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. 2022 Oct 6:12:991246.
doi: 10.3389/fonc.2022.991246. eCollection 2022.

Infiltration of the spinal cord and peripheral nerves in multiple myeloma

Xiaoyun Su  1   2 , Xiangquan Kong  1   2 , Xiangchuang Kong  1   2 , Zuneng Lu  3 , Chuansheng Zheng  1   2
Affiliations

Infiltration of the spinal cord and peripheral nerves in multiple myeloma

Xiaoyun Su et al. Front Oncol. .

Abstract

Background: Multiple myeloma (MM) is a hematological malignancy, and intramedullary spinal cord metastasis is extremely rare.

Methods: Clinical and radiological data were collected from electronic medical records as well as a literature review of reported cases.

Results: We report a rare case of IgA-LAM stage IIB MM with involvement of the spinal cord and peripheral nervous system. Laboratory studies showed elevated levels of serum β2-macroglobulin and cerebrospinal fluid protein. Electromyography revealed a demyelinating process with motor conduction blocks. On MRI, the lesions of MM bone marrow are characterized as a type of diffuse infiltration. MR neurography demonstrated an enhanced nodule in the thoracic segment with swelling of the cervicothoracic segments of the spinal cord. Moreover, swelling and hypertrophy of the entire nerve branchial, lumbosacral plexus, and cauda equina were detected, accompanied by myofascitis and denervated muscles. Ultimately, the condition of the patient deteriorated quickly and she died with a diagnosis of refractory MM.

Conclusion: MRI not only has the advantage of displaying the primary involved site of the bone marrow but also facilitates detecting extramedullary hematopoietic MM, such as infiltrating sites of the central and/or peripheral nervous system.

Keywords: infiltration; magnetic resonance neurography; multiple myeloma; peripheral nerves; spinal cord.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
The bone marrow signals of the lumbosacral and caudal vertebrae were diffusely reduced on T1WI (A) and increased on T2WI images (B) that corresponds with the type of diffuse infiltration (triangles). A focal lesion with long T2 signal was seen in the body of the L4 vertebrae (white arrow). There was swelling of the cauda equina and terminus (yellow arrows in B). Swelling of bilateral S1 nerve roots was observed (yellow arrows in C,D), accompanied by a wide range of myofascitis and atrophy in denervated lumbar gluteal muscles on PDWI sequence (C, D, white arrows). In addition, the L5 vertebral body slipped forward I degree, and the surrounding tissues were affected by artifacts after internal fixation (A, B, D).
Figure 2
Figure 2
Sagittal T1WI (A) and T2WI images (B) revealed extensive swelling in the cervicothoracic segments of the spinal cord with long T1 and T2 signals (arrows). Axial magnified views (B) showed lesions both involving gray and white matter of the spinal cord and covering more than one-half of the cross-sectional area. Images (C) (coronal) and (D) (axial) showed an enhanced nodule with a diameter of about 7 mm in the thoracic segment of the spinal cord at the right Th3/4 intervertebral (arrows). Reconstructed magnetic resonance neurography revealed symmetrical remarkable swelling and hypertrophy of the brachial plexus, nerve roots, fascicles and their branches, with increased T2 signal intensity, especially in the fascicles (arrows in coronal (E, F), circles outline in axial G).
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