Working Diagnosis:
Multiple myeloma characterized by serum monoclonal IgG kappa gammopathy and clavicular destructive plasmacytoma.

Treatment:
Referral to Hematology-Oncology where the patient was started on chemotherapy. His clavicular pain has resolved. He has achieved a 95% response to treatment.

Outcome:
He is cleared for all non-contact activity and enjoys running, cycling and swimming. He continues chemotherapy and awaits a hematopoietic stem cell transplantation.

Author's Comments:
Multiple myeloma is the most common bone malignancy. It accounts for 1% of all cancers and slightly more than 10% of hematologic malignancies in the US. The annual incidence is 4-5 per 100,000. The median age at diagnosis of multiple myeloma is about 70 years, and the occurrence increases with age. Only 2% of patients are diagnosed at younger than 40 years old. It is characterized by the neoplastic proliferation of plasma cells which produces a monoclonal immunoglobulin. These plasma cells proliferate in the bone marrow and often result in extensive skeletal destruction with osteolytic lesions, osteopenia and/or pathological fractures. Most patients present with symptoms related to the infiltration of plasma cells into the bone or other organs. 58% of patients have some bone pain at first presentation.

The diagnosis of multiple myeloma requires either clonal bone marrow plasma cells > 10% or a biopsy proven bony or soft tissue plasmacytoma along with presence of related organ or tissue impairment (anemia, hypercalcemia, renal insufficiency or bone lesions).

After diagnosis, staging and risk stratification, treatment generally involves induction therapy with chemotherapy, followed by hematopoetic stem cell transplantation.

Editor's Comments:
Interesting case in a patient not typically in the demographic for MM.

References:
1. Becker, Nikolaus. "Epidemiology of multiple myeloma." Multiple Myeloma. Springer Berlin Heidelberg, 2011. 25-35.

2. Kyle, Robert A., et al. "Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group." British journal of haematology 121.5 (2003): 749-757.

3. Coleman, Elizabeth Ann, et al. "Feasibility of exercise during treatment for multiple myeloma." Cancer nursing 26.5 (2003).

4. Jobe, F. W., and J. P. Bradley. "The diagnosis and nonoperative treatment of shoulder injuries in athletes." Clinics in sports medicine 8.3 (1989): 419-438.

Return To The Case Studies List.