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A woman in her 50's with nausea, fatigue, lethargy, and a right femoral bone lesion

Submitted by henry on Wed, 05/12/2010 - 17:53
Case Identification
Case ID Number: 
20100512NF
Periosteal Reaction: 
absent
Benign/Malignant: 
unknown
Clinical case information
Case presentation: 

This patient is 54, she presents with nausea, fatigue, lethargy, and a bone lesion in the right femur. On presentation, she was anemic, hypercalcemic, and hyperkalemic. She had had right knee pain for approximately 2 weeks and was taking frequent large doses of ibuprofen for pain control.

Radiological findings:: 
In the right distal femur, there is a Fairly large, permeative lesion, extending approximately two thirds of the way across the femur, in the metaphysis above the lateral femoral condyles, with multiple small punctate lesions. There is no definite damage to the cortex, but there is a periosteal reaction in the lateral cortex at the junction of the metaphysis and diaphysis.
Laboratory results:: 
The patient was afebrile. Her blood pressure was 203/112. The patient presented with a hemoglobin of 10.4, calcium of 11.1, potassium of 6.3, creatinine is 14.1, BUN 146. Serum electrophoresis revealed a positive M spike but no monoclonal gammopathy.
Pathology results:: 
A bone marrow aspirate was performed. Maturing orderly tri-lineage hematopoesis was present. Numerous plasma cells are seen, many with an immature appearance with nucleoli and multi-nucleation. Bone marrow biopsy reveals sheets of plasma cells, many of which are atypical with prominent nucleoli and multinucleation. Impression: Plasma cell dyscrasia.
Image Reference: 
A woman in her 50's with nausea, fatigue, lethargy, and a right femoral bone lesion
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