{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,20]],"date-time":"2026-05-20T17:15:29Z","timestamp":1779297329726,"version":"3.51.4"},"reference-count":12,"publisher":"Pensoft Publishers","issue":"2","license":[{"start":{"date-parts":[[2025,3,21]],"date-time":"2025-03-21T00:00:00Z","timestamp":1742515200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FM"],"abstract":"<jats:p>Multiple myeloma (MM) is a clonal plasma cell malignancy often confined to the bone marrow, although extramedullary disease (EMD) can develop, especially in advanced or relapsed cases. Leptomeningeal EMD is a rare and aggressive manifestation associated with a dismal prognosis. This case report highlights the critical role of 18F-FDG PET\/CT in managing such complex presentations.<\/jats:p>\n          <jats:p>A 73-year-old man with relapsed multiple myeloma and new lumbar pain was re-staged with 18F-FDG PET\/CT, which showed metabolically active osteolytic lesions and possible leptomeningeal involvement. Subsequent MRI confirmed pathological intradural lesions, corroborated by histopathology as plasma cell neoplasms. PET\/CT\u2019s ability to detect hypermetabolic activity in atypical and non-enhancing lesions provided essential insights into disease progression, which guided effective treatment with radiotherapy and carfilzomib\/dexamethasone-based therapy, resulting in sustained complete response.<\/jats:p>\n          <jats:p>This case underscores the advantages of PET\/CT, including early detection of subtle extramedullary lesions, superior sensitivity compared to conventional imaging, and precise monitoring of therapeutic response. Through the integration of advanced imaging and multidisciplinary care, this patient achieved 15 months of progression-free survival post-EMD detection, emphasizing the transformative impact of PET\/CT in personalized myeloma management.<\/jats:p>","DOI":"10.3897\/folmed.67.e132922","type":"journal-article","created":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T09:25:18Z","timestamp":1742376318000},"source":"Crossref","is-referenced-by-count":2,"title":["Extramedullary dissemination in multiple myeloma: a case report of rare leptomeningeal involvement and comprehensive treatment outcomes"],"prefix":"10.3897","volume":"67","author":[{"given":"Tanya","family":"Stoeva","sequence":"first","affiliation":[{"name":"St Marina University Hospital, Varna, Bulgaria"},{"name":"Medical University of Varna, Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0033-4871","authenticated-orcid":true,"given":"Zhivka","family":"Dancheva","sequence":"additional","affiliation":[{"name":"St Marina University Hospital, Varna, Bulgaria"},{"name":"Medical University of Varna, Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Sofiya","family":"Chausheva","sequence":"additional","affiliation":[{"name":"St Marina University Hospital, Varna, Bulgaria"},{"name":"Medical University of Varna, Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tsvetelina","family":"Yordanova","sequence":"additional","affiliation":[{"name":"St Marina University Hospital, Varna, Bulgaria"},{"name":"Medical University of Varna, Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Borislav","family":"Chaushev","sequence":"additional","affiliation":[{"name":"St Marina University Hospital, Varna, Bulgaria"},{"name":"Medical University of Varna, Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aneliya","family":"Klisarova","sequence":"additional","affiliation":[{"name":"Medical University of Varna, Varna, Bulgaria"},{"name":"St Marina University Hospital, Varna, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"2258","published-online":{"date-parts":[[2025,3,21]]},"reference":[{"key":"132922_B1","unstructured":"1. Myeloma \u2013 CancerStatFacts. Available from: https:\/\/seer.cancer.gov\/statfacts\/html\/mulmy.html (Accessed on 7 July 2024)."},{"key":"132922_B2","doi-asserted-by":"crossref","unstructured":"2. Varettoni M, Corso A, Pica G, et al. Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients. Ann Oncol 2010; 21(2):325\u201330.","DOI":"10.1093\/annonc\/mdp329"},{"key":"132922_B3","unstructured":"3. Gagelmann N, Eikema DJ, Iacobelli S, et al. Impact of extramedullary disease in patients with newly diagnosed multiple myeloma undergoing autologous stem cell transplantation: a study from the chronic malignancies working party of the EBMT. Haematologica 2018; 103:890\u20137."},{"key":"132922_B4","doi-asserted-by":"publisher","DOI":"10.1093\/annonc\/mdp329"},{"key":"132922_B5","doi-asserted-by":"publisher","DOI":"10.1182\/blood-2021-150876"},{"key":"132922_B6","doi-asserted-by":"publisher","DOI":"10.3389\/fonc.2022.934240"},{"key":"132922_B7","doi-asserted-by":"publisher","DOI":"10.14748\/vmf.v10i2.7872"},{"key":"132922_B8","unstructured":"8. Goranova-Marinova VS. [Modern treatment of multiple myeloma in patients with relapse and\/or refractory disease]. MedInfo 2020; 1:534. Retrieved November 16, 2024. Available from: https:\/\/shorturl.at\/YALH3 [Bulgarian]."},{"key":"132922_B9","doi-asserted-by":"publisher","DOI":"10.14748\/vmf.v0i0.8418"},{"key":"132922_B10","doi-asserted-by":"crossref","unstructured":"10. Jurczyszyn A, Grzasko N, Gozzetti A, et al. Central nervous system involvement by multiple myeloma: a multi-institutional retrospective study of 172 patients in daily clinical practice. Am J Hematol 2016; 91:575\u201380.","DOI":"10.1002\/ajh.24351"},{"key":"132922_B11","doi-asserted-by":"crossref","unstructured":"11. Bommer M, Kull M, Teleanu V, et al. Leptomeningeal myelomatosis: a rare but devastating manifestation of multiple myeloma diagnosed using cytology, flow cytometry, and fluorescent in situ hybridization. Acta Haematol 2018; 139:247\u201354.","DOI":"10.1159\/000489484"},{"key":"132922_B12","unstructured":"12. Eldridge L. Leptomeningeal Disease. Verywell Health, 2023. Available from: https:\/\/www.verywellhealth.com\/leptomeningeal-carcinomatosis-overview-4175117"}],"container-title":["Folia Medica"],"original-title":[],"link":[{"URL":"https:\/\/foliamedica.bg\/article\/132922\/download\/pdf\/","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/foliamedica.bg\/article\/132922\/download\/xml\/","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/foliamedica.bg\/article_preview.php?id=132922&skip_redirect=1","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,3,19]],"date-time":"2025-03-19T09:25:26Z","timestamp":1742376326000},"score":1,"resource":{"primary":{"URL":"https:\/\/foliamedica.bg\/article\/132922\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,21]]},"references-count":12,"journal-issue":{"issue":"2","published-online":{"date-parts":[[2025,3,21]]}},"URL":"https:\/\/doi.org\/10.3897\/folmed.67.e132922","relation":{},"ISSN":["1314-2143","0204-8043"],"issn-type":[{"value":"1314-2143","type":"electronic"},{"value":"0204-8043","type":"print"}],"subject":[],"published":{"date-parts":[[2025,3,21]]},"article-number":"e132922"}}