Osteolytic-variant POEMS syndrome: an uncommon presentation of "osteosclerotic" myeloma.
Polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome, a form of osteosclerotic myeloma, is a multisystem disease related to a monoclonal plasma cell proliferative disorder. Osseous lesions are most commonly sclerotic on radiographs and computed tomography (CT), demonstrate low T1 and T2 signal intensity on magnetic resonance imaging (MRI), and have variable degrees of avidity on positon emission tomography (PET) imaging using 18-fluorodeoxyglucose (18F-FDG). We present three cases of POEMS syndrome manifesting as osteolytic lesions with indolent features, including well-defined thin sclerotic rims, no cortical disruption or periosteal reaction, no associated soft-tissue mass, and a periarticular location, all features that could lead to misinterpretation as benign bone lesions. We also report increased T1 signal and diffuse solid enhancement of these lesions on MRI, features previously unreported. POEMS syndrome should not be discounted as a diagnostic consideration in the setting of osteolytic lesions with non-aggressive imaging characteristics on radiographs or CT, especially in the presence of other supportive clinical features.
Department of Radiology, Mayo Clinic, Mayo Building, E2, 200 First Street SW, Rochester, MN, 55905, USA.
Michael S
MS
Clark
Department of Radiology, Mayo Clinic, Mayo Building, E2, 200 First Street SW, Rochester, MN, 55905, USA.
Benjamin M
BM
Howe
Department of Radiology, Mayo Clinic, Mayo Building, E2, 200 First Street SW, Rochester, MN, 55905, USA.
Katrina N
KN
Glazebrook
Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA.
Michelle L
ML
Mauermann
Department of Radiology, Mayo Clinic, Mayo Building, E2, 200 First Street SW, Rochester, MN, 55905, USA. broski.stephen@mayo.edu.
Stephen M
SM
Broski
D000328:Adult; D000368:Aged; D001859:Bone Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging*; D001842:Bone and Bones / Q000000981:diagnostic imaging; D003937:Diagnosis, Differential; D019788:Fluorodeoxyglucose F18; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D016878:POEMS Syndrome / Q000150:complications*; D000072078:Positron Emission Tomography Computed Tomography; D019275:Radiopharmaceuticals
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18
CT; Osteosclerotic myeloma; PET-CT; POEMS syndrome; Radiography