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Osteolytic-variant POEMS syndrome: an uncommon presentation of “osteosclerotic” myeloma

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Abstract

Polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes (POEMS) syndrome, a form of osteosclerotic myeloma, is a multisystem disease related to a monoclonal plasma cell proliferative disorder. Osseous lesions are most commonly sclerotic on radiographs and computed tomography (CT), demonstrate low T1 and T2 signal intensity on magnetic resonance imaging (MRI), and have variable degrees of avidity on positon emission tomography (PET) imaging using 18-fluorodeoxyglucose (18F-FDG). We present three cases of POEMS syndrome manifesting as osteolytic lesions with indolent features, including well-defined thin sclerotic rims, no cortical disruption or periosteal reaction, no associated soft-tissue mass, and a periarticular location, all features that could lead to misinterpretation as benign bone lesions. We also report increased T1 signal and diffuse solid enhancement of these lesions on MRI, features previously unreported. POEMS syndrome should not be discounted as a diagnostic consideration in the setting of osteolytic lesions with non-aggressive imaging characteristics on radiographs or CT, especially in the presence of other supportive clinical features.

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Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, Mayo Building, E2, 200 First Street SW, Rochester, MN, 55905, USA

    Michael S. Clark, Benjamin M. Howe, Katrina N. Glazebrook & Stephen M. Broski

  2. Department of Neurology, Mayo Clinic, 200 First Street SW, Rochester, MN, 55905, USA

    Michelle L. Mauermann

Authors
  1. Michael S. Clark
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  2. Benjamin M. Howe
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  3. Katrina N. Glazebrook
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  4. Michelle L. Mauermann
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  5. Stephen M. Broski
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Correspondence to Stephen M. Broski.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research.

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Clark, M.S., Howe, B.M., Glazebrook, K.N. et al. Osteolytic-variant POEMS syndrome: an uncommon presentation of “osteosclerotic” myeloma. Skeletal Radiol 46, 817–823 (2017). https://doi.org/10.1007/s00256-017-2607-8

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  • DOI: https://doi.org/10.1007/s00256-017-2607-8

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