Rare Combination of Diseases Diagnosed and Managed at KIMS
The Department of Surgical Oncology is always at the forefront when it comes to taking up challenging cases, with specialized services being offered for cancer affecting most parts of the human body. Recently, a challenging and rare case was diagnosed and managed by us with the active guidance of Specialists from the disciplines of Orthopaedics, Endocrinology, Radio diagnosis, Pathology and Laboratory services.
A 70yr old male presented to Orthopedics Consultant Dr. Debashis Mishra with complaints of severe incapacitating low back pain progressing over past 1 year, making him bedridden for most part of the day. He had been evaluated at various centres in our state and nearby with repeated MRI scans, and various lines of management without much relief. After admission to inpatient ward, initial evaluation and management of pain and associated problems, the case was referred to Surgical Oncology for opinion and evaluation for any malignant etiology; Dr. Sabyasachi Parida, Consultant, Surgical Oncology took up the case.
Further tests were advised which revealed generalized osteoporosis with multiple lytic skeletal lesions involving entire spine, pelvic bones and multiple collapsed dorso-lumbar vertebrae. Skeletal survey did not reveal any other bone lesions.Such a presentation can be due to several diseases, including several types of malignancies and non malignant diseases. Specific tests were ordered which revealed M-spike in gamma globulin region on serum electrophoresis & plasmacytosis on bone marrow biopsy- suggestive of Multiple Myeloma.
Further evaluation was requested from Endocrinologist to rule out other possible etiologies in view of osteoporosis and atypical presentation of multiple myeloma. Dr. Dayanidhi Meher, Consultant Endocrinology, investigated the case further which revealed very high parathormone and serum calcium levels. He emergently treated the patient to achieve normal calcium levels. MIBI scan revealed increased uptake in left superior parathyroid gland. Dedicated imaging to localize the gland was done by Dr. Sanjeet Mishra, Consultant and Radiodiagnosis.
Thus a diagnosis of MULTIPLE MYELOMA WITH PRIMARY HYPERPARATHYROIDISM was reached. This is significant because such a combination of diseases is rare and could have been easily missed , had it not been for the clinical acumen and dedicated efforts of all the concerned specialists.
Left superior parathyroidectomy was done by team of Surgical Oncologists Dr. Sabyasachi Parida & Dr. Saroj Ranjan Sahoo with intraoperative blood sampling for parathormone pre excision and post excision from both internal jugular veins and peripheral blood which confirmed normalization of parathormone post excision- express reports provided by Central Laboratory , KIMS.
This patient is doing well now and undergoing chemotherapy with significant resolution of symptoms.