Abstract
A 54-year-old woman was referred to our hospital because of paraproteinemia in November, 1975. Serum protein electrophoresis disclosed a monoclonal immunoglobulin which was identified as IgG-κ by immunoelectrophoresis, and the amount of the monoclonal IgG was 2.4 g/dl. Bence Jones protein in the urine was negative. Sternal marrow aspirate showed normocellularity with 6.8% (3% immature form) plasma cells. Hematological examination was non-specific, and no bone lesion was observed on skeletal X-ray films. A tentative diagnosis of monoclonal gammo-pathy of undetermined significance was made.
In December, 1980, the patient was found to have advanced stomach cancer (poorly differentiated adenocarcinoma) and subtotal gastrectomy was performed.
In August, 1981, a diagnosis of multiple myeloma was established based on increased amount of the monoclonal IgG over 3.0 g/dl and plasma cells over 20% (11% immature form) in the bone marrow. The patient was treated with melphalan or cyclophosphamide without noticeable response.
In October, 1982, the patient became anemic and Borrmann II rectal cancer was found. The tumor was surgically removed and the histological diagnosis was moderately differentiated adenocarcinoma. After the operation, myeloma became aggressive without beneficial effect of plasma exchange and chemotherapy.
In January, 1983, the patient developed pleural effusion of the left side. In the effusion, numerous atypical plasma cells were seen and the amount of the monoclonal protein was 4.8 g/dl. The patient died of renal insufficiency in February, 1983.
An autopsy revealed widespread plasma cell infiltration in the bone marrow, liver, kidney, spleen and systemic lymph nodes including mediastinal lymph nodes. No metastatic tumor of gastric or rectal cancer was found. The significance of associated carcinomas and pleural effusion was discussed.
