Combination of MLAT Lymphoma and Myeloma

Introduction:
MLAT lymphoma is a rare form of non-Hodgkin's malignant lymphoma that affects B lymphocytes and develops at the expense of lymphoid tissue associated with mucous membranes, but also in a rarer way at the level of a lymph node, it seems to have an indolent evolution and the evolution towards or in a concomitant way has a multiple myeloma has never been described before. We report the case of a young man with these 2 pathologies concomitantly.
Methods:
This is a 43 year old patient, with a history of daily alcohol consumption >‚Äâ3 glasses / day for 15‚Äâyears, his history dates back to February 2022, where the patient presented suddenly with excruciating abdominal pain associated with a stop of matter and gas. He was initially admitted to the emergency room where an abdominal CT scan was done showing a gallbladder tumor with intestinal perforation and peritonitis, operated and put under antibiotics with excellent evolution. Anatomopathological examination of the surgical specimen came back in favor of a MALT lymphoma.
Discussion: Our observation reports an unusual case of association of Malt's lymphoma and multiple myeloma, and shows that in spite of the spectacular evolution of the means of investigation and explanation of the physiopathological mechanisms of development of pathologies, certain mechanism remains enigmatic and stimulates us clinicians to put on the cap of detective in order to find satisfactory answers
The patient was subsequently lost to follow-up and returned 5 months later with diffuse abdominal and bone pain and respiratory distress. The clinical examination found a conscious patient tachycardia at 120 beats/min, polypneic 25 cycles/min, saturation at 97% on room air, a very distended abdomen with diffuse dullness, and a muscle strength in both lower limbs estimated at 3/5. An abdominal CT scan was redone, and it showed a perineal carcinosis with an intra-abdominal tissue mass and multiple osteolytic bone lesions threatening the dorsal and lumbar vertebrae (from D3 to L4) with endo-canalar extension, as well as at the pelvis level. In front of this picture a myeloma assessment was requested,
Results:
The medullogram showed a 52% plasma cell invasion, the protein electrophoresis showed a monoclonal peak in gamma zone at 46g/l, the immunofixation showed an IgA kappa band, bence Jones proteinuria came back positive, for CRAB criteria: on the blood count was found an anemia to 6.5 normochromic normocytic aregenerative, with normal renal function and calcemia. A rereading of the anatomopathological examination of the graft tumor was requested, which confirmed MALT lymphoma. Therapeutically, the decision of the multidisciplinary consultation meeting was to initially treat the myeloma and then re-evaluate the patient after 2 months in order to manage his myeloma as well.