ArticleFrontiers in oncology2026
Contrast-enhanced ultrasound-guided biopsy and perfusion monitoring for bladder involvement in relapsed multiple myeloma: a case report.
Article in Frontiers in oncology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Objective: Extramedullary involvement of the urinary bladder by plasma cell myeloma is extremely rare. This report presents a case to explore the clinical application value of contrast-enhanced ultrasound (CEUS) in the diagnosis and therapeutic monitoring of this condition. Methods: A 54-year-old man with high-risk multiple myeloma (IgAλ type, R-ISS stage II, 1q21 amplification) developed newly-onset urinary frequency during systemic therapy. Grayscale ultrasound, color Doppler ultrasound, and CEUS were performed, followed by CEUS-guided percutaneous biopsy. After pathological confirmation, salvage therapy was administered, and follow-up CEUS was performed to evaluate treatment response. Results: Grayscale ultrasound showed diffuse thickening of the bladder wall (maximum thickness approximately 2.5 cm) with abundant color Doppler flow signals. CEUS observed a perfusion pattern of "rapid arterial uptake, slow washout, and hyperenhancement": the muscular layer demonstrated early enhancement at 11 seconds with centrifugal (serosal-to-mucosal) filling, and marked contrast agent retention was observed during the venous phase. CEUS-guided biopsy and subsequent immunohistochemistry confirmed monoclonal plasma cell myeloma infiltration of the bladder (strongly positive for CD38, kappa-negative, lambda-positive). Follow-up CEUS after salvage therapy demonstrated a reduction in bladder wall thickness to 0.72 cm with delayed arterial enhancement. Conclusion: CEUS-guided transabdominal biopsy targeting the muscular layer may be considered in patients with suspected bladder plasmacytoma and high-risk features for transurethral resection to avoid false negatives from mucosal sampling. Furthermore, CEUS provides a nephrotoxicity-free modality for monitoring treatment response.
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