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Front. Oncol. | doi: 10.3389/fonc.2018.00137

Synchronous Bone Metastasis from Multiple Myeloma and Prostate Adenocarcinoma as Initial Presentation of Coexistent Malignancies

 Diego A. Adrianzen Herrera1*, Schlomit Goldberg-Stein2, Alexander Sankin2,  Judy Saungbam2, Janaki Sharma2 and  Benjamin A. Gartrell2
  • 1Montefiore Medical Center, Albert Einstein College of Medicine, United States
  • 2Montefiore Medical Center, United States

The radiographic appearance of bone metastases is usually determined by tumor histology and can be osteolytic, osteoblastic or mixed. We present a patient with coexistent bone metastasis from multiple myeloma and prostate adenocarcinoma who exhibited synchronous bone involvement of both histologies within the same bone lesion, a rare phenomenon that has not been previously reported and led to atypical radiographic findings. The radiograph of a 71-year-old man with thigh swelling and pain demonstrated a lytic femoral lesion. Magnetic resonance imaging (MRI) confirmed a destructive process but showed coexistent metaphyseal sclerosis. Multiple myeloma was suspected by demonstration of monoclonal gammopathy and confirmed by computed tomography (CT)-guided biopsy. Incidentally, CT demonstrated areas of sclerosis corresponding to T2 hypointensity on MRI. Further studies revealed osteoblastic spinal metastasis, prostate enhancement on CT and prostate-specific antigen (PSA) level of 90 ng/mL, concerning for concomitant prostate neoplasm. After endoprosthetic reconstruction, pathology of the femur identified both plasma cell neoplasm and metastatic prostate adenocarcinoma. An association between prostate cancer and multiple myeloma is hypothesized due to tumor microenvironment similarities and possible common genetic variations, however, coexisting bone metastases have never been reported. This unusual finding explains the discrepant imaging features in our patient and is evidence that certain clinical situations merit contemplation of atypical presentations of common malignancies even if this leads to additional testing.

Keywords: bone metastasis, Radiographic imaging, synchronous malignancies, Multiple Myeloma, prostate cancer

Received: 28 Feb 2018; Accepted: 16 Apr 2018.

Edited by:

Freimut D. Juengling, PET CT Center, St. Claraspital Basel, Switzerland

Reviewed by:

Orazio Schillaci, Università degli Studi di Roma Tor Vergata, Italy
Ellen Ackerstaff, Memorial Sloan Kettering Cancer Center, United States  

Copyright: © 2018 Adrianzen Herrera, Goldberg-Stein, Sankin, Saungbam, Sharma and Gartrell. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

* Correspondence: Dr. Diego A. Adrianzen Herrera, Albert Einstein College of Medicine, Montefiore Medical Center, 111 E. 210th Street, Hofheimer Bldg. Suite 100, New York City, 10467, New York, United States, dadrianz@montefiore.org