Diagnosis:
A paraneoplastic syndrome to osteoclastic plasmacytoma
Pathology:
Muscle actin stain; increased vessels in nerves
VEGF: elevated serum levels
Criteria/Features:
Polyneuropathy: Demyelinating sensorimotor polyneuropathy (motor>sensory), usually painless, length dependent
Monoclonal gammopathy: Serum protein electrophoresis with immunofixation IFE: M protein, Lambda light chain, immunofixation is necessary to avoid false negatives
Osteoclastic plasmacytoma i.e. note lytic
Skin changes
Endocrinopathy
Other features:
Peripheral edema
Treatment:
Corticosteroids or cyclophosphamide
Consider:
- Irradiation of solitary osteosclerotic lesions
- Stem cell transplantation