engleski

Myeloma ascites: rare initial sign of multiple myeloma

Myeloma cells in ascites have rarely been reported, over 50% of cases with cavitary involvement being of IgA type. A 57 y.o. male patient with history of alcohol abuse, liver cirrhosis and ascite was admitted to our hospital eith suspicion of spontaneous bacterial peritonitis. Diagnostic paracentesis was performed and cytologic examination revealed numerous immature plasma cells with nucleoli and scant cytoplasm. Total cell count was 6400/mm3 with 90% of plasma cells. Immunocytochemistry showed LCA- and EMA+ plasma cells and flow cytometry immunophenotyping revealed CD45-, CD138+kappa+, CD38+, CD56- phenotype. Laboratory findings were as follows: sedimentation rate 115, Hb 103, Hct 0.33, total proteins 87, LDH 581, Ca 2.15, beta2- microglobulin 9.7 mcg/L. Further routine workup for myeloma was negative: bone marrow aspiration and biopsy showed only 8% of mature looking plasma cells, MSCT of the chest and abdomen didn't show lymphadenopathy nor tumor masses. Serum protein electrophoresis showed broad band in beta and gamma region with no clear M-spike. Electrophoresis of ascitic fluid showed monoclonal spike in gamma region and immunoelectrophoresis confirmed presence of IgG-kappa light chains. Despite therapy, disease followed aggressive course and patient died two months later. Conclusion: Cytological examination is a necessary diagnostic procedure in evaluation of ascites. In this rare presentation og IgG myeloma it helped to establish a correct diagnosis as well as rule out spontaneous bacterial peritonitis.

multiple myeloma; ascites

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