title: Lambda light chain myeloma with co-migrating paraprotein at beta region on agarose gel electrophoresis: a case report.
abstract: Paraproteinemia is one of the diagnostic features of multiple myeloma. A commonly used method is the detection of paraprotein by agarose gel electrophoresis (AGE) followed by by immunofixation electrophoresis (IFE) to confirm monoclonality. Due to their smaller size, immunoglobulin A (IgA) and light chain only paraproteins may appear at the beta or even alpha 2 protein fractions. Here, we discuss a case report of a 47-year-old man who presented with pathological fracture of third thoracic (T3) vertebra. Serum protein electrophoresis (SPE) was initially reported as no paraprotein detected. However, a bone biopsy was reported to show plasma cell proliferation with light chain restriction. A repeat sample for protein electrophoresis together with IFE revealed lambda light chain paraprotein co-migrating at the beta region. The beta band plus paraprotein was quantitated as 4.3 g/L (7.0%), which was within normal limits of the beta protein fraction. Hence, it has to be remembered that if the SPE is negative, it does not necessarily mean that the paraprotein is absent in cases which are highly suspicious.
authors.affiliation: Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur.
authors.forename: M
authors.initials: M
authors.lastname: Siti Sarah
authors.affiliation: Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur.
authors.forename: U
authors.initials: U
authors.lastname: Nor Aini
authors.affiliation: Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur.
authors.forename: M I
authors.initials: MI
authors.lastname: Nurismah
authors.affiliation: Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur.
authors.forename: A
authors.initials: A
authors.lastname: Hafiza
authors.affiliation: Department of Pathology, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Bandar Tun Razak, Cheras, 56000, Kuala Lumpur.
authors.forename: M
authors.initials: M
authors.lastname: Khalidah
authors.forename: A B
authors.initials: AB
authors.lastname: Mokhtar
authors.affiliation: Department of Anatomy, Universiti Kebangsaan Malaysia, Jalan Raja Muda Abd Aziz, 50300 Kuala Lumpur, Malaysia.
authors.forename: S
authors.initials: S
authors.lastname: Das
mesh_terms: D049109:Cell Proliferation; D004587:Electrophoresis, Agar Gel / Q000379:methods*; D005598:Fractures, Spontaneous / Q000209:etiology; D006801:Humans; D007122:Immunoelectrophoresis; D007146:Immunoglobulin lambda-Chains / Q000378:metabolism; D008297:Male; D008875:Middle Aged; D009101:Multiple Myeloma / Q000175:diagnosis*; D009194:Myeloma Proteins / Q000378:metabolism; D010265:Paraproteinemias / Q000209:etiology*; D010266:Paraproteins / Q000378:metabolism
chemical_list: D007146:Immunoglobulin lambda-Chains; D009194:Myeloma Proteins; D010266:Paraproteins; C085016:multiple myeloma M-proteins