J Korean Orthop Assoc.  2013 Apr;48(2):130-137. 10.4055/jkoa.2013.48.2.130.

Multiple Skeletal Involvement of Multiple Myeloma Associated Amyloidosis Presented with Pathologic Fracture

• Kim DS
• Yi CH
• Yoon WS
• Yoon YS

• KMID: 1424104
• DOI: http://doi.org/10.4055/jkoa.2013.48.2.130

Abstract

Amyloidosis, which refers to amyloid deposits accumulated in various organs, belongs to the same category as multiple myeloma; it can be accompanied by pathologic fracture. It is important to find out the exact cause of amyloidosis in order to decide treatment options and to predict prognosis. The authors described an amyloidosis case with multiple musculoskeletal involvements presented with pathologic fracture and arthrosis, and also reviewed the related articles.

Keyword

amyloidosis; fractures; multiple myeloma

MeSH Terms

Amyloidosis
Fractures, Spontaneous
Multiple Myeloma
Plaque, Amyloid
Prognosis

Figure

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  Figure 1 (A) Right femoral neck fracture was seen on the initial anterior-posterior radiograph of the pelvis. (B) Hemiarthroplasty was conducted; (C, D) however, in the left femoral shaft, an oval shaped osteolytic lesion was observed on the plain radiograph. (E) On the coronal view of pelvic computed tomography, another osteolytic lesion was seen in the right ilium. (F) On the magnetic resonance image (T1) of the left thigh, a high signal heterogenous mass was seen below the hip joint (upper arrow) and a low signal homogenous mass in the left femoral shaft.

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  Figure 2 On the plain radiographs of the (A) antero-posterior view and (B) axial view of the shoulder, osteopenia was seen in the humeral head with diffuse swelling of the deltoid area. On the magnetic resonance image of the shoulder, fluid collection in the subdeltoid area was seen; (C) Multilobular heterogenous mass in the proximal humerus and around the soft tissue was also observed.

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  Figure 3 Heterogenous and less demarcated soft tissue mass mixed with bony fragment was seen in the resected mass of the humeral head as well as around the soft tissue.

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  Figure 4 On H&E staining, (A) inflammatory cells and amyloid deposits were seen around the bone tissue. (C) In soft tissue mass, lobulated amyloid deposit and fibrosis with inflammatory cells were seen in the low power field (A, C: ×10 section). (B) In the high power field (B, D: ×40 section), amyloid deposit was seen significantly (D) along with plasma cell aggregation.

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  Figure 5 (A) In Congo red stain (×4 section), an apple-green appearance was confirmed. (B) A positive stain with light chain was seen on immunohistochemistry (×10 section).

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  Figure 6 (A) On urine protein electrophoresis, the monoclonal peak was seen in the kappa light chain. (B) Definite amyloid deposit was not seen in the bone marrow aspirate (H&E stain, ×10 section). (C) Diffuse plasma cell aggregation was seen (H&E stain, ×100 section). L, low; N, normal; H, high.

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  Figure 7 (A) On the bone scan, an obscure hot uptake in the left hip area was detected. (B) Femoral neck fracture with bone resorption was seen in the plain radiograph. (C) In the operative field, heterogenous, less demarcated mass with bony fragment was seen similar to shoulder mass. (D) Hemiarthroplasty was performed.

Reference

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