Multiple Myeloma in Man 32 Years Old With Metachronous Soft Tissue Sarcoma : A Multiple Primary Malignant Tumors With Successful Chemotherapy Medication

Abstract

Author(s): Loudry Amsal Elfa G* and Muhammad Darwin Prenggono

Background: Multiple Primary Malignant Tumors (MPMTs) are defined two or more histologically distinct malignancies in one individual, the occurrence of MPMTs are a rare clinical entity. The association between solid malignancies with a haematological neoplasm is even rare.

Case Presentation: We present a case of a 32 years old Indonesian male who was known case of Multiple Myeloma and on regular chemotherapy medication (vincristine, doxorubicin, and dexamethasone) since 2018, was admitted with a lump in his back with size 6x10cm since 6 months before admission, initially it was a small size but it’s getting bigger slowly. The patient did not complain about pain or numbness in his back. From the imaging studies, MSCT we found soft tissue mass originates from the left spinal rectus as high as the left thoracal 7 to the left 12 thoracal, the mass infiltrates the left pleura and subcutaneous fat with no visible destruction of ribs and impression of malignancy. When we did the core biopsy, we found proliferated tissue consisting of development mass or tumour cells with oval cells and from immature fatty cells (lipoblast) with the conclusion is liposarcoma and differential diagnosed round cell rhabdomyosarcoma. We managed the patient with chemotherapy treatment because the mass was unrespectable and the patient itself did not want to undergo surgery. We give the ifosfamide, mesna and etoposide regimen for the soft tissue sarcoma. After 3 cycles, evaluated imaging MSCT have done and the lump disappeared, there was no visible left thoracal region soft tissue mass, intrapulmonary metastases was not seen, there was no visible destruction of the ribs or thoracal vertebrae.

Conclusion: the case described represents a rare clinical condition called multiple primary malignant tumours, through the metachronous occurrence of multiple myeloma and soft tissue sarcoma. The lack of studies on this metachronous association, as well as the few reported cases in the literature, inhibits a greater clarification of the involved pathogenesis. However, soft tissue sarcoma was disappearing when we did chemotherapy treatment, further observation from the patients was necessary.

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