Multiple Myeloma

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Multiple Myeloma
2010-09-12 16:41:15
Skel Rad

Final Material
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  1. Category of Multiple Myeloma
    • Primary, marrow, malignant
    • #1 MC malignant bone tumor
  2. What type of cells is multiple myeloma composed of?
    Plasma cells => B cells
  3. MC structure in bone for multiple myeloma to be?
  4. MC bone region for multiple myeloma to be?
  5. 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
  6. Typical age that multiple myelomas occur at
    • Over 40 yoa
    • 50-75 yoa- 75%
    • 5th to 7th decade
    • Male 2:1
  7. 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
  8. 4 abnormalities associated with multiple myeloma
    • Anemia
    • Deossification of red marrow bones
    • Abnormal serum & urinary proteins
    • Renal disease
  9. Symptoms of anemia due to multiple myeloma
    • Normocytic, normochromic
    • Nothing wrong with RBC
    • Elevated ESR
  10. 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
  11. Complications of renal disease associated with multiple myeloma
    Bence Jones protein clogs kidney
  12. Survival rate for multiple myeloma patients
    30 months- death due to renal failure
  13. Why is plain film important for the determination of multiple myeloma?
    Because MM is negative on bone scan
  14. Size of multiple myelomas
    Vary in size, but less than 2 cm
  15. Appearance of multiple myeloma
    • Osteoporosis- thinning of cortex
    • Uniform vertebral collapse
    • Well defined margin
    • No sclerosis to margin
    • Radiolucent- dark
    • Compression fractures present
  16. 4 presentations of osteolytic defects associated with multiple myeloma
    • Classical
    • Myelomatosis
    • Plasmacytoma
    • Extraosseous
  17. What is the classical presentation for MM
    • Punched out lesion
    • MC presentation
  18. 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
  19. What is a plasmacytoma associated w/ MM
    Localized subacute geographic lesion
  20. What is an extraosseous osteolytic defect associated w/ MM
    • External to bone marrow & appears in nasopharynx
    • Rare
    • Dysphagia, mouth breathing
  21. 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
  22. What is solitary plasmacytoma?
    • More localized, low-grade form of MM
    • Can become MM
  23. What are common sites for solitary plasmacytoma?
    • Mandible
    • Ilium
    • Vertebra
    • Rib
    • Proximal Femur
    • Scapula
  24. What is the size of a solitary plasmacytoma?
    occupies space >2 cm
  25. Is there pain with solitary plasmacytoma
  26. What is the appearance of a solitary plasmacytoma?
    • Geographic
    • Radiolucent
    • Highly expansile
    • Soap bubble