Multiple myeloma in a patient with suspected hyperparathyroidism

Document Type : Case Report

Authors

1 Research Center for Nuclear Medicine, Tehran University of Medical Sciences, Tehran, Iran

2 Association of Nuclear Medicine and Molecular Imaging (ANMMI), Universal Scientific Education and Research Network (USERN), Tehran, Iran

Abstract

Multiple myeloma (MM) is a clonal B-lymphocyte neoplasm of terminally differentiated plasma cells. Imaging modalities which allow the recognition of the effects of myeloma cells on the skeletal system have been utilized for a long time. Herein, we represent a patient with generalized osteoporosis and hypercalcemia, who was referred for parathyroid scan, in whom the widespread bone marrow technetium-99m-methoxy-2-isobutylisonitrile (99mTc-MIBI) uptake suggested the presence of a bone marrow involving pathology, which turned out to be multiple myeloma on bone marrow biopsy. The current case report highlights the importance of 99mTc-MIBI scintigraphy, with a relatively low cost and better accessibility compared with other high sensitivity modalities such as PET-CT, to be used to demonstrate multiple myeloma bone marrow involvement, which could incline physicians to consider 99mTc-MIBI scintigraphy as a complementary diagnostic tool for multiple myeloma.

Keywords

Main Subjects


  1. Bladé J, Kyle RA, Greipp PR. Multiple myeloma in patients younger than 30 years. Report of 10 cases and review of the literature. Arch Intern Med. 1996 Jul 8;156(13):1463-8.
  2. Kyle RA. Diagnostic criteria of multiple myeloma. Hematol Oncol Clin North Am. 1992 Apr;6(2):347-58.
  3. Walker R, Barlogie B, Haessler J, Tricot G, Anaissie E, Shaughnessy JD Jr, Epstein J, van Hemert R, Erdem E, Hoering A, Crowley J, Ferris E, Hollmig K, van Rhee F, Zangari M, Pineda-Roman M, Mohiuddin A, Yaccoby S, Sawyer J, Angtuaco EJ. Magnetic resonance imaging in multiple myeloma: diagnostic and clinical implications. J Clin Oncol. 2007 Mar 20;25(9):1121-8.
  4. Schirrmeister H, Bommer M, Buck AK, Müller S, Messer P, Bunjes D, Döhner H, Bergmann L, Reske SN. Initial results in the assessment of multiple myeloma using 18F-FDG PET. Eur J Nucl Med Mol Imaging. 2002 Mar;29(3):361-6.
  5. Nilsson-Ehle H, Holmdahl C, Suurküla M, Westin J. Bone scintigraphy in the diagnosis of skeletal involvement and metastatic calcification in multiple myeloma. Acta Med Scand. 1982;211(6):427-32.
  6. Mele A, Offidani M, Visani G, Marconi M, Cambioli F, Nonni M, Catarini M, Brianzoni E, Berbellini A, Ascoli G, Brunori M, Agostini V, Corvatta L, Isidori A, Spinelli A, Gradari M, Leoni P. Technetium-99m sestamibi scintigraphy is sensitive and specific for the staging and the follow-up of patients with multiple myeloma: a multicentre study on 397 scans. Br J Haematol. 2007 Mar;136(5):729-35.
  7. Fallahi B, Beiki D, Mousavi SA, Gholamrezanezhad A, Eftekhari M, Fard-Esfahani A, Alimoghaddam K, Mirpour S, Eskandarian A, Saghari M. 99mTc-MIBI whole body scintigraphy and P-glycoprotein for the prediction of multiple drug resistance in multiple myeloma patients. Hell J Nucl Med. 2009 Sep-Dec;12(3):255-9.
  8. Fallahi B, Saghari M, Fard Esfahani A, Eftekhari M, Iravani M, Beiki D, Dabbagh Kakhki VR, Sadeghi R. The value of 99mTc-MIBI whole body scintigraphy in active and in remission multiple myeloma. Hell J Nucl Med. 2005 Sep-Dec;8(3):165-8.
  9. Fonti R, Del Vecchio S, Zannetti A, De Renzo A, Di Gennaro F, Catalano L, Califano C, Pace L, Rotoli B, Salvatore M. Bone marrow uptake of 99mTc-MIBI in patients with multiple myeloma. Eur J Nucl Med. 2001 Feb;28(2):214-20.
  10. Pace L, Catalano L, Pinto A, De Renzo A, Di Gennaro F, Califano C, Del Vecchio S, Rotoli B, Salvatore M. Different patterns of technetium-99m sestamibi uptake in multiple myeloma. Eur J Nucl Med. 1998 Jul;25(7):714-20.
  11. Terpos E, Dimopoulos MA. Myeloma bone disease: pathophysiology and management. Ann Oncol. 2005 Aug;16(8):1223-31.
  12. Angtuaco EJ, Fassas AB, Walker R, Sethi R, Barlogie B. Multiple myeloma: clinical review and diagnostic imaging. Radiology. 2004 Apr;231(1):11-23.
  13. Mulligan ME. Skeletal abnormalities in multiple myeloma. Radiology. 2005 Jan;234(1):313-4.
  14. Gleeson TG, Moriarty J, Shortt CP, Gleeson JP, Fitzpatrick P, Byrne B, McHugh J, O'Connell M, O'Gorman P, Eustace SJ. Accuracy of whole-body low-dose multidetector CT (WBLDCT) versus skeletal survey in the detection of myelomatous lesions, and correlation of disease distribution with whole-body MRI (WBMRI). Skeletal Radiol. 2009 Mar;38(3):225-36.
  15. Healy C, Murray J, Eustace S, Madewell J, O'Gorman P, O'Sullivan P. Multiple myeloma: a review of imaging features and radiological techniques. Bone Marrow Res. 2011;2011:583439.
  16. Ludwig H, Kumpan W, Sinzinger H. Radiography and bone scintigraphy in multiple myeloma: a comparative analysis. Br J Radiol. 1982 Mar;55(651):173-81.
  17. Durie BG, Waxman AD, D'Agnolo A, Williams CM. Whole-body (18)F-FDG PET identifies high-risk myeloma. J Nucl Med. 2002 Nov;43(11):1457-63.
  18. Fonti R, Salvatore B, Quarantelli M, Sirignano C, Segreto S, Petruzziello F, Catalano L, Liuzzi R, Rotoli B, Del Vecchio S, Pace L, Salvatore M. 18F-FDG PET/CT, 99mTc-MIBI, and MRI in evaluation of patients with multiple myeloma. J Nucl Med. 2008 Feb;49(2):195-200.
  19. Hanrahan CJ, Christensen CR, Crim JR. Current concepts in the evaluation of multiple myeloma with MR imaging and FDG PET/CT. Radiographics. 2010 Jan;30(1):127-42.
  20. Tirovola EB, Biassoni L, Britton KE, Kaleva N, Kouykin V, Malpas JS. The use of 99mTc-MIBI scanning in multiple myeloma. Br J Cancer. 1996 Dec;74(11):1815-20.
  21. Balleari E, Villa G, Garrè S, Ghirlanda P, Agnese G, Carletto M, Clavio M, Ferrando F, Gobbi M, Mariani G, Ghio R. Technetium-99m-sestamibi scintigraphy in multiple myeloma and related gammopathies: a useful tool for the identification and follow-up of myeloma bone disease. Haematologica. 2001 Jan;86(1):78-84.
  22. Nandurkar D, Kalff V, Turlakow A, Spencer A, Bailey MJ, Kelly MJ. Focal MIBI uptake is a better indicator of active myeloma than diffuse uptake. Eur J Haematol. 2006 Feb;76(2):141-6.
  23. Luthra K, Bhave A, Lele RD. Tc 99m Sestamibi Scanning in Multiple Myeloma--a New look with SPECT-CT. J Assoc Physicians India. 2014 Sep;62(9):801-12.
  24. Martín MG, Romero Colás MS, Dourdil Sahún MV, Olave P, Alba PR, Banzo JB. BaselinTc99-MIBI scanning predicts survival in multiple myeloma and helps to differentiate this disease from monoclonal gammopathy of unknown significance. Haematologica. 2005 Aug;90(8):1141-3.
  25. Pace L, Catalano L, Del Vecchio S, De Renzo A, Fonti R, Salvatore B, Andretta C, Di Nuzzo C, Rotoli B, Salvatore M. Washout of [99mTc] sestamibi in predicting response to chemotherapy in patients with multiple myeloma. Q J Nucl Med Mol Imaging. 2005 Sep;49(3):281-5.
  26. Fanari Z, Kadikoy H, Haque W, Pacha O, Abdellatif A. Medical management of primary hyperparathyroidism with concomitant multiple myeloma. Intern Med. 2010;49(6):581-4.
  27. Chantry A, Kazmi M, Barrington S, Goh V, Mulholland N, Streetly M, Lai M, Pratt G; British Society for Haematology Guidelines. Guidelines for the use of imaging in the management of patients with myeloma. Br J Haematol. 2017 Aug;178(3):380-393.