Quiz - Issue 1

  • A.T., a 46-year-old gentleman with negative past history, presented with acute back pain and the X-rays revealed a vertebral fracture at D9. The CT showed a lytic lesion at D9 plus tumor mass 6 cm x 4 cm with spinal cord compression. The patient underwent an emergency vertebral surgery and the tumor biopsy showed that the mass included 85% of monoclonal plasma cells, indicative of a plasma cell neoplasm. Due to this result, the patient was referred to hematology department. The full blood count was normal; normal hepatic function; normal serum calcium levels; normal LDH; serum creatinine was 1.48 mg/dl (eGFR 55.9 mL/min/1.73m² based on CKD-EPI equation). Total serum protein was 7.7gr/dl; IgG 1016mg/dL, IgA 203mg/dL, IgM 56mg/dL; /FLC ratio 1.33 (=2.05 mg/dL, =1.54 mg/dL). The 24h urine protein was 1.2 g. Serum and urine electrophoresis did not reveal any M-protein; serum and urine immunofixation electrophoresis showed no M-component. The bone marrow biopsy showed no monoclonal plasma cells and Cong red staining was negative. A PET/CT was performed and showed: (1) D9-10 positive signal (performed surgery); (2) Pelvis: “left iliac bone, near the synchondrosis, one osteolytic lesion in the CT part, PET positive (SUV max 6.8)”; (3) no other abnormal finding.

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