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Extramedullary relapse of multiple myeloma presenting as hematemesis and melena

Nature Clinical Practice Oncology volume 3, pages 223–226 (2006)Cite this article

Abstract

Background A 60-year-old woman with multiple myeloma relapsed after a good partial response to high-dose chemotherapy (melphalan 200 mg/m2) and autologous stem-cell transplantation, followed by thalidomide and prednisolone maintenance therapy. She presented with hematemesis and melena following salvage chemotherapy with dexamethasone, cyclophosphamide, etoposide, cisplatin, and rescue therapy with single-agent bortezomib.

Investigations Physical examination, laboratory investigations, gastroscopy, 2-[18F]fluoro-2-deoxyglucose-PET (FDG-PET), breast biopsy and histology.

Diagnosis Multifocal extramedullary relapse of multiple myeloma involving the stomach and duodenum.

Management High-dose infusion of omeprazole, blood product support, palliative analgesics and anxiolytic agents.

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Figure 1: Endoscopic images demonstrating deposits of myeloma.
Figure 2: Whole body 2-[18F]fluoro-2-deoxyglucose-PET scan demonstrating widespread relapsed disease, including prominent disease activity in the stomach (black arrow) and small intestine, and right breast.

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Authors and Affiliations

  1. MA Dawson and MN Polizzotto are advanced trainees in clinical and laboratory hematology, A Gordon is an advanced trainee in gastroenterology, SK Roberts is a consultant gastroenterologist and hepatologist and Director of Gastroenterology, and A Spencer is a consultant hematologist and bone-marrow transplant physician, all at The Alfred Hospital, Melbourne, Australia

    Mark A Dawson, Mark N Polizzotto, Adam Gordon, Stuart K Roberts & Andrew Spencer

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  1. Mark A Dawson
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  2. Mark N Polizzotto
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  3. Adam Gordon
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  4. Stuart K Roberts
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  5. Andrew Spencer
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Correspondence to Mark A Dawson.

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The authors declare no competing financial interests.

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Dawson, M., Polizzotto, M., Gordon, A. et al. Extramedullary relapse of multiple myeloma presenting as hematemesis and melena. Nat Rev Clin Oncol 3, 223–226 (2006). https://doi.org/10.1038/ncponc0454

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