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

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),...

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Bibliographic Details
Published in:Skeletal radiology 2017-06, Vol.46 (6), p.817-823
Main Authors: Clark, Michael S., Howe, Benjamin M., Glazebrook, Katrina N., Mauermann, Michelle L., Broski, Stephen M.
Format: Article
Language:English
Subjects:
Adult
Aged
Bone and Bones - diagnostic imaging
Bone Neoplasms - complications
Bone Neoplasms - diagnostic imaging
Case Report
CT imaging
Diagnosis, Differential
Fluorodeoxyglucose F18
Humans
Imaging
Magnetic Resonance Imaging
Male
Medicine
Medicine & Public Health
Middle Aged
Nuclear Medicine
Orthopedics
Pathology
POEMS Syndrome - complications
Positron Emission Tomography Computed Tomography
Radiology
Radiopharmaceuticals
Skin
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Summary: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 ( 18 F-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.
ISSN:0364-2348
1432-2161
DOI:10.1007/s00256-017-2607-8