To report a rare case of concurrent lymphoplasmacytic lymphoma (LPL) and multiple myeloma (MM) and discuss diagnostic challenges.
Approach:
Case Presentation: A 68-year-old man presented with fatigue and bone pain, with laboratory findings indicating severe anemia, thrombocytopenia, and hyperglobulinemia. Imaging revealed osteolytic lesions, and bone marrow analysis identified distinct B-cell populations.
Molecular Testing: Next-generation sequencing confirmed MYD88 and CXCR4 mutations, supporting the diagnosis of LPL and active MM.
Key Findings:
The patient exhibited both LPL and MM, with dual monoclonal proteins identified.
Bone marrow flow cytometry revealed two distinct B-cell populations consistent with LPL and MM.
The presence of osteolytic lesions and severe anemia met the CRAB criteria for active MM.
Interpretation:
This case highlights the need for careful diagnostic evaluation to differentiate between plasmacytic differentiation and true biclonal disease.
Limitations:
Definitive proof of biclonality requires sorted-cell molecular studies, which were not performed.
The clonal plasma cell percentage was below the traditional 10% threshold for MM diagnosis.
Conclusion:
The case emphasizes the importance of integrating clinical, immunophenotypic, and molecular data in diagnosing concurrent LPL and MM.
An updated clinical practice guideline from the American Society for Radiation Oncology substantially expands and modernizes recommendations for the use of radiation therapy in pancreatic cancer.
