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54. A serum chemistry panel is performed on a healthy
48-year-old male with no complaints other than his worry-
ing about getting older and having cancer. His total serum
protein concentration is 7.4 g/dL, and the albumin level is
3.9 g/dL. The serum calcium and phosphorus levels are
normal. Urinalysis reveals no Bence Jones proteinuria. A
serum protein electrophoresis reveals a small (2.8-g) spike
of y-globulin, which is determined to be lgG kappa by
immunoelectrophoresis. A physical examination reveals no
hepatosplenomegaly or lymphadenopathy. A bone marrow
biopsy reveals normal cellularity with maturation of all cell
lines. Plasma cells constitute about 4% of the marrow. A
bone scan is normal, with no areas of increased uptake.
Which of the following conditions is most likely?

Solitary plasmacytoma
Waldenstr/Sm macroglobulinemia
Monoclonal gammopathy of undetermined signifi-
Heavy-chain disease
Multiple myeloma


3 ??


54. (C) Monoclonal gammopathy of uncertain signifi-
cance (MGUS) is characterized by the presence of an M
protein "spike" in the absence of any associated disease of
B cells. The diagnosis of MGUS is made when the mono-
clonal spike is small (>3 g) and the patient has no Bence
Jones proteinuria. MGUS may progress to multiple mye-
loma in about 20% of patients over 10 to 15 years. A
plasmacytoma should appear on a bone scan. Waldenstr6m
macroglobulinemia should be accompanied by an IgM
spike, hepatosplenomegaly, and lymphadenopathy. Heavy
chain disease is a rare condition that may be seen with
chronic lymphocytic leukemia. In multiple myeloma, the
spike is greater than 3 g, and usually the patient has bone

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