Abstract
We reported a case of IgA multiple myeloma characterized with pleural fluid and multiple extramedullary tumor formation at terminal stage.
The patient was a 61-year-old female who had been suffering from lumbal pain since early December in 1982, but had received no treatment. When she fell out in the middle of March in 1983, she was injured in the right knee joint (intra-articular hemorrhage) and came to our clinic. The result of blood and biochemical analyses strongly suggested the presence of IgA myeloma and chemotherapy was started. Because the presence of fluid in the right pleural cavity was suggested on the chest roentgenograms, pleurocentesis was performed. The aspirated pleural fluid contained many multinuclear, highly metamorphic plasmacytes. While the serum IgA level decreased under VENP therapy, a palpable tumor came out in the right abdomen in early December, which rapidly grew larger. Finally the patient died from blood loss due to marked hemorrhagic diathesis, which did not respond to any treatment.
Autopsy revealed direct tumor extention into femurs, vertebrae, ribs and sternum. Metastatic lesions were present in various organs, including stomach, duodenum, pancreas, urinary bladder, endometrium and abdominal wall. Especially in abdominal wall, the tumor took the shape of a Borrmann IV type tumor with 8-cm diameter. Fluorescent antibody study demonstrated marked staining of the tumor cells with anti-IgA serum.
