title: Atypical imaging feature of non-secretory multiple myeloma.
abstract: Non-secretory multiple myeloma (NSMM) is a rare variant of the classic form of multiple myeloma in which no monoclonal gammopathy can be demonstrated in the serum or urine. We describe a rare case of non-secretory multiple myeloma in a 23 year old female presenting with bilateral limb weakness of two years duration. Clinically she was diagnosed to have Pott's spine and was treated with category 1 anti tubercular drugs. Hematological investigations showed plasmacytosis and radiography showed osteolytic lesions. No monoclonal gammopathy was found in the serum or urine. MRI showed multiple compressions with sclerosis within vertebral bodies suggestive of osteomalacia/ diffuse infiltrative disorder. The free light chain (FLC) assay revealed increment in the free kappa light chain and an abnormal κ/λ ratio. Free Light Chain assay (FLC) when used in complement with Protein Electrophoresis (PEP) and Immunofixation Electrophoresis (IFE) were pivotal in diagnosis of non secretory multiple myeloma or light chain myelomas. FLC is a useful monitoring tool because it reflects therapy results due to short serum half life.
authors.affiliation: Department of pathology, Bangalore Medical College and Research Institute (BMC&RI), Bangalore, India. drasha72@gmail.com
authors.forename: Ashalatha
authors.initials: A
authors.lastname: Neeravari
authors.forename: Panchal
authors.initials: P
authors.lastname: Netravati
authors.forename: Raj
authors.initials: R
authors.lastname: Mohammed
authors.forename: Ajanahalli Ramaiah
authors.initials: AR
authors.lastname: Ragupathi
authors.forename: Arehalli Hallappa
authors.initials: AH
authors.lastname: Nagarajappa
mesh_terms: D001854:Bone Marrow Cells / Q000473:pathology; D005260:Female; D006801:Humans; D007122:Immunoelectrophoresis / Q000379:methods; D007147:Immunoglobulin Light Chains / Q000097:blood; D009101:Multiple Myeloma / Q000150:complications / Q000175:diagnosis*; D010014:Osteolysis / Q000150:complications / Q000473:pathology*; D010024:Osteoporosis / Q000150:complications / Q000000981:diagnostic imaging / Q000473:pathology; D010950:Plasma Cells / Q000473:pathology; D011859:Radiography; D013131:Spine / Q000000981:diagnostic imaging; D055815:Young Adult
chemical_list: D007147:Immunoglobulin Light Chains