Journal of Medical Cases, ISSN 1923-4155 print, 1923-4163 online, Open Access
Article copyright, the authors; Journal compilation copyright, J Med Cases and Elmer Press Inc
Journal website http://www.journalmc.org

Case Report

Volume 9, Number 9, September 2018, pages 309-312

A Collision Tumor With Features of Breast Cancer and Plasma Cell Myeloma as Primary Tumors

Figures

Figure 1.
Figure 1. Imaging CT hip: right femoral neck fracture with nondisplaced fracture of the left sacral ala.
Figure 2.
Figure 2. Breast cancer cells in bone marrow. (a) Presence of cells with breast origin, high power field. (b) Presence of plasma cells and breast cells, medium power field. (c) GATA 3 staining as marker of breast cancer.
Figure 3.
Figure 3. Sections of femoral head with metastatic breast cancer. (a) Strongly positive for estrogen receptor. (b) Strongly positive for progesterone receptor.
Figure 4.
Figure 4. Morphology evaluation of bone marrow. (a) Hyper-cellular bone marrow. (b) Plasma cells intermixed with few small lymphocytes. (c) CD138 positive.

Tables

Table 1. Laboratory Results on Admission
 
CBC: complete blood count; MCV: mean corpuscular volume; RDW: red blood cell distribution; AKP: alkaline phosphatase; ALT: alanine amino transferase; AST: aspartate aminotransferase; ALB: albumin; PT: prothrombin time; APTT: activated partial thromboplastin time; INR: international normalized ratio; LFT: liver function test; BMP: basic metabolic panel; CEA: carcinoembryonic antigen; L: low; H: high.
CBC
  White blood cell count6.3
  Neutrophils66
  Lymphocytes21
  Monocytes12 (H)
  Red blood cell count3.09 (L)
  Hemoglobin8.1 (L)
  Hematocrit25.6 (L)
  MCV83.0
  RDW19.3 (H)
  Platelets187
LFT and coagulation factors
  AKP68
  ALT10
  AST53 (H)
  Bilirubin0.5
  ALB2.5 (L)
  Protein9.8 (H)
  Globulin7.3 (H)
  PT15.5 (H)
  APTT28.8
  INR1.23 (H)
BMP
  Glucose100 (H)
  BUN20
  Creatinine0.65
  Sodium130 (L)
  Chloride100
  Potassium4.4
  Calcium9.3
  CO222
Tumor marker
  CEA< 1

 

Table 2. More Diagnostic Data Suggestive for Plasma Cell Dyscrasia
 
SPEP: serum protein electrophoresis; IgA: immunoglobulin A; IgG: immunoglobulin G; IgM: immunoglobulin M; Alpha 1: alpha-1 globulin; Alpha 2: alpha-2 globulin; Beta: beta globulin; Gamma: gamma globulin.
SPEP
  Total protein10.3 (H)
  Albumin3.2
  Alpha 10.5 (H)
  Alpha 20.9
  Beta0.9
  Gamma4.7
B2 microglobulin3.5
Free light chain
  Kappa698.0 (H)
  Lambda0.29 (L)
  K/L ratio2,406.90
Immunofixation
  IgA< 19
  IgG5,300 (H)
  IgM< 8