Infiltrating ductal breast carcinoma with monoclonal gammopathy of undetermined significance:A case report

BACKGROUND Infiltrating ductal breast carcinoma with monoclonal gammopathy of undetermined significance(MGUS)is rare and easily misdiagnosed.Most patients are first diagnosed with MGUS.We report a rare case of MGUS secondary to infiltrating ductal breast carcinoma.We also review the literature to analyze the clinical characteristics and diagnostic methods.CASE SUMMARY A 51-year-old woman underwent modified radical mastectomy for infiltrating ductal carcinoma of the right breast and was then treated with radiation and chemotherapy.A decreased platelet count was found on routine blood examination,and MGUS was subsequently diagnosed.This is the first report of the occurrence of MGUS after breast cancer surgery.CONCLUSION Vigilance is required to distinguish this rare comorbidity from breast plasmacytoma.

Monoclonal Gammopathy of Undetermined Significance Occurred after Golimumab Therapy in a Patient with Ankylosing Spondylitis

Background: Ankylosing spondylitis (AS) is a chronic inflammatory disease which is characterized by the involvement of the sacroiliac joint and the spine, the main therapy includes biological agents, which may increase the risk of tumor and infection in long term application. Case Presentation: A fifty-year- old man was diagnosed of AS. He received the therapy of golimumab 50 mg once every one month subcutaneously. After receiving this treatment for two years and eight months, the patient had an elevated level of IgA. The monoclonal protein was finally identified as the type of IgA-kappa from the immunofixation study. Bone marrow aspirate smear revealed infiltration by plasma cells (5%) and immunophenotyping was positive for CD27, CD28, CD38, CD45, CD138 and cKappa, which was finally diagnosed of MGUS. Conclusion: This case demonstrates that golimumab may increase the risk of premalignant disease in patients with AS. With our case report, we also like to highlight that patients with AS may have increased risk of plasma cell malignancies.

Monoclonal Gammopathy of Renal Significance(MGRS): Prospects for Treatment in Integrated Chinese and Western Medicine

Monoclonal gammopathy of renal significance(MGRS)is a pathological state which presents with a spectrum of renal lesions.MGRS is characterized by pathogenic monoclonal immunoglobulins or light chains produced by a premalignant plasma cell or B cell clone.In view of inadequate understanding in the past,the low detection rate of MGRS often results in poor outcomes and reduces quality of life of patients.Thus,MGRS stands for a group of clinical refractory renal diseases.To date,no standard treatment strategy for MGRS is available.Current consensus suggests a clone-directed approach that aims to eradicate the offending clone,but its long-term prognosis is not clear.In this article,we discuss the diagnostic methods,highlight treatment advances,and introduce integrated Chinese and Western medicine in the management of MGRS.

Impact of health care insurance on overall survival of patients with multiple myeloma and monoclonal gammopathy of undetermined significance

Aim:Health care insurance improves access to care and thus outcome in patients with solid tumors.Little information on the impact of health care insurance on hematological malignancies including multiple myeloma exists.The authors aimed to analyze the effect of health care insurance on the survival of patients with multiple myeloma(MM)and monoclonal gammopathy of undetermined significance(MGUS)at Louisiana State University Health Sciences Center in Shreveport,LA.Methods:Two hundred fifty seven patients were reviewed,of which 208 had MM and 49 had MGUS.Results:One hundred and seventy seven patients(69%)were funded and 80(31%)were non-funded.Funded patients with MM had an overall survival(OS)of 6.2 years compared to 3.8 years for non-funded patients(P<0.001).Survivals were not significantly affected by race or gender.The analysis demonstrates that funded patients with MM and MGUS patients have statistically significant increased OS compared to patients with no insurance.Conclusion:This study showed that patients with multiple myeloma and MGUS with health care insurance have longer overall survival when compared to non-funded patients.

Extensive Bi-Atrial Remodeling on Hypertensive Patient with Permanent Atrial Fibrillation Delayed Diagnosis of Fatal Cardiac Lambda Amyloidosis

Background: Amyloidosis is a disease characterized by the deposition of fibrillar proteins in tissues. The nature of the protein defines the type of amyloidosis. Cardiac involvement is most often secondary to deposits of transthyretin and immunoglobulin light chains. Treatment depends on the type of amyloidosis. Cardiac light chain amyloidosis is a medical emergency. Aim: To highlight the importance of an early diagnosis of cardiac light chain amyloidosis. Case Presentation: We report the case of an 88-year-old hypertensive female patient with sustained atrial fibrillation and recurrent heart failure, in whom echocardiography showed concentric left ventricle hypertrophy with mildly reduced left ventricle ejection fraction (LVEF) to 45%. Bone scintigraphy was normal. Serum analysis showed increased lambda free light chains. Accessory salivary gland biopsy revealed weak Kappa light chain staining and clear overexpression of lambda light chain deposits. The diagnosis of stage 3B cardiac amyloidosis secondary to lambda light chain myeloma was made. After a multidisciplinary meeting, it was decided to start treatment with DARATUMUMAB + LENALIDOMIDE. Patient’s general condition deteriorated with the occurrence of febrile pancytopenia. Chemotherapy was stopped and management was limited to comfort care until the patient’s death. Conclusion: Cardiac light-chain amyloidosis must be diagnosed early as it can be rapidly fatal.

Multiple myeloma presenting with amyloid arthropathy as the first manifestation:Two case reports

BACKGROUND Multiple myeloma(MM)can be accompanied by amyloidosis,which occurs in a small number of patients and is characterized by deposition of light chains in the joints,leading to multiple myeloma-associated amyloid arthropathy(MAA).As a rare complication of MM,clinical manifestations of MAA are often similar to those of rheumatoid arthritis,and the two are easily confused.CASE SUMMARY In recent years,our center treated two patients of MM with amyloid arthropathy as the first manifestation,both of whom presented with polyarthritis.After treatment for MM,both patients achieved complete remission.However,subsequently,the two patients underwent hip arthroplasty for femoral neck fractures.Congo red staining and immunofluorescence of the joint tissues confirmed MAA after surgery.Eventually,one of the patients died of MM recurrence,while the other survived.CONCLUSION MAA should be regarded as an initial symptom of MM and should be taken seriously.

Laboratory Characterizations on 2007 Cases of Monoclonal Gammopathies in East China

Monoclonal gammopathies are characterized by the presence of monoclonal immunoglobulin in patients with or without evidence of multiple myeloma （MM）, macroglobulinemia, amyloidosis （AL）, or a related plasma cell proliferative disorder. This study aims to evaluate laboratory diagnostic characters of monoclonal gammopathies and investigates the correlation between monoclonal gammopathies and transforming growth factor β1 （TGFβ1）. Immunofixation electrophoresis （IFE）, serum protein electrophoresis （SPE）, nephelometry and urine light chain ELISA were used for laboratory identification of monoclonal immunoglobulins. Plasma TGFβ1 was detected with double-antibodies ELISA. Lightcycler was used for single nucleotide polymorphism （SNP） analysis. Totally 2,007 cases of monoclonal immunoglobulin （M protein） were identified in 10,682 samples. The isotypes of M protein were IgG type 47.1%, IgA 23.0%, IgM 8.7%, IgD 5.3%, free light chain κ 6.1%, λ 9.8%. In reference to IFE, the coherency of diagnosis was serum light chain ratio （κ/λ） 94.4%, quantitation of Igs 83%, light chain quantitation 80.9%, and urine light chain ratio （κ/λ） 58.0%. Plasma TGFβ1 was elevated significantly compared to normal control. The allelic frequency of codon 10 （C 〉 T） was neither associated with the existence of the M protein nor with the M protein isotype. Monoclonal gammopathies can be identified with the combination of IFE, SPE, Igs quantitaion and urine light chain determination. Although TGFβ1, an important cytokine in immune regulation, was elevated in monoclonal gammopathies, the SNPs in coding region of TGFβ1 gene did not confer susceptibility to the development of monoclonal gammopathies in this study. Cellular ＆ Molecular Immunology. 2008;5（4）： 293-298.