Abstract
A 50-year-old man was admitted to the Kinki University Hospital in February, 1978, because of cough and exertional dyspnea. Two years before admission the patient was pointed out the monoclonal gammopathy (3.2g/dl M-protein) in serum at another hospital, therefore, he was reffered to our hospital for precise detailed examination. There was a long history of essential hypertension, which was regulated with oral medication.
The bone marrow showed 12.5% of atypical plasma cells. Monoclonal gammopathy was observed IgG (L) type on immunoelectrophoresis. Quantity of the immunoglobulins were 5850mg/dl IgG, 30mg/dl IgA and 40mg/dl IgM. Bence-Jones protein in urine was negative. He was discharged on 20th hospital day with the diagnosis of IgG (L) type myeloma without chemotherapy.
Nine months before admission the patient began to have lower back pain, and intermittent therapy of melphalan was performed. Three weeks before admission he was developed cough and exertional dyspnea. X-ray films of the chest disclosed left pleural effusion, and he was readmitted to our hospital on February 19, 1978. Bloody fluid with no atypical cells were obtained by pleural puncture. Cyclophsphamide and prednisolone were administered. On the end of May, X-ray films of the chest disclosed multiple nodular shadow in the both lung field without hilar lymphadenopathy. The patient died on the 144th hospital day.
Autopsy findings revealed multiple myeloma in lumbar vertebrae and costae, and Grawitz's tumor on the upper pole of left kidney. Metastases of Grawitz's tumor disclosed the both lung, diaphragma and peribronchial lymph nodes. Complication of multiple myeloma and carcinoma were reviewed.
