CLINICAL AND LABORATORY FINDINGS IN NINE PATIENTS WITH CARCINOMA AND PARAPROTEINAEMIA Case Age Sex

Abnormal proteins have been known for some time to occur in sera from patients with multiple myeloma and other neoplasms of reticulo-endothelial cells, as well as macroglobulinaemia and cryoglobulinaemia (Adams, Alling, and Lawrence, 1949; Fudenberg and Kunkel, 1957; Azar, Hill, and Osserman, 1957; Putnam, 1960; Waldenstrom, 1961; Osserman and Takatsuki, 1963; Sunderman, 1964; Franklin and Lowenstein, 1964). Similar proteins may also occur in sera from patients with no apparent causal disease (Waldenstrdm, 1952; Laurell, Laurell, and Waldenstrom, 1957; Osserman, 1958; Owen, Pitney, and O'Dea, 1959; Waldenstrom, 1961; Hammack and Frommeyer, 1962). Most of these papers, whether discussing multiple myeloma or paraproteinaemia, mention the occasional occurrence of patients with paraproteinaemia and epithelial rather than reticulo-endothelial neoplasms. Adams et al. (1949) reviewed 61 patients with myeloma, and noted a further two with paraproteins and carcinoma. One of these had a carcinoma of the stomach; in the other the primary site was unknown although widespread bony metastases were present. Similarly, Owen et al. (1959) found one of nine patients with paraproteinaemia but without myeloma to have a thyroid carcinoma with metastases in ribs. Eight of the 24 patients with 'premyeloma' reported by Osserman (1958) had carcinoma at different primary sites. Hammack and Frommeyer (1962) studied 37 patients with paraproteinaemia not associated with myeloma, and found five with epithelial neoplasms, the primary sites being lung two, rectum two, and prostate. These paraproteins were of IgG type. (Here and subsequently nomenclature has been altered to conform with that of the World Health Organization, 1964.)