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Objetive: To describe the atypical histopathologic presentation in bone marrow of multiple myeloma. Case Report: We present the case of a 75-year-old male who manifested low back pain of variable intensity associated with decreased urinary flow, for which he went to the emergency room. On physical examination, vital functions were within normal parameters with generalized decrease in adipose tissue and earthy pallor, the rest of the examination being non-contributory. Bone marrow studies showed 13% of plasma cells with tetranucleated neoplastic cells with 1 and 2 nucleoli, basophilic cytoplasm with presence of vacuoles, which was corroborated in flow cytometry with pathological phenotype in relation to plasma cell neoplasia. The patient receives a therapeutic regimen with cyclophosphamide, dexamethasone and thalidomide. Conclusion: Tetranucleated presentation is a rare histopathologic variant of multiple myeloma, so this peculiar finding should be appreciated in the microscopic diagnosis of this clinical entity. Objetivo: Describir la presentación histopatológica atípica en médula ósea de mieloma múltiple. Reporte de Caso: Presentamos el caso de un varón de 75 años, quien manifiesta lumbalgia de intensidad variable asociada a disminución del flujo urinario, por lo que acude a emergencia. Al examen físico se encuentran funciones vitales dentro de parámetros normales, disminución generalizada del tejido adiposo y palidez terrosa, el resto del examen no contributorio. En estudios de médula ósea se reporta 13% de células plasmáticas, observándose células neoplásicas tetranucleadas con 1 y 2 nucleolos, citoplasma basófilo con presencia de vacuolas; es corroborado en citometría de flujo con fenotipo patológico en relación a neoplasia de células plasmáticas. Paciente recibe esquema terapéutico con ciclofosfamida, dexametasona y talidomida. Conclusión: La presentación tetranucleada es una variante histopatológica del mieloma múltiple poco frecuente; por lo que este hallazgo peculiar, debe ser valorado en el diagnóstico microscópico de la entidad clínica.

Resumen Introducción: El mieloma múltiple (MM) es una tumoración hematológica que se caracteriza por la proliferación incontrolada de células plasmáticas y la existencia de una importante cantidad de cadenas libres en sangre (CLLs) que puede ocasionar un fallo renal agudo por la precipitación intratubular de ellas, causando nefropatía por cilindros. La insuficiencia renal aguda es una complicación que puede presentarse en más de un 20% de los pacientes con MM, y la mitad de estos precisarán diálisis. Métodos: Presentamos nuestra experiencia de 13 pacientes tratados con diálisis mediante filtros de high cut off (HCO), durante el período comprendido entre julio de 2011 y febrero de 2015. Se realizan 6 sesiones consecutivas de 6 h de duración, utilizando un filtro de HCO (Theralite® de Gambro®) de 2,1 m2 de superficie. Posteriormente se continúa con sesiones a días alternos de igual duración. Resultados: Se realizaron un total de 151 sesiones; una media de 11,6 sesiones/paciente (rango 6-27). El tratamiento se mostró efectivo para eliminar tanto CLLs kappa como lambda. El porcentaje de disminución de CLLs desde el inicio hasta el final del tratamiento fue del 93,7%. La reducción media por sesión de diálisis fue del 57,7%. En 10 de los 13 casos se recuperó la función renal y los pacientes pudieron permanecer sin diálisis. No hubo grandes cambios en los niveles de albúmina utilizando un protocolo de infusión de 2 viales de 50 mL de albúmina al 20% al final de la sesión de diálisis. Conclusiones: El tratamiento combinado con quimioterapia más diálisis largas con filtros de HCO resultó eficaz para reducir el nivel de CLLs y recuperar un nivel de función renal suficiente en el 77% de los casos. Con filtros de HCO se consigue un ahorro significativo, en contraposición a lo descrito previamente en la literatura. Abstract Introduction: Multiple myeloma (MM) is a haematological tumour that is characterised by uncontrolled proliferation of plasma cells and a significant volume of serum free light chains (sFLCs), which can cause acute renal failure due to intratubular precipitation, resulting in cast nephropathy. Acute renal failure is a complication that can arise in more than 20% of patients with multiple myeloma, half of which will require dialysis. Methods: We report our experience with 13 patients who were treated with dialysis using high cut off filters (HCO) between July 2011 and February 2015. A total of 6 consecutive 6-hour sessions were performed using a 2.1 m2 HCO filter (Theralite® by Gambro®). Afterwards, further 6-hour sessions were continued on alternate days. Results: A total of 151 sessions were conducted, with an average of 11.6 sessions per patient (range 6-27). The treatment proved to be effective in removing both kappa and lambda sFLCs, resulting in a 93.7% fall in sFLCs by the end of treatment. The average reduction was 57.7% per dialysis session. 10 out of the 13 cases recovered sufficient renal function to become independent of dialysis. There were no major changes in albumin levels using an infusion protocol of 2 50-mL vials of 20% albumin at the end of the dialysis session. Conclusions: Combination treatment with chemotherapy and long dialysis with HCO filters was effective in reducing the sFLC levels and recovering sufficient renal function in 77% of cases. With HCO filters, significant cost savings are achieved, contrary to what was previously believed.

Background: Mortality rate records are the only data available in Chile about the prognosis of patients with multiple myeloma (MM). Aim To characterize clinical features, survival rate and factors related to mortality in cases with MM treated in six large medical centers in Chile. Material and Method: Retrospective analysis of demographic data, clinical features and survival rate records of patients with MM, collected between 1998 and 2002. Survival curves were generated and a multivariate analysis of factors associated to early mortality was carried out. Results: Data from 245patients aged 38 to 95years (129 women) was collected. Fifty two percent had an IgG myeloma, 25% had and IgA and 6.1% had light chains myeloma. According to Durie and Salmon staging system, 8,2% were in Stage 112.6% in Stage II, 60.5% in Stage III and in 18.8% the information about staging was not available. Fifty percent had an hemoglobin level below 10 g/dL, 30% had a serum creatinine over 2 mg/dL and 28% had a serum calcium level over 10.5 mg/dL. Median survival was 33 months. Twenty percent of patients died within the first six months after diagnosis (early mortality). Predictive factors for early mortality were male sex, thrombocytopenia, anemia, renal failure, hypercalcemia, a beta2-microglobulin >5.5 mg/L and a serum albumin level

We report a 67 years old woman admitted to the hospital for the study of a cholestatic jaundice and massive hepatomegaly. On admission, the patient did not have liver failure. During hospital stay, the patient experienced a progressive deterioration of liver function and a monoclonal gammopathy was detected. An IgG Kappa myeloma was diagnosed. A fine needle liver biopsy disclosed the presence of amyloid. The patient developed acute liver failure and died three weeks after admission (Rev Méd Chile 2003; 131: 1301-04)

We report a 67 years old woman admitted to the hospital for thestudy of a cholestatic jaundice and massive hepatomegaly. On admission, the patient did nothave liver failure. During hospital stay, the patient experienced a progressive deterioration of liv-er function and a monoclonal gammopathy was detected. An IgG Kappa myeloma was diag-nosed. A fine needle liver biopsy disclosed the presence of amyloid. The patient developed acuteliver failure and died three weeks after admission (Rev Med Chile 2003; 131: 1301-04).(