Paraneoplastic Sarcoidosis in Multiple Myeloma

Abstract

Sarcoidosis predominantly affects the lungs, intrathoracic lymph nodes, and eyes; it less frequently affects the musculoskeletal system. We herein report a case of paraneoplastic sarcoidosis in a patient presenting with multiple myeloma. The patient developed ocular sarcoidosis and showed an increased ¹⁸F-fluorodeoxyglucose uptake in the mediastinal lymph nodes and vertebral column. A lymph node specimen showed the histological features of sarcoidosis, while an examination of the vertebral tumor revealed myeloma. Although the simultaneous occurrence of sarcoidosis and myeloma is extremely rare, our case indicates the importance of exculing any underlying malignancies before establishing a diagnosis of skeletal sarcoidosis when bone lesions are observed at unusual sites.

Keywords: bone; multiple myeloma; sarcoidosis.

Figure 1.

Imaging findings. a: A chest computed tomographic scan showing a right upper lobe mass. b: ¹⁸F-fluorodeoxyglucose positron emission tomography scan combined with computed tomographic scan showing an increased ¹⁸F-fluorodeoxyglucose uptake in the bilateral hilar and mediastinal lymph nodes. c: Magnetic resonance image showing a destructive lesion of the T11 vertebral body.

Figure 2.

Histopathological findings. a: A lymph node specimen showing numerous non-necrotizing granulomas composed of epithelioid cells and multinucleated giant cells with asteroid bodies (arrows) [original magnification ×100, Hematoxylin and Eosin (H&E) staining]. b: A bone biopsy specimen showing monotonous plasma cell infiltration (original magnification ×400, H&E staining).