PMC6174775_01
Magnetic resonance imaging (MRI) of the head and spine. MRI captured a 2.8 x 2.2 x 1.9-centimeter enhancing lytic mass centered in the left clivus and occipital condyle (red arrow). Additionally, an expansile soft tissue lesion was noted in the T4 spinous process (white arrow).
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Magnetic resonance imaging (MRI) of the head and spine were obtained and showed a lytic mass centered in the left clivus and occipital condyle, as well as an expansile soft tissue lesion in the T4 spinous process (Figure 1).
Positron emission tomography (PET). PET scan displayed a fluorodeoxyglucose (FDG)-avid lytic lesion in the left skull base where the previously noted mass on MRI was seen, as well as FDG uptake within the previously noted T4 lesion, seen here as the purple coloration within the T4 vertebral body.
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A positron emission tomography-computed tomography (PET-CT) was also obtained (Figure 2).
Bone marrow biopsy. (a) Staining with hematoxylin and eosin shows a population of abnormal plasma cells, many with binucleate and multinucleate forms. (b) Staining for CD138, a plasma marker, shows strong and diffuse positivity. (c) Fluorescence in situ hybridization (FISH) shows a monoclonal population with lambda light chain restriction, as essentially all cells are positive for lambda light chain and negative for kappa light chain.
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A biopsy of the T4 lesion showed a plasma cell neoplasm, and a bone marrow biopsy showed a clonal population of >10%, confirming the diagnosis of multiple myeloma (Figure 3).