Myeloma with manifestation of digestive tract and complications. Case-report

A 54 years old man with growing subcutaneous abnormality above his shoulder-blade was admitted in our hospital. CT-scan showed destruction of the right scapula and ribs by the tumour and it was spreading to the spinal channel. The thickness of the colon wall at hepatic flexure was also described. Histological examination of colon and subcutaneous abnormality referred to plasmocytoma. Cytostatic therapy and irradiation of the affected chest-wall was introduced.

After first cycle of chemotherapy, melena developed, so we produced urgent upper endoscopy. Endoscopic examination showed tumorous infiltration of the duodenum wall, and digested blood was observed on the top of infiltration. Subsequently our patient had jaundice. Cholangio MRI was made and showed a dilatation of the bile duct. ERCP examination found a tumorous lesion, which infiltrated the papilla and caused obstruction of the bile duct. After bile duct stent implantation the duodenum was irradiated. The first line chemotherapy was ineffective, thus EDAP protocol was introduced as 2nd line therapy. Due to this chemotherapy, after 1st cycle the patient near complete remission was achieved, so ASCT was introduced. After ASCT CR was achieved. He was disease free until 1 year, but unfortunately his disease reappear and despite the repeated chemotherapy he was died shortly.

We would like to interpret our team-work in our hospital in this multi-disciplinal case.