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Case History: 62-year-old male with proven case of monoclonal gammopathy of unknown significance with shoulder swelling, pain.
Case History: A 62-year-old male with proven case of monoclonal gammopathy of unknown significance presented with complaint of left shoulder swelling and pain for three months.
Figure 1. On X-ray imaging, AP and LATERAL views a large, well-defined expansile lytic lesion with wide zone of transition is noted involving head of left humerus and scapula associated with cortical destruction.
Figure 2. On NECT axial, coronal and saggital image, a large soft tissue mass lesion is noted superolaterally of head of left humerus involving supraspinatus, infraspinatus, and deltoid muscle associated with medullary expansion, endosteal scalloping and punched out cortical destruction.
Figure 3. On NECT axial, coronal and saggital image, a large soft tissue mass lesion is noted superolaterally of head of left humerus involving supraspinatus, infraspinatus, and deltoid muscle associated with medullary expansion, endosteal scalloping and punched out cortical destruction.
Figure 4: On MRI axial, saggital and coronal image, the cyst appears hypointense on T1, hyperintense on T2 pulse sequences.
On MRI left shoulder, a large altered signal intensity soft tissue mass lesion is noted superolaterally to head of left shoulder hypointense on T2 and iso to hypointense on T1 pulse sequences, hyperintense on PD fat sat.
Patients are stratified according to the risk level associated with their specific monoclonal gammopathy to identify those who are in need of close monitoring.
Plasma cell leukemia is a more aggressive form of multiple myeloma that is characterized by a proportion of circulating plasma cells of more than 20% at the time of initial diagnosis or at disease progression.
Multiple myeloma staging has traditionally relied on serum and urine markers of disease as well as conventional radiography.
The presence and number of lytic lesions identified in the radiographic skeletal survey may alter disease staging, and these data are an integral part of the original Durie and Salmon staging system.
Marrow disease in the presence of multiple myeloma is identifiable at MR imaging as areas of decreased fat and increased signal intensity within the marrow on T1-weighted images.