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Category of Multiple Myeloma
- Primary, marrow, malignant
- #1 MC malignant bone tumor
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What type of cells is multiple myeloma composed of?
Plasma cells => B cells
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MC structure in bone for multiple myeloma to be?
Medullary
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MC bone region for multiple myeloma to be?
Metaphysis
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Common sites for multiple myeloma to occur
- Spine- lower thoracic or lumbar; typically in body, not in posterior arch
- Long bone
- Skull- raindrop
- MULTICENTRIC- multiple bones, multiple areas
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Typical age that multiple myelomas occur at
- Over 40 yoa
- 50-75 yoa- 75%
- 5th to 7th decade
- Male 2:1
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Is there pain associated with multiple myeloma?
- YES
- Deep bone pain- aggravated by exercise & weight bearing, better at night, worse at day
- Weakness
- Low back pain
- Fatigue
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4 abnormalities associated with multiple myeloma
- Anemia
- Deossification of red marrow bones
- Abnormal serum & urinary proteins
- Renal disease
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Symptoms of anemia due to multiple myeloma
- Normocytic, normochromic
- Nothing wrong with RBC
- Elevated ESR
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Complications of abnormal serum & urinary proteins associated with multiple myeloma
- Marrow replaced with cancer cells
- See spike in electrophoresis
- Monoclonal gammopathy=> one group of same gamma globulin cells without antigenic stimulus
- Confirmed with bone marrow biopsy
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Complications of renal disease associated with multiple myeloma
Bence Jones protein clogs kidney
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Survival rate for multiple myeloma patients
30 months- death due to renal failure
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Why is plain film important for the determination of multiple myeloma?
Because MM is negative on bone scan
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Size of multiple myelomas
Vary in size, but less than 2 cm
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Appearance of multiple myeloma
- Osteoporosis- thinning of cortex
- Uniform vertebral collapse
- Well defined margin
- No sclerosis to margin
- Radiolucent- dark
- Compression fractures present
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4 presentations of osteolytic defects associated with multiple myeloma
- Classical
- Myelomatosis
- Plasmacytoma
- Extraosseous
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What is the classical presentation for MM
- Punched out lesion
- MC presentation
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What is myelomatosis associated w/ MM
- Osteopenia
- Only exhibit loss of bone density
- May want to test person exhibiting oseteoporosis for MM- electrophoresis, bone biopsy, show up with compression fractures
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What is a plasmacytoma associated w/ MM
Localized subacute geographic lesion
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What is an extraosseous osteolytic defect associated w/ MM
- External to bone marrow & appears in nasopharynx
- Rare
- Dysphagia, mouth breathing
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What is the differential for multiple myeloma?
- Lytic osteosarcoma- not usually in spine & younger age
- Osteomyelitis- more diaphyseal for infection
- Ewing's Sarcoma- feel bad & not usually in spine
- Non-Hodgkin's Lymphoma- feels ok
- Lytic metastasis- in posterior arch of spine
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What is solitary plasmacytoma?
- More localized, low-grade form of MM
- Can become MM
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What are common sites for solitary plasmacytoma?
- Mandible
- Ilium
- Vertebra
- Rib
- Proximal Femur
- Scapula
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What is the size of a solitary plasmacytoma?
occupies space >2 cm
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Is there pain with solitary plasmacytoma
NO
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What is the appearance of a solitary plasmacytoma?
- Geographic
- Radiolucent
- Highly expansile
- Soap bubble
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