melphalan and Hyperparathyroidism

We report a case of 77-year-old woman who presented with lumbago and hypercalcemia. Multiple myeloma (MM) was first diagnosed by serum protein electrophoresis and bone marrow aspiration, but intact parathyroid hormone (intactPTH) was also found to be high in the presence of persistent hypercalcemia with anorexia and nausea. After lowering serum calcium with bisphosphonate administration, parathyroidectomy was performed. Upon histologic examination, the tumor was determined to be parathyroidal chief-cell hyperplasia and the patient was treated with melphalan and prednisolone. The relationship between MM and primary hyperparathyroidism (I degree HPT) remains unknown. Although the co-existence of MM and I degree HPT was reported in 12 reports from various parts of the world, there was only 1 report in Japan. The present case is an example of successful treatment for a complicated disorder, and suggests that patients suffering from bone pain or hypercalcemia need to be examined both endocrinologically and hematologically.

Topics: Aged; Antineoplastic Agents; Female; Humans; Hypercalcemia; Hyperparathyroidism; Hyperplasia; Low Back Pain; Melphalan; Multiple Myeloma; Osteoporosis; Parathyroid Glands; Prednisolone

To prospectively assess molecular imaging of multiple myeloma (MM) by using the radiolabeled amino acid carbon 11 ((11)C) methionine and positron emission tomography (PET)/computed tomography (CT).. The study was approved by the institutional local ethics committee and the national radiation protection authorities. All patients with MM and control patients gave written informed consent. Nineteen patients with MM (11 women, eight men; age range, 42-64 years) and 10 control patients with hyperparathyroidism without hematologic diseases (six women, four men; age range, 43-75 years) underwent PET/CT 20 minutes after injection of a mean of 1.0 GBq +/- 0.2 (standard deviation) (11)C-methionine. Presence and extent of CT-assessed tumor manifestations and (11)C-methionine bone marrow (BM) uptake were determined on the basis of maximum standardized uptake value (SUV(max)). BM imaging patterns, normal BM, and maximal lesion (11)C-methionine uptake in patients with MM were compared with those in control patients. In two patients with MM, sulfur 35 ((35)S) methionine uptake in freshly isolated BM plasma cells was measured. Values for SUV(max) of groups were compared by using the Mann-Whitney test on a per-patient basis.. (35)S-methionine uptake of plasma cells was five- to sixfold higher than in normal BM cells. (11)C-methionine BM uptake in control patients was homogeneous and low. All patients with MM except one with exclusively extramedullary myeloma had (11)C-methionine-positive lesions. Maximal lesion and normal BM (11)C-methionine mean SUV(max) were 10.2 +/- 3.5 and 4.3 +/- 2.0, respectively, and thus were significantly higher than that of BM in the control group (mean, 1.8 +/- 0.3; P < .001). Extramedullary MM was clearly visible in three patients (mean SUV(max), 7.2 +/- 2.4). Additional (11)C-methionine-positive lesions in normal cancellous bone were found in nearly all patients with MM. In pretreated patients with MM, a moderate fraction of osteolytic lesions had no (11)C-methionine uptake.. On the basis of increased methionine uptake in plasma cells, active MM can be imaged with (11)C-methionine PET/CT.

Topics: Adult; Aged; Antineoplastic Agents, Alkylating; Bone and Bones; Bone Marrow; Carbon Radioisotopes; Cohort Studies; Female; Follow-Up Studies; Humans; Hyperparathyroidism; Image Processing, Computer-Assisted; Male; Melphalan; Methionine; Middle Aged; Multiple Myeloma; Osteolysis; Plasma Cells; Positron-Emission Tomography; Prospective Studies; Radiopharmaceuticals; Sulfur Radioisotopes; Syndecan-1; Tomography, X-Ray Computed

The authors report the case of an 82 year old woman hospitalized for hypercalcemia associated with low serum phosphate. Multiple myeloma was first diagnosed. However, despite chemotherapy, hypercalcemia persisted and she was subsequently diagnosed as primary hyperparathyroidism; eucalcemic state was then obtained after parathyroidectomy. Fifteen similar cases are reported in the literature and the mechanisms and implications of such an association are discussed.

Topics: Aged; Aged, 80 and over; Female; Humans; Hypercalcemia; Hyperparathyroidism; Immunoglobulin kappa-Chains; Immunoglobulin Light Chains; Melphalan; Multiple Myeloma; Parathyroidectomy; Prednisone

Topics: Aged; Aged, 80 and over; Calcium; Cyclic AMP; Etidronic Acid; Humans; Hypercalcemia; Hyperparathyroidism; Immunoglobulin G; Immunoradiometric Assay; Male; Melphalan; Multiple Myeloma; Parathyroid Hormone; Phosphorus; Prednisone; Ultrasonography