Disfagia en paciente diagnosticado de mieloma múltiple en tratamiento

Resumen

A 56 year old male complains of asthenia, anorexia and 10 day fever. The analytical study showed renal failure requiring dialysis, a monoclonal component (Lambda light chains 437 and Kappa light chains 115) and plasmacytosis revealed in the bone marrow aspiratation (60%). The bone map detected an osteolytic lesion in the posterior arch of the left 6th rib. He was diagnosed stage III B Lambda light chain multiple myeloma, starting chemotherapy without good response. A year later the patient showed progressive dysphagia. The CT scan showed a soft tissue mass of 12 x 11 cm, infiltrating the gastric region, liver, pancreas and spleen with retroperitoneal lymphadenopathy. Oral endoscopy showed gastric mucosa with infiltrative appearance, at fundal level, surrounding the cardia. Biopsy samples taken during endoscopy were described as gastric mucosa with diffuse infiltration by plasma cells, which, considering the histological findings and the history of myeloma patient, suggested infiltration by this entity at gastric level.

Multiple myeloma with gastric involvement is rare. In fact, we studied 869 cases of multiple myeloma from a review comprising between 1905 and 1997 in which 714 patients showed extramedullary involvement but only 17 of them showed multiple myeloma with gastric involvement.