SHM Converge Scientific Abstract ePoster Gallery-When Light Chains Break Bones

Pdf Summary

A 61-year-old man presented with severe, progressive back pain and prior sudden left clavicle pain that spread to multiple sites. Exam showed marked tenderness over the clavicle, sternum, and left posterior chest wall, with limited lower-extremity strength testing due to pain. Initial CBC and metabolic panel were normal. CT and MRI revealed destructive bone lesions, including a soft tissue mass involving the left posterior 9th rib and a pathologic T12 fracture with epidural tumor causing severe spinal canal stenosis and cord compression.<br /><br />Because of concern for hematologic malignancy-related spinal cord compression, high-dose steroids were started promptly. Neurosurgery found no indication for surgery in the absence of clear myelopathy. The patient was admitted for expedited workup and pain control, and interdisciplinary management involved Hematology and Radiation Oncology. He later received palliative radiation to the T12 lesion, with improvement in pain and function.<br /><br />Diagnostic testing showed normal immunoglobulins but markedly elevated serum free kappa light chains and a kappa-to-lambda ratio of 140. SPEP and UPEP demonstrated monoclonal kappa light chains. PSA was normal. Bone marrow biopsy showed 5–9% kappa light chain-restricted plasma cells, and CT-guided biopsy of a sternal lytic lesion confirmed a kappa light chain-restricted plasma cell neoplasm. He was discharged with plans for outpatient chemotherapy for newly diagnosed kappa light chain multiple myeloma.<br /><br />Key takeaways are that serum free light chains should be checked in addition to immunoglobulins when evaluating for multiple myeloma, light chain myeloma accounts for 15–20% of new cases, and myeloma can present without classic findings. A free light chain ratio of 100 or more is a myeloma-defining biomarker.

Asset Subtitle

Hee Korleski

Meta Tag

Author List Hee Korleski

Category Clinical Vignettes

Concept Multiple Myeloma

Concept Free Light Chain Ratio

Concept Plasma Cell Neoplasm

Concept Spinal Cord Compression

Concept Free Light Chain Assay

Distinguished Non-Finalist

Presenter Organization Mayo Clinic School of Graduate Medical Education

Presenting Author Hee Korleski

Track Adult

Keywords

multiple myeloma

kappa light chain

spinal cord compression

pathologic fracture

plasma cell neoplasm

bone lesions

serum free light chains

monoclonal gammopathy

epidural tumor

palliative radiation

Multiple Myeloma

Free Light Chain Ratio

Plasma Cell Neoplasm

Spinal Cord Compression

Free Light Chain Assay