This retrospective study aimed to compare the clinical features of paramedullary lesions (PLs) and extramedullary lesions (ELs) of plasmacytomas at diagnosis, using positron emission tomography integrated with computed tomography, using glucose labeled with the positron-emitting radionuclide ¹⁸F (¹⁸F-FDG-PET/CT) in newly diagnosed multiple myeloma (NDMM), and to address their prognostic impact. Sixty-four patients with NDMM presenting ELs (n=22) and/or PLs (n=42) were included. Patients with ELs at initial presentation had unfavorable laboratory parameters of calcium and lactate dehydrogenase, a higher percentage of bone marrow plasma cells, and showed a trend toward advanced international staging system (ISS), compared to patients with PLs. Using X-ray imaging, high bone disease (HBD) was observed in 50% and 71% of patients with ELs and PLs, respectively. After a median follow-up of 29.2 months (range, 3.4–76.5 months) in survivors, patients with ELs had a significantly lower overall survival (OS) (p=0.033) than patients with PLs did, whereas the progression-free survival (PFS) did not differ significantly (p=0.818). However, the PFS after 1(st) progression was significantly worse in patients with ELs than in those with PLs (p=0.017). In the multivariate analyses, the negative impact of initial ELs on OS (p=0.033) was sustained. Our results demonstrated the different clinical features and outcomes of ELs and PLs in NDMM. Patients with initial ELs showed a shorter PFS after 1(st) progression, which translated into poor OS, providing insight into the different biological effect of ELs.
Bone Diseases ; Bone Marrow ; Calcium ; Diagnosis ; Disease-Free Survival ; Follow-Up Studies ; Glucose ; Humans ; L-Lactate Dehydrogenase ; Multiple Myeloma* ; Multivariate Analysis ; Plasma Cells ; Plasmacytoma ; Positron-Emission Tomography ; Retrospective Studies ; Survivors

Objectives: Waldenstrom Macroglobulinemia (WM) is a malignant disease of the B lymphocytes. We report on a patient in Mongolia having WM complicated with hyperviscosity syndrome. Methods: A 28 year-old Mongolian woman had symptoms due to hyperviscosity syndrome such as vision loss, headache, dizziness and, epistaxis. Upon examination, her morphology, biochemistry, histology, flow cytometry and serum protein electrophoresis indicated WM complicated with hyperviscosity syndrome. Results: The patient was was successfully treated with a combination chemotherapy and plasmapheresis. Conclusion: Hyperviscosity syndrome manifestations should be treated with plasmapheresis.