SP24 | NOT ONLY OSTEOLYTIC LESIONS... LIVER LOCALIZATIONS OF MULTIPLE MYELOMA: WHEN MULTIDISCIPLINARY COLLABORATION BECOMES FUNDAMENTAL

Extramedullary disease (EMD) represents a rare and aggressive form of multiple myeloma (MM) with worse outcomes. Liver involvement is a rare condition; it can be present at the time of diagnosis or occure during the course of the disease. Although liver involvement in MM by autopsy series is relatively common (ranging from 26% to 46% of cases), these findings are rarely evident premortem. The clinical presentation of liver involvement in MM can range from asymptomatic to liver failure. Radiologically, it can mimic other pathologies (benign focal lesions, hepatocellular or cholangiocellular carcinomas, metastatic carcinomas, metastatic endocrine tumors, lymphoma), with heterogeneous presentation mode. Diagnosis requires histologic confirmation. There are several publications and guidelines regarding the radiological characteristics of osteolytic lesions; other rarer localizations lack the support of the literature and deserve the expert eye of the radiologist. We report a case series of three patients (one female, two males; median age 66 years old) with incidental finding of liver involvement by MM, referred to our center between 2019 and 2021. All 3 patients were affected by secretory MM (IgA k, IgG l, IgG k) with multiple osteolytic lesions who needed to start MM-specific therapy. In all patients liver lesions were found, at onset (one case) and at relapse (two cases), incidentally, in the absence of clinical and laboratory signs of liver failure, following skeletal CT and abdominal US performed for MM re-evaluation and, in one case, for abdominal pain, respectively. The radiological features of liver lesions are described in Figure 1. Liver localizations were all confirmed by biopsy. Further study is required with larger numbers of patients to definitively establish the optimal approach to the management of these patients. Although rare, liver EMD should be included in the differential diagnosis of radiologically indistinct hepatic lesions, especially in the context of hypercalcemia and concurrent bone lesions. The management of these cases is complex and must necessarily be multidisciplinary: due to the rarity, the heterogeneity of the presentation as well as the absence of specific radiological characteristics, even the most expert radiologist may have difficulties and collaboration with the haematologist becomes fundamental.