Multiple myeloma associated with diffuse pulmonary calcifications: pathomorphological study

Background. Multiple myeloma is an aggressive lymphoproliferative disease with plasma cell dyscrasia, with symptoms associated with bone marrow infiltration, damage of the hematopoiesis, finally leading to renal failure, bone damage, hypercalcemia, and metastatic calcification. As with all lymphatic tumors, multiple myeloma is characterized by the development of secondary immunodeficiency. Antibody deficiency syndrome is the cause of increased susceptibility of patients to bacterial infections, primarily of the bronchopulmonary system. Objective: to study the nature of pathomorphological changes in the lungs of patients who died from multiple myeloma, and to establish the relationship between multiple myeloma disease with renal dysfunction and metastatic pulmonary calcification. Methods. A pathomorphological study of the autopsy material of two cases of deceased persons, who were diagnosed with multiple myeloma during their lifetime, was carried out. According to autopsies, morphological changes in internal organs were studied, with an emphasis on changes in the lungs. A detailed morphological examination of the kidneys, bone marrow in the sternum, vertebral bodies and the ilium was carried out also. Results. Two cases of multiple myeloma associated with diffuse pulmonary calcinosis in patients in whom renal and pulmonary-cardiac failure were the immediate cause of death are presented. Myeloma disease with damage to many bones was complicated by nephropathy, diffuse metastatic calcification in the lungs and focal - in the myocardium and blood vessels. Diffuse focal deposits of calcium in the interstitium and interalveolar membranes, numerous intraalveolar polypous growths of loose connective tissue (according to the type of organized pneumonia), foci of carnification were found in the lungs. In the lumen of the alveoli there is a thick edematous liquid, fibrin threads, separate siderophages, desquamated alveolocytes, macrophages. There are widespread hemorrhages, focal round cell infiltration of the interstitium, emphysema, dystelectasis, foci of purulent pneumonia, erythrostasis in the microhemocirculatory channel. Conclusion. Metastatic calcification and metastatic pulmonary calcification are rare complications in patients with multiple myeloma, even in patients with renal failure. The risk of metastatic calcification in multiple myeloma is likely strongly related to renal impairment.