[Relapsed/refractory multiple @entity1582 with @entity13221 shedding and formation of extramedullary disease in the common bile duct region presenting as XXXX ].

@entity1 @entity632 @entity3883 @entity1087 @entity6872 @entity5 @entity2816 @entity1126 @entity1582 @entity619 @entity1891 @entity6985 @entity13221 @entity1749
A 56-year-old @entity1 was diagnosed with immunoglobulin (Ig) A-k multiple @entity1582 in July 2007. After three courses of @entity1891 , @entity632 , and @entity619 (VAD) chemotherapy, autologous peripheral blood stem cell transplantation was performed and achieved a very good partial response. In February 2010, an increase in the M-protein concentration and plasmacytoma in the L3/4 lumbar vertebrae were observed, and radiation treatment was performed. This was followed by administrations of @entity1749 , @entity6985 , and @entity2816 , none of which achieved a good response. In November 2011, the @entity1 presented with @entity3883 , and imaging tests revealed @entity5 in the lower bile duct region and bilateral kidneys. @entity6872 was diagnosed from biopsy of the right renal mass. Radiotherapy to the common @entity1126 resulted in @entity1087 amelioration, but the @entity1 died despite subsequent treatment efforts. Autopsy revealed multiple extramedullary lesions in the abdominal cavity and in the region around the common bile duct. @entity13221 shedding was observed in the @entity1582 cells. We include a discussion of the literature on @entity13221 shedding and 38 reports of @entity3883 associated with extramedullary disease.
