Plasma Cell Neoplasm Mimicking Metastatic Bone Disease in a Breast Cancer Survivor - A Case Report Highlighting the Role of Serum Protein Electrophoresis

Sep 22, 2026

Breast cancer survivor case presenting with one-year post-treatment bone lesions and anemia initially treated as metastatic bone disease. Elevated serum total protein and globulins, alongside a markedly altered albumin-to-globulin ratio, triggered serum protein electrophoresis, revealing an M band in the gamma region consistent with a plasma cell neoplasm. Subsequent evaluation confirmed the diagnosis and treatment was initiated. The report emphasizes that increased total protein, globulins, and abnormal albumin-to-globulin ratio should prompt consideration of plasma cell neoplasms in breast cancer patients with bone lesions.

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Introduction

Case Report

Investigations and Laboratory Findings

Case Report Plasma Cell Neoplasm Mimicking Metastatic Bone Disease in a Breast Cancer Survivor: A Case Report Highlighting the Role of Serum Protein Electrophoresis ArshiyaAnjum 1*, Sanjay Bagade 1, Sanath Kandem2 1Basavatarakam Indo-American Cancer Hospital and Research Institute, Department of clinical Biochemistry, Telangana, India 2Basavatarakam Indo-American Cancer Hospital and Research Institute, Department of Medical Oncology, Telangana, India Article Info Abstract *Corresponding Author: ArshiyaAnjum Department of Clinical Biochemistry, Basavatarakam Indo-American Cancer Hospital and Research Institute Road No. 10, IAS Officers Quaters, Nandi Nagar, Banjara Hills, Hyderabad, Telangana 500034, India E-mail: [dr1arshiya@gmail.com](dr1arshiya@gmail.com) Keywords Albumin-to-globulin ratio, breast cancer, bone lesions, plasma cell neoplasm, serum protein electrophoresis Breast cancer, a prevalent solid tumor, is the most common cancer among women worldwide. Hematological malignancies, such as acute myeloid leukemia, myelodysplastic syndrome, and acute lymphoblastic leukemia, are more frequent in breast cancer survivors, while plasma cell neoplasms are less common. We report the case of a 44-year-old woman with breast cancer who underwent neoadjuvant chemotherapy and surgery, presenting one year later with bone lesions and anemia. Initially suspected to be metastatic bone disease, the findings of elevated serum total protein and globulins prompted serum protein electrophoresis, which revealed a distinct M band in the gamma region, suggesting a plasma cell neoplasm. Further evaluation confirmed this diagnosis, and treatment was initiated. This case underscores the importance of considering elevated total protein, globulins, and an altered albumin-to-globulin ratio as primary bone marrow disorders, such as plasma cell neoplasms, in breast cancer patients with bone lesions. eJIFCC2026Vol37No2pp367-371 Page367 Introduction Plasma cell neoplasm is a systemic malignancy characterized by the uncontrolled proliferation of monoclonal plasma cells in the bone marrow, resulting in the production of nonfunctional immunoglobulins or immunoglobulin light chains, known as M-protein. Diagnosing this condition is challenging due to nonspecific symptoms, such as bone pain, fatigue, and aches at multiple sites [1]. Typically diagnosed in individuals aged 65– 75 years with a male predominance [2], plasma cell neoplasms may be overlooked in younger female patients, where symptoms might be mistaken for aging or other conditions. Indications for testing include incidental findings of elevated total protein, unexplained anemia or cytopenias, hypercalcemia, renal impairment, lytic bone lesions, or unexplained osteopeniain patients with bone pain or fractures [3] . Breast cancer, the most common cancer among women globally, has seen reduced mortality rates due to advancesin screening and treatment. However, its association with secondary malignancies, such as plasma cell neoplasms, is rare [4]. We present a case of a 44-year-old woman with invasive ductal carcinoma of the right breast, treated with chemotherapy, modified radical mastectomy, and radiotherapy. One-year post-treatment, she developed back pain, anemia, acute kidney injury, and bone lesions, initially suggestive of metastatic tumor deposits. Further evaluation revealed a plasma cell neoplasm, highlighting the diagnostic challenges of distinguishing between metastatic disease and primary bone disorders. Case Report A 44-year-old woman presented with a right breast nodule and was evaluated at our hospital. Examination revealed a retroareolar nodule with a peau d’orange appearance and enlarged right axillary lymph nodes. Biopsy confirmed grade 3 invasive ductal carcinoma, with immunohistochemistry indicating ER-negative, PR-low positive, and HER2/neupositive status. A bone scan showed no lytic or metastatic lesions. The final diagnosis was carcinoma of the ri

FAQs

Why was metastatic bone disease initially suspected in this breast cancer survivor?

After chemotherapy and surgery, the patient developed back pain and anemia, and imaging later showed multiple lytic bone lesions, which initially suggested metastatic tumor deposits.

What laboratory findings led to suspicion of a plasma cell neoplasm?

Markedly elevated serum total protein and globulins, together with an altered albumin-to-globulin ratio, indicated a pattern not typical for isolated metastatic bone disease.

How did serum protein electrophoresis contribute to the final diagnosis?

Serum protein electrophoresis demonstrated a distinct M band in the gamma region, supporting the diagnosis of a plasma cell neoplasm and enabling appropriate treatment initiation.

Sep 22, 2026

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