Extramuscular Myeloma

Myeloma Institute Case Presentation:

Extramuscular Myeloma
Prepared by Sarah Waheed, M.D., Assistant Professor of Medicine

Patient diagnosed in February 2008 with multiple myeloma presented to the Myeloma Institute. Patient was also found to have cardiac amyloidosis. After induction chemotherapy, patient received Melphalan transplant, achieving remission that was maintained with velcade and thalidomide. Patient relapsed in July 2011 with 100+ focal lesions and extramedullary disease in lymph nodes. Patient received salvage chemotherapy, again achieving remission, but relapsed in January 2012 with calf muscle extramedullary disease, the myeloma deposits were found in between muscles of the thigh. Disease resolved completely with Salvage PACMED chemotherapy. During the disease course the patient’s cardiac amyloid remained stable.

Extramuscular myeloma-masses-1Extramuscular myeloma-masses-close-up-web

Left: Myeloma masses in the thigh between hamstring muscle group. Right: Close up shows the myeloma deposits to be abutting the muscle but not invading it. Biopsy shows plasma cells from the deposits between muscles.
extramuscular myeloma-improving-web
Myeloma between the muscle groups around the knee joint muscles and thigh showing marked improvement with chemotherapy.