Multiple Myeloma Mimicking Bone Metastasis: The Contribution of Biochemistry Laboratory to Differential Diagnosis

Sara Harrar¹, Abderrahim Raissi², Ayoub Bouchehboun¹, Ibtissam Mhirig¹, Saliha Chellak¹, Abderrahman Boukhira¹

Corresponding Author: Sara Harrar

¹Clinical Biochemistry and Toxicology Department, Avicenne Military Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco

²Clinical Hematology Department, Avicenne Military Hospital, Faculty of Medicine and Pharmacy, Cadi Ayyad University, Marrakech, Morocco

International Journal of Biomedical Science and Engineering, Volume 11, Issue 4, December 2023

Pages: 50-53

Received: Jun. 01, 2023

Accepted: Jun. 28, 2023

Published: Oct. 28, 2023

DOI: 10.11648/j.ijbse.20231104.11

Downloads:

Views:

Download PDF: Download PDF

Export Citation: Export citation to RIS Export citation to BibTeX

Abstract

Breast carcinoma is a tumor that tends to metastasize to various organs. The hasty diagnosis of metastasis in patients treated for breast carcinoma who report symptoms for another malignant tumor, may be the cause of diagnostic and therapeutic delay. We report the case of a patient with breast ductal carcinoma, having completed her therapeutic protocol, she came in 3 years later with severe bone pain, epistaxis and headache in a context of asthenia and anorexia, suggesting a relapse of her breast cancer with bone metastasis. On clinical examination, the patient presented with cutaneous and mucosal pallor. She had no other signs of secondary localization, the performance of electrophoresis and immunofixation of serum proteins, led to a diagnosis of multiple myeloma. This observation highlights the diagnostic difficulty that can arise in patients treated for breast carcinoma who present with a malignant hemopathy mimicking a metastasis of the initial cancer, or other cases where the multiple myeloma is synchronous with other malignancies. This clinical similarity may delay treatment and worsen the patient's condition. This situation can be avoided by the simple performance of protein electrophoresis, which is a relevant method of diagnosis and follow-up of monoclonal gammopathies thanks to the efficient separation of serum proteins and quantification of monoclonal peaks.

Keywords

Multiple Myeloma, Breast Carcinoma, Serum Protein Electrophoresis, Immunofixation

To cite this article

Sara Harrar, Abderrahim Raissi, Ayoub Bouchehboun, Ibtissam Mhirig, Saliha Chellak, et al. (2023). Multiple Myeloma Mimicking Bone Metastasis: The Contribution of Biochemistry Laboratory to Differential Diagnosis . International Journal of Biomedical Science and Engineering, 11(4), 50-53. https://doi.org/10.11648/j.ijbse.20231104.11

Copyright © 2023 Authors retain the copyright of this article.
This article is an open access article distributed under the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

References

1.	Shaheenah D, Xiudong L, K. Litton J, et al. Incidence of brain metastases as a first site of recurrence among women with triple receptor-negative breast cancer -Cancer. 22 Feb 2012; 118: 4652–4659.
2.	Fujii T, Yajima R, Yamaki E, Kohsaka T, Yamaguchi S, Tsutsumi S, et al. Pulmonary Metastasis From Breast Cancer With an 18-Year Disease-Free Interval: Implication of the Role of Surgery. Int Surg. 2012; 97 (4): 281–4.
3.	Rajkumar SV, Kumar S. Multiple Myeloma: Diagnosis and Treatment. Mayo Clin Proc. 1 janv 2016; 91 (1): 101–19.
4.	Savage D, Garrett TJ. Multiple myeloma masquerading as metastatic breast cancer. Cancer. 1 mars 1986; 57 (5): 923–4.
5.	Brook N, Brook E, Dharmarajan A, Dass CR, Chan A. Breast cancer bone metastases: pathogenesis and therapeutic targets. Int J Biochem Cell Biol. mars 2018; 96: 63–78.
6.	Tomono H, Fujioka S, Kato K, Yoshida K, Nimura Y. Multiple myeloma mimicking bone metastasis from breast cancer: Report of a case. Surg Today. déc 1998; 28 (12): 1304–6.
7.	Rossi D, Sarti D, Malerba L, Tommasoni S, Visani G, Martignetti A, et al. Secondary Bone Marrow Malignancies after Adjuvant Chemotherapy for Breast Cancer: A Report of 2 Cases and a Review of the Literature. Tumori J. nov 2016; 102 (2_suppl): S29–31.
8.	Chandra H, Chandra S, Verma SK. Multiple myeloma or metastatic carcinoma breast: Diagnostic dilemma in a case presenting with lytic bony lesion. Breast Dis. 31 juill 2015; 35 (3): 199–201.
9.	Mastroianni A, Panella R, Morelli D. Differential diagnosis between bone relapse of breast cancer and lambda light chain multiple myeloma: role of the clinical biochemist. Tumori. déc 2019; 105 (6): NP17–9.
10.	Vennepureddy A, Motilal Nehru V, Liu Y, Mohammad F, Atallah JP. Synchronous Diagnosis of Multiple Myeloma, Breast Cancer, and Monoclonal B-Cell Lymphocytosis on Initial Presentation. Case Rep Oncol Med [Internet]. 2016 [cited 2021 Nov 29]; 2016: 1–4. Available from: http://www.hindawi.com/journals/crionm/2016/7953745/
11.	Khalbuss WE, Fischer G, Ahmad M, Villas B. Synchronous Presentation of Breast Carcinoma with Plasmacytoid Cytomorphology and Multiple Myeloma. Breast J [Internet]. 2006 Mar [cited 2021 Nov 29]; 12 (2): 165–7. Available from: https://onlinelibrary.wiley.com/doi/10.1111/j.1075-122X.2006.00226.x
12.	Sokołowski M, Mazur G, Butrym A. Breast cancer and synchronous multiple myeloma as a diagnostic challenge: Case report and review of literature. Curr Probl Cancer. 2018 Apr; 42 (2): 231–4.
13.	Li N, Liu X, Song Y, Luo S, Fang B. The Synchronous Presence of Multiple Myelomas and Other Primary Malignant Tumors: Case Series with Literature Review. Cancer Manag Res. 2020; 12: 2829–38.
14.	Cao F, Zhang R, Xu L, Liu M, Yuan Y. Application of Capillary Electrophoresis in Monoclonal Gammopathies and the Cutoff Value of Monoclonal Protein in Differential Diagnosis of Multiple Myeloma and Other Monoclonal Gammopathies. Ann Clin Lab Sci. mai 2021; 51 (3): 400–7.
15.	McCudden CR, Mathews SP, Hainsworth SA, Chapman JF, Hammett-Stabler CA, Willis MS, et al. Performance comparison of capillary and agarose gel electrophoresis for the identification and characterization of monoclonal immunoglobulins. Am J Clin Pathol. 2008 Mar; 129 (3): 451–8.
16.	Wolff AC, Blackford AL, Visvanathan K, Rugo HS, Moy B, Goldstein LJ, et al. Risk of Marrow Neoplasms After Adjuvant Breast Cancer Therapy: The National Comprehensive Cancer Network Experience. J Clin Oncol [Internet]. 2015 Feb 1 [cited 2021 Dec 8]; 33 (4): 340–8. Available from: https://ascopubs.org/doi/10.1200/JCO.2013.54.6119