Working Diagnosis:
Multiple myeloma characterized by serum monoclonal IgG kappa gammopathy and clavicular destructive plasmacytoma.

Treatment:
Referral to Hematology-Oncology where the patient was started on chemotherapy. His clavicular pain has resolved. He has achieved a 95% response to treatment.

Outcome:
He is cleared for all non-contact activity and enjoys running, cycling and swimming. He continues chemotherapy and awaits a hematopoietic stem cell transplantation.

Author's Comments:
Multiple myeloma is the most common bone malignancy. It accounts for 1% of all cancers and slightly more than 10% of hematologic malignancies in the US. The annual incidence is 4-5 per 100,000. The median age at diagnosis of multiple myeloma is about 70 years, and the occurrence increases with age. Only 2% of patients are diagnosed at younger than 40 years old. It is characterized by the neoplastic proliferation of plasma cells which produces a monoclonal immunoglobulin. These plasma cells proliferate in the bone marrow and often result in extensive skeletal destruction with osteolytic lesions, osteopenia and/or pathological fractures. Most patients present with symptoms related to the infiltration of plasma cells into the bone or other organs. 58% of patients have some bone pain at first presentation. <br> <br>The diagnosis of multiple myeloma requires either clonal bone marrow plasma cells &gt; 10% or a biopsy proven bony or soft tissue plasmacytoma along with presence of related organ or tissue impairment (anemia, hypercalcemia, renal insufficiency or bone lesions). <br> <br>After diagnosis, staging and risk stratification, treatment generally involves induction therapy with chemotherapy, followed by hematopoetic stem cell transplantation.

Editor's Comments:
Interesting case in a patient not typically in the demographic for MM.

References:
1. Becker, Nikolaus. &quot;Epidemiology of multiple myeloma.&quot; Multiple Myeloma. Springer Berlin Heidelberg, 2011. 25-35. <br> <br>2. Kyle, Robert A., et al. &quot;Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group.&quot; British journal of haematology 121.5 (2003): 749-757. <br> <br>3. Coleman, Elizabeth Ann, et al. &quot;Feasibility of exercise during treatment for multiple myeloma.&quot; Cancer nursing 26.5 (2003). <br> <br>4. Jobe, F. W., and J. P. Bradley. &quot;The diagnosis and nonoperative treatment of shoulder injuries in athletes.&quot; Clinics in sports medicine 8.3 (1989): 419-438.

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