Final diagnosis:

Non-secretory plasma cell myeloma lacking light chain expression

Discussion:

Non-secretory myeloma is a rare subtype of plasma cell myeloma.

The initial work-up used for diagnosing non-secretory myeloma is no different than the standard multiple myeloma. The diagnosis of non-secretory myeloma relies on presence of monoclonal plasma cells established by immunophenotyping. Lack of light chain expression in non-secretory myeloma poses a diagnostic challenge.

The addition of immunohistochemical stain for heavy chain and Cyclin D1 may aid in definitive diagnosis.

A high incidence (83%) of t(11;14) (q13;q32) is present in non-secretory myeloma; which can be detected by karyotyping or fluorescence in situ hybridization (FISH).

Due to the rarity of the disease; there is no enough data to support using different treatment regimen other than the standard multiple myeloma regimen.

Monitoring patients with non-secretory myeloma is challenging; since we can us serum or urine Ig level in detecting response to therapy.

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List of References:

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3. Caron M. Grin, M.D., Department of Dermatology, MC 6230, University of Connecticut Health Center, 263 Farmington Avenue, Farmington, CT 06030, USA. Does pregnancy alter melanocytic nevi? J Cutan Pathol. 2001 Sep;28(8):389-92.

4. Driscoll MS, Grant-Kels JM. Nevi and melanoma in pregnancy. Dermatol Clin. 2006 Apr;24(2):199-204.

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