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Atypical amyloidosis of bone

B. D. Daly, MRCPI, FRCR, FFR(RCSI) ^*,* and D. P. Moore, MB, MRCPI ^,

^* Department of Radiology, Meath Hospital, Dublin 8, Eire Department of Renal Medicine, Meath Hospital, Dublin 8, Eire

This excerpt was created in the absence of an abstract.

Amyloid deposits involving bone have usually been considered to be indistinguishable from lytic metastases or myeloma deposits (Resnick, 1981). Bone or joint involvement by amyloidosis is recognized to occur in up to one in seven cases of multiple myeloma (Stoker, 1986). We present a rare case where amyloidosis of bone mimicked the appearances of a cartilaginous tumour in a patient who presented simultaneously with myeloma.

A 60-year-old man presented with a 6-month history of malaise and weight loss. He had no relevant past history and was on no medication. On examination he was cachectic and a painless, hard swelling was noted at the medial end of his left clavicle. On questioning, the patient admitted that this lesion had been gradually increasing in size over a 2-year period.

Laboratory investigations revealed a haemoglobin of 10mg/ dl with an erythrocyte sedimentation rate (ESR) of over lOOmm/h, plasma urea and creatinine elevated to four times normal levels and a heavy proteinuria (>35g/l) with positive Bence-Jones protein. A bone marrow aspirate containing 20% primitive plasma cells confirmed a diagnosis of multiple myeloma.

^* Current address: Department of Radiology, The General Infirmary at Leeds, Great George Street, Leeds LS1 3EX

Department of Medicine, Royal Postgraduate Medical School, Hammersmith Hospital, Du Cane Road, London.

Received for publication November 1, 1988. Revision received April 1, 1989.