Question: My wife (age 74) was diagnosed with multiple myeloma based on amyloidosis based on echocardiogram and severe congestive heart failure. She has all symptoms of amyloidosis, including purpura and "raccoon eyes". The BM biopsy did not show amyloid in the bone marrow, however.

A few days ago we found a lump in the muscle of her upper right arm. It is about the shape and size of a large pecan, or a small hen egg. I saw the ultrasound in progress, and was struck by the roughly grid shaped black lines within the lump, as was the technician. Went for biopsy on Friday 4/5/13, but they could not do it because her blood pressure was 79/45, and would not go up over two hours. Scheduled again for Monday 4/8/13.

Question: I'm very worried about the lump. Is this common with multiple myeloma? Is there a most likely explanation? Can you provide a source of information on such lumps?
Additional background:

My wife was admitted to hospital on December 28, 2012 with severe congestive heart failure. She was in ICU for about 8 days of a 14 day hospital stay. The day after she was released, we saw our cardiologist. An echocardiogram was done, and the amyloidosis was diagnosed. Within a week after that diagnosis, we went my oncologist/hematologist, who suspected multiple myeloma, as well as amyloidosis. Her Lambda light chain numbers (at 226) were 10 time the high end of range.

A subsequent fat pad biopsy was reported negative, but I'm having it checked at the Amyloidosis Center of Boston University. Then a bone marrow biopsy was done, which confirmed multiple myeloma.

As noted earlier, a few days ago we found the lump in her upper right arm.

The lump scares me. She is very weak. Her blood pressure runs very low, and her heart rate very high--almost never lower than 100, and often in the 120s. Oxygen saturation usually is in mid to high 90s. She takes 60mg of Lasiks daily, but her ankles still are swollen.

Thank you Dr. XXXXXXX

I have read a number of studies and other literature on amyloidosis, some of the best published by the Amyloidosis Center at Boston University. But of course I know very little about this terrible disease.

She took her first shot of Velcade on Thursday 4/4. She is also taking pulses of Dexamethazone four days each month. I think the Velcade may be increased soon, as my understanding is that it is normally a day 1, 4, 8 and 11 then a rest period before starting again.

Is plasmacytoma a common thing with multiple myeloma?

Is a subcutaneous deposition of amyloid common? In the reading I've done, I don't think I have encountered that. Could you recommend or send a link to literature on that?

Would it (amyloid deposition) be as large as a small hen egg? I know the biopsy is the real source of an answer, but I want to learn as much as possible about what this could be.
Would such a deposition of amyloid show a pattern of black grid-like lines inside the mass?

Thanks very much for answering these questions.

Thank you Dr. XXXXXXX

The link you provided is very helpful, and it makes me grateful that my wife has not suffered some of the worst of the possible effects. The only outward sign so far, unless the lump proves to be related, is the purpura. She has been having those for almost 2 years. But neither I nor our doctors related it to amyloidosis.

I am very confident in our oncologist/hematologist, but it is good that you think the treatment we are undertaking is a proper choice.

If I am able to get copies of the ultrasound images of the lump, I will upload them for you.

Question:
What is the best way to ascertain whether the amyloidosis has impacted her digestive system? She feels a drawing, hunger-like feeling often, even just after a meal. She feels full after eating only a little food...has lost 20 pounds in the last 4 months...but is not seemingly stable at about 110. She is about 5' 4" tall.

She has had many basal cell skin cancers removed over the years, but there is not history of cancer in her family.