Skeletal survey (consisting of plain X-rays of the skull, spine, pelvis and long bones) did not reveal any lytic bone lesions, and bone marrow immuno-histochemistry of plasma cells with CD138 showed strong linear staining of cytoplasmic membrane (a specific marker for plasma cells), thereby confirming myeloma cells (Number 2). Open in a separate window Figure 2 Photomicrograph of immuno-histochemistry of plasma cells showing CD138 membrane positivity (indicated by arrows) (H &E stain 40) Muscle mass biopsy revealed normal perimyseal and endomyseal Bazedoxifene parts, polygonal materials with peripherally placed nuclei, and an occasional regenerating fibre. and haematologic malignancies including non- Hodgkins and Hodgkins lymphoma.2,3 Cancers associated with PM and DM are diverse and very few reports are available.2,3 The most common tumours associated with DM are cancers of the ovaries, lungs, belly, colon and pancreas, along with non-Hodgkins lymphoma. The most significant associations are with cancers of the bladder, breast and uterus2. The epidemiological data on IIM – connected cancer types, however are scarce and assorted in the Asian human population. Breast cancer, belly and nasopharyngeal cancers have been reported to be more generally associated with DM in Korea4, whereas Bazedoxifene studies in Singapore, Hong Kong, southeastern China, and Taiwan exposed that nasopharyngeal carcinoma was 6C10 fold more commonly associated with IIM.5,6,7 Case details A 47-year-old male patient from Kerala (a state of south India) presented with a four-month history of both knees giving way while walking. This was associated with frequent falls and swelling above both knees. He needed support while walking, and reported difficulty in getting up from a squatting position and with putting his legs on a bed. He Bazedoxifene also complained of neck pain and constant low backache. There was no history of any sensory disturbances, weakness of the top limbs, or bladder or bowel disturbances. On exam there was grade 3 power of both knee extensors, with patellar jerks absent bilaterally. There was bilateral swelling of the knee in the insertion of the quadriceps tendon. No fasciculations were observed. Examination of the skull and spine was normal. Laboratory investigations exposed the following: haemoglobin 11 gm%, total leukocyte count 9900 cells/cumm, ESR 48 mm in 1 hour, blood urea 121 mg/dl, serum creatinine 5.6 mg/dl, sodium 135 mg/dl, and potassium 5.0 mg/dl. Liver function tests showed a mild increase in liver enzymes with normal bilirubin. The level of creatine kinase was 1343, and urinanalysis showed 2+ protein with granular casts. Serum calcium levels were 14.2 mg/dl. The serum undamaged parathyroid hormone (PTH) level was low 2.5 pg/ml (Normal range: 14C72 pg/ml). In view of anaemia, renal failure, and hypercalcaemia with low PTH levels, an ectopic source of calcium was suspected and a bone marrow exam performed. This exposed 16% plasma cells with atypical forms, a few cells with immature nuclear chromatin, and binucleate forms suggestive of myeloma (Number 1). Open in a separate window Number 1 Photomicrograph of bone marrow aspiration showing plasma cells, atypical forms, few with immature nuclear chromatin, binucleate forms (indicated by arrows) suggestive of myeloma (H &E stain 40) However, protein electrophoresis did not reveal any M PIK3CA band. Serum immunoglobulin IgA was 46 (200C280 mg/dl), IgG 949 (1200C1480 mg/dl), IgM was 40 (110C136 mg/dl) and urinalysis for the living of Bence-Jones protein was bad. Thyroid function checks were within normal limits. Skeletal survey (consisting of plain X-rays of the skull, spine, pelvis and very long bones) did not expose any lytic bone lesions, and bone marrow immuno-histochemistry of plasma cells with CD138 showed strong linear staining of cytoplasmic membrane (a specific marker for plasma cells), therefore confirming myeloma cells (Number 2). Open in a separate window Number 2 Photomicrograph of immuno-histochemistry of plasma cells showing CD138 membrane positivity (indicated by arrows) (H &E stain 40) Muscle mass biopsy revealed normal perimyseal and endomyseal parts, polygonal materials with peripherally placed nuclei, and an occasional regenerating fibre. There were few foci of perimyseal perivascular swelling involving small vessels which was suggestive of PM. Electromyography of the quadriceps showed razor-sharp positive waves and polyphasic engine unit potentials of low amplitude and short duration. Both findings were consistent with myopathy. With this patient the initial clinical analysis was.
