Nodular extramedullary multiple myeloma: hepatic involvement presenting as hypervascular lesions on CT.

Dear Editor, Multiple myeloma (MM) presenting as nodular liver masses is rare in clinical practice and the literature published thus far has been limited to few reports and case series.1-9 In a retrospective review of more than 2000 patients, Talamo et al10 reported that only 9 cases where there was nodular involvement of the liver by MM, whereas in one autopsy study, nodular liver involvement was present in 13.4% of patients.11 This discrepancy in fi ndings between clinical diagnosis and autopsy fi ndings suggests that nodular involvement of the liver by MM may be under-diagnosed. Liver involvement by MM is associated with light chain restricted disease.5 Histologically, hepatic involvement may manifest in sinusoidal, portal, nodular or mixed patterns.12 Macroscopically, these can present as either diffusely infi ltrative or focally nodular types. We report a case of a 68-year-old female with biopsy proven non-secretory type multiple myeloma involving the liver and manifesting as arterial enhancing mass lesions on computed tomography, an imaging fi nding that is not well recognised.