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Weekly Chest CasesArchive of Old Cases

Case No : 1218 Date 2021-02-23

  • Courtesy of Kyongmin Sarah Beck, Suyon Chang, Dae Hee Han, Jung Im Jung / Seoul St. Mary’s Hospital
  • Age/Sex 69 / F
  • Chief ComplaintGeneralized edema, palpable mass in lower neck, tingling sensation in the hands and feet
  • Figure 1
  • Figure 2
  • Figure 3
  • Figure 4
  • Figure 5

Diagnosis With Brief Discussion

Diagnosis
Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes (POEMS) syndrome
Radiologic Findings
Fig 1. Chest PA shows moderate amount of right pleural effusion.
Fig 2-5. Chest CT scan reveals multiple enlarged lymph nodes in the bilateral lower neck and axillae, generalized subcutaneous edema, moderate amount of right pleural effusion, and multifocal sclerotic lesions in the cervical and thoracic vertebrae and the right first rib.
Brief Review
Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal gammopathy, and Skin changes (POEMS) syndrome, also known as osteosclerotic myeloma, is a rare paraneoplastic syndrome due to an underlying plasma cell disorder. The diagnosis of POEMS syndrome is based on having both polyradiculoneuropathy and monoclonal plasma cell disorder, at least 1 of 3 other major criteria (Castleman disease, sclerotic bone lesions, or elevated VEGF), and at least 1 minor criterion in Table 1. The biopsy of lower neck lymph nodes in our patient also revealed Castleman disease.
Please refer to
Case 1025,
References
Keywords

No. of Applicants : 81

▶ Correct Answer : 52/81,  64.2%
  • - Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
  • - , Japan HIROAKI ARAKAWA
  • - ZIGONG TCM HOSPITAL OF CHINA , China CAO CUN YOU
  • - Kinki University Faculty of Medicine, , Japan MITSURU MATSUKI
  • - Showa University Fujigaoka Hospital , Japan KYOKO NAGAI
  • - Niigata University , Japan ATSUSHI UEHARA
  • - TWMU Medical Center East , Japan MASAFUMI KAIUME
  • - Mayo Clinic , United States AKITOSHI INOUE
  • - The University of Tokyo Hospital , Japan MOTO NAKAYA
  • - , Italy PAOLO BALDASSARI
  • - Tiger Gate Hospital , Japan SHIN-ICHI CHO
  • - Ichinomiya Nishi Hospital , Japan CHIHIRO KIGUCHI
  • - Samsung Medical Center , Korea (South) CHOHEE KIM
  • - Asan Medical Center , Korea (South) EUNJI CHOI
  • - , Chile DANIEL OCTAVIO CAMPOS
  • - Vita Hospital , Brazil DIOGO LAGO PINHEIRO
  • - Other , Korea (South) SEONGSU KANG
  • - , Korea (South) JIN YOUNG LEE
  • - Samsung Medical Center , Korea (South) JUHYUN KIM
  • - Hamamatsu University Hospital , Japan HAYATO NOZAWA
  • - National Center for Global Health and Medicine , Japan MASATOSHI HOTTA
  • - , Korea (South) HYEWON CHOI
  • - The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
  • - Seoul National University Bundang Hospital , Korea (South) SUNG HYUN YOON
  • - Yeungnam University Medical Center , Korea (South) JONGSOO PARK
  • - Gifu University Hospital , Japan Yo Kaneko
  • - , Japan KANAE TAKAHASHI
  • - Chonbuk National University Hospital , Korea (South) HYUNSOO BAE
  • - The University of Tokyo Hospital , Japan RYO KUROKAWA
  • - Mallinckrodt Institute of Radiology , United States NAGANATHAN MANI
  • - Osaka City General Hospital , Japan SHU MATSUSHITA
  • - Other , Korea (South) MINSU KIM
  • - University of Tsukuba, Dept of Radiology , Japan MANABU MINAMI
  • - Eskisehir Sehir Hastanesi , Turkey MURAT SAHIN
  • - Chonbuk National University Hospital , Korea (South) KUM JU CHAE
  • - Kitano Hospital , Japan SATOSHI IKEDA
  • - Fortis hospital , Mohali , India SHALEEN RANA
  • - University of Tsukuba Hospital , Japan SODAI HOSHIAI
  • - Chonbuk National University Hospital , Korea (South) MINJEE KIM
  • - Toranomon Hospital , Japan KAORU SUMIDA
  • - Ichinomiya Nishi Hospital , Japan Takao Kiguchi
  • - , Japan KAZUMA TERAUCHI
  • - Samsung Changwon Hospital , Korea (South) DONG SU KIM
  • - , Japan TOMOKI IMOKAWA
  • - Tokyo Metropolitan Bokutoh Hospital , Japan TOMOKI WADA
  • - Chonbuk National University Hospital , Korea (South) YOUNG JU SONG
  • - Private sector , Greece VASILIOS TZILAS
  • - College of Medicine, CHA University , Korea (South) PARK JONG WON
  • - Hamamatsu University Hospital , Japan YUKI HAYASHI
  • - , Korea (South) WONJU HONG
  • - the first affiliatited hospital of nanjing medical univercity , China HAI XU
  • - Hanyang University Hospital , Korea (South) SEUNG JIN YOO
▶ Correct Answer as Differential Diagnosis : 1/81,  1.2%
  • - Kyoto university , Japan AKIHIKO SAKATA
▶ Semi-Correct Answer : 2/81,  2.5%
  • - Chonbuk National University Hospital , Korea (South) JUNGHWAN KIM
  • - HHS , Canada S LEE
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