Limitations of routine skeletal survey: detection of critical but asymptomatic cervical spine lesion in multiple myeloma

Description

A 67-year-old asymptomatic man was found to have a total plasma protein level of 10.2 mg/dL on routine work-up. Serum protein electrophoresis (SPEP) revealed an M spike of 4 g/L and an elevated IgG level of 4759, and free kappa chain of 170.72 (H), free lambda chain of 3.15 (L) and kappa:lambda ratio of 54.20. Bone marrow biopsy showed a kappa light chain restricted plasma cell neoplasm involving 20%–30% of marrow cellularity. Fluorescence in situ hybridisation (FISH) test demonstrated polysomy of chromosome 9 in 70%, trisomy 11 in 57% and trisomy 7 in 50.5% of cells. Skeletal survey showed generalised mild osteopaenia with heterogeneous appearance of the osseous structures and a suspicious lytic lesion in the pelvis. To investigate bone lesion, full-body positron emission tomography scan demonstrated multiple hypermetabolic skeletal lesions, with the dominant one involving the C2 vertebra showing a maximum standardised uptake value (SUV) of 11, suggesting viable myeloma. Neck CT confirmed lytic lesions...

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