J Korean Med Sci.  2008 Jun;23(3):544-547. 10.3346/jkms.2008.23.3.544.

Newly Developed Multiple Myeloma in a Patient with Primary T-Cell Lymphoma of Bone

• Hwang JE
• Cho SH
• Kim OK
• Shim HJ
• Lee SR
• Ahn JS
• Yang DH
• Kim YK
• Lee JJ
• Kim HJ
• Chung IJ

• KMID: 1786900
• DOI: http://doi.org/10.3346/jkms.2008.23.3.544

Abstract

Primary non-Hodgkin's lymphoma of bone (PLB) is rare, and generally presents as a single extensive and destructive bone lesion. Histopathologically, most cases present as diffuse large B-cell lymphoma, and T-cell lymphoma is rare. By contrast, multiple myeloma is a disease defined as the neoplastic proliferation of a single clone of plasma cells producing a monoclonal immunoglobulin. We report a case of multiple myeloma that developed during treatment of PLB in a type of T-cell. A 48-yr-old man was diagnosed as T-cell PLB, stage IE, 18 months ago. The patient received the chemoradiotherapy and salvage chemotherapy for PLB. However, the lymphoma progressed with generalized bone pain, and laboratory findings showed bicytopenia and acute renal failure. On bone marrow biopsy, the patient was diagnosed as having multiple myeloma newly developed with primary T-cell lymphoma of bone. In spite of chemotherapy, the patient died of renal failure.

Keyword

Lymphoma, Non-Hodgkin; Multiple Myeloma; T-Cell Lymphoma of Bone

MeSH Terms

Bone Neoplasms/*complications/diagnosis/therapy
Fatal Outcome
Humans
Kidney Failure, Acute/etiology
Lymphoma, T-Cell/*complications/diagnosis/therapy
Male
Middle Aged
Multiple Myeloma/*complications/diagnosis/therapy

Figure

• 

  Fig. 1 Simple radiography showed osteolytic lesions in the right distal tibia (A). Magnetic resonance imaging (MRI) of the right ankle revealed a heterogeneous, extraosseous mass in the right tibia (B). The Tc-99m bone scan revealed diffuse hot uptake in the right tibia without any other bony involvement at the time of diagnosis of lymphoma (C).

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  Fig. 2 Diffuse infiltration of large tumor cells with vesicular prominent nucleoli, abundant cytoplasm, and numerous mitotic cells (A, H&E, ×200). Immunohistochemical staining for CD45RO showed positive (B, ×200).

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  Fig. 3 After chemoradiotherapy, F-18 FDG PET-CT showed the residual hypermetabolic lesion on tibia, but also revealed hot uptakes at the inferior ramus of the right pubis (A). Despite salvage chemotherapy, F-18 FDG PET-CT revealed diffuse hot uptake in a skeletal area (B).

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  Fig. 4 CD138 expression in the lymphoma mass (A) and bone marrow biopsy at the diagnosis of multiple myeloma (B) (×200).

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