Multiple Myeloma Rather Than Metastatic Lung Cancer: An Unexpected Cause of Spinal Cord Compression

Abstract

Spinal cord compression caused by cancer metastasis is a medical emergency that should be managed positively. Both multiple myeloma and lung cancer can lead to metastatic deposits in the spinal column to induce compression of the spinal cord. However, co-occurring multiple myeloma and lung cancer in a single patient causing spinal cord compression are rarely reported in the literature. We describe a case of a 61-year-old female with multiple myeloma and lung cancer whose radiologic characteristics of spinal cord compression mimicked those of metastatic lung cancer. Finally, the diagnosis was multiple myeloma. We showed the systematic imaging manifestations of metastatic multiple myeloma and discussed their therapeutic management.

Keywords: Diagnostic challenge; Metastatic lung cancer; Multiple myeloma; Spinal cord compression.

Figure 1

(a) Computed tomography (CT) scan showing a neoplasm in the right lung (arrow). (b) Enhanced CT scan confirmed the existence of neoplasm in the right lung (arrow). Arrows indicate the location of the tumor. T1 (c and d), T2 (e and f), and fat-suppressed T2WI weighted spin echo magnetic resonance image of the thoracic spine in the sagittal planes (g, h). The tumor (arrow) showed hyperintensity on T1WI, mild hypointensity on T2WI, and hyperintensity on fat-suppressed T2WI, mimicking metastatic lung cancer.

Figure 2

Pathological images of the tumor. (a) (H&E, × 200) and (b) (H&E, × 400) show the morphology of tumor cells. Immunohistochemical findings. The tumor cells expressed CD38 (c, original magnification × 200) and kappa (d, original magnification × 200) without expression of lambda (e, original magnification × 200). H&E: hematoxylin and eosin.