneous biopsy. In conclusion, calcification in amyloid produced by plasma cell tumors may at time simulate the radiographic appearance of chondrosarcoma.
References
Fig. 2. Axial CT section of pelvis showing large soft tissue mass associated with punctate calcified matrix involving right iliac bone and right hemi sacrum.
trophic calcification on necrotic myeloma tissue, (3) residual bone fragments from native destroyed tumor containing bone and (4) deposition of calcium on amyloid produced by the tumor.
[1] Bataille R, Harousseau L. Multiple myeloma. N Engl J Med 1997;334:16. [2] Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol 1995;32:45–59. [3] Mulder JD, Van Rijssel TG. Case report 233. Skeletal Radiol 1983;10:53–5. [4] Reinus WR, Kyriaskos M, Gilula LA, Brower AC, Merkel K. Plasma cell tumors with calcified amyloid deposition mistaken for chondrosarcoma. Radiology 1993;189:505–9. [5] Hall FM, Gore SM. Osteosclerotic myeloma variants. Skeletal radiol 1988;17:101–5. [6] Rosai J. Ackerman’s surgical pathology. 6th ed. St. Louis, MO: Mosby; 1981. pp. 1357–1358. [7] Fayemi AO, Wisniewski M. Pulmonary calcification in a patient with plasma cell related dyscrasias. Chest 1973;64:765–9. [8] Simoens WA, van den Hauwe L, Van Hedent E, et al. Amyloidoma of the skull base. Am J Neuroradiol 2000;21(8):1559–62.
Plasma cell tumors with calcified amyloid mimicking chondrosarcoma Hiralal a , Shivanand Gamanagatti b,∗ , Sahibinder Bhatti c a
b
CGHS, Kanpur, India Department of Radio diagnosis, All India Institute of Medical Sciences, New Delhi 110029, India c Department of Pathology, All India Institute of Medical Sciences, New Delhi 110029, India Received 21 March 2006; received in revised form 6 May 2006; accepted 16 May 2006
Abstract We report a case of amyloidoma of iliac bone, mimicking chondrosarcoma radiologically, associated with multiple myeloma in a 52-year-old man. This patient in addition had myeloma deposit in the nasal cavity. © 2006 Published by Elsevier Ireland Ltd. Keywords: Multiple myeloma; Amyloidoma; Bone; Chondrosarcoma
Multiple myeloma is a malignant plasma cell disorder characterized by monoclonal immunoglobulin production with a peak incidence in the seventh decade of life. Most of these patients have bone pain, renal insufficiency, or anemia. About 10–15% of myeloma patients have extracellular deposition of amyloid in tissues resulting in amyloidoma [1]. Amyloid deposition in solid organs such as liver, kidney and heart is well known [2]. Bone amyloidomas are very rare and are frequently misinterpreted as chondrosarcomas [3,4]. Typical radiographic appearance of plasma cell related tumor is that of well defined lytic lesion. Occasionally these lesions may contain foci calcifications within their matrix causing them to simulate chondrosarcoma. We describe a case report of amyloidoma of iliac bone mimicking chondrosarcoma in an elderly patient with light chain multiple myeloma.
obstruction of recent onset, otherwise patient had no other complaints. Physical examination revealed mass in the left nasal cavity on anterior rhinoscopy. Incidentally a calcified mass overlapping right iliac bone and sacrum was detected on routine skeletal survey (Fig. 1). Computed tomography (CT) of paranasal sinuses revealed soft tissue with destruction of middle turbinate, completely occluding the left nasal cavity. CT scan of pelvis showed large soft tissue mass associated with punctate calcified matrix involving right iliac bone and right hemi sacrum (Fig. 2). The matrix of soft tissue also showed calcified matrix. Appearance of iliac fossa lesion radiologically was consistent with chondrosarcoma. Biopsy from nasal fossa mass showed mature plasma cells consistent with myeloma deposit. Biopsy from right iliac bone lesion demonstrated intrasseous amyloid, which was positive for beta2 -microglobulin. There were no symptoms referable to right iliac bone lesion.
2. Case report
3. Discussion
A 52-year-old man was bone marrow biopsy proven case of light chain multiple myeloma, presented with nasal
Amyloidosis occurs in approximately 10–15% of cases of myeloma [5]. There are sporadic case reports of calcifications in plasma cell tumors that simulate chondrosarcoma [3,4,6]. There are several causes of calcification arising in plasma cell tumors. These include (1) metastatic tissue calcification in which serum calcium–phosphrous product is raised, (2) dys-
1. Introduction
∗ Corresponding author at: C/o Vijay Kumar Uppal, 198/58, East of Kailash, Uppal’s House, Ramesh Market, New Delhi 110065, India. Tel.: +91 11 26864851x4889/26412131; fax: +91 11 26862663. E-mail address: [email protected] (S. Gamanagatti).
1571-4675/$ – see front matter © 2006 Published by Elsevier Ireland Ltd. doi:10.1016/j.ejrex.2006.05.001
132
Hiralal et al. / European Journal of Radiology Extra 59 (2006) 131–132
Fig. 1. Plain radiograph of pelvis showing calcified mass overlapping right iliac bone and sacrum.
Typically, these calcifications are amorphous or punctate and not of the typical “O” or “C” or punctate types associated with chondrosarcoma. In our case, possible cause of deposition is metastatic deposition of calcium on amyloid. There are several case reports of soft tissue calcifications associated with plasma cell dyscrasias without associated amyloid deposition [7,8]. Soft tissue calcification can occur in association with both primary and secondary amyloidosis. Amyloid is frequently associated with chain than with k chain plasma cell dyscrasias. Bone amyloidomas are very rare, only few cases have been reported in radiology literature [3,4,8]. Detailed radiologic findings are very scarce. On plain radiographs they appear as well defined lytic lesions that may cause cortical destruction. Occasionally their matrix may calcify and simulate typical chondrosarcoma. CT may be better for evaluating the degree of bone involvement and cortical destruction and can be used as an adjunct to percutaneous biopsy. In conclusion, calcification in amyloid produced by plasma cell tumors may at time simulate the radiographic appearance of chondrosarcoma.
References
Fig. 2. Axial CT section of pelvis showing large soft tissue mass associated with punctate calcified matrix involving right iliac bone and right hemi sacrum.
trophic calcification on necrotic myeloma tissue, (3) residual bone fragments from native destroyed tumor containing bone and (4) deposition of calcium on amyloid produced by the tumor.
[1] Bataille R, Harousseau L. Multiple myeloma. N Engl J Med 1997;334:16. [2] Kyle RA, Gertz MA. Primary systemic amyloidosis: clinical and laboratory features in 474 cases. Semin Hematol 1995;32:45–59. [3] Mulder JD, Van Rijssel TG. Case report 233. Skeletal Radiol 1983;10:53–5. [4] Reinus WR, Kyriaskos M, Gilula LA, Brower AC, Merkel K. Plasma cell tumors with calcified amyloid deposition mistaken for chondrosarcoma. Radiology 1993;189:505–9. [5] Hall FM, Gore SM. Osteosclerotic myeloma variants. Skeletal radiol 1988;17:101–5. [6] Rosai J. Ackerman’s surgical pathology. 6th ed. St. Louis, MO: Mosby; 1981. pp. 1357–1358. [7] Fayemi AO, Wisniewski M. Pulmonary calcification in a patient with plasma cell related dyscrasias. Chest 1973;64:765–9. [8] Simoens WA, van den Hauwe L, Van Hedent E, et al. Amyloidoma of the skull base. Am J Neuroradiol 2000;21(8):1559–62.