Bortezomib combined with lenalidomide as the first-line treatment for the rare synchronous occurrence of multiple myeloma and pulmonary adenocarcinoma: A case report

Abstract

Background: Simultaneous multiple myeloma (MM) and pulmonary adenocarcinoma is a rare occurrence, and thus, treatment is a challenge. This study reports on 1 such case of MM with concurrent lung cancer, where an accurate diagnosis was made and the patient underwent treatment for both cancers.

Case summary: A 68-year-old man presented with 2 months of progressive lower back pain. Visualization with magnetic resonance imaging (MRI) revealed multiple collapsed vertebrae from T12 to S3, as well as an altered signal intensity at the T3 vertebra. The patient was diagnosed with MM upon examination. A chest computed tomography (CT) scan revealed a round mass in the left lower lobe of the lungs, and a CT-guided needle biopsy uncovered a moderately differentiated adenocarcinoma. There were no additional notable findings in the left lung using positron emission tomography computed tomography (PET-CT). Therefore, a diagnosis of MM with pulmonary adenocarcinoma was made. Surgery was performed to excise the lung cancer. Bortezomib was used as first-line induction therapy against both tumors and lenalidomide was used for maintenance. The patient went into complete remission. Using this combined chemotherapy, the patient has survived for over 3 years since a diagnosis was made despite relapsing twice after the first year.

Conclusion: This report clearly delineates the diagnosis and treatment of a rare case of synchronous MM and pulmonary adenocarcinoma, as well as depicts a potentially positive outcome for the patient. It also overviews some diagnostic and therapeutic implications for clinicians.

Figure 1

(A) Pretreatment, an immunoglobin G monoclonal band containing a kappa light chain was visualized using immunoelectrophoresis (IEP) analysis. (B) Post-treatment, the monoclonal band had disappeared. Serum 1 refers to the patient's serum. IEP = immunoelectrophoresis.

Figure 2

(A) There was an increased population of abnormal plasma cells with dysplastic features in the bone marrow (Wright staining ×1000). (B) A CT-guided needle biopsy of the left lung sampled moderately-differentiated adenocarcinoma (H&E ×600). (C) Pathological analysis of the T3 tissue found diffuse infiltration of plasma cells with unclear intranuclear findings and unevenly distributed nuclei (H&E ×600). CT= computed tomography, H&E = hematoxylin and eosin staining.

Figure 3

(A) Before treatment, CT-scans revealed a round mass with ground glass opacities in the lower left lobe of the lungs. (B) After surgery, the CT-scan displayed the shadow of the left lower lung wedge resection. CT= computed tomography.