Tuesday, November 19, 2013

MULTIPLE MYELOMA

Clinical
  • Average age is 60-70
  • Men much more common than women
  • Most have an elevated serum protein with 80-90% in the globulin fraction, especially IgG
  • Bence-Jones protein in 40-60% of patients (light chains)
  • X-ray findings
    • Osteoporosis is most common skeletal abnormality in this disease
    • Lesions are usually multiple and found in vertebrae, ribs, skull, pelvis, and femur
    • Over 50% of solitary lesions are found in vertebrae
    • Mandible involved in 1/3 of patients with diffuse involvement
    • Widespread lucencies in bone
      • Discrete, “punched-out” lesions
      • Uniform in size
    • Distinctive to MM are the lucent, elliptical, subcortical shadows, especially in long bones=endosteal scalloping
      • Due to buttressing since MM is usually a slower process than mets
    • In spine, MM destroys body and spares pedicle
  • DDX: mets and disuse osteoporosis
    • MM is more widespread
    • More discrete holes in MM
    • Large foci of coalescence more often due to mets
    • Severe disuse osteoporosis may simulate bone changes of MM
  • Sclerosis is usually seen only with treatment or fracture
    • Bone scans may typically be negative and many hot  areas on scan may be healing fractures
  • Most believe that almost all patients with a solitary plasmacytoma will develop multiple myeloma
    • Solitary plasmacytoma produces “soap-bubbly” expansile, septated lesion, when characteristic
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    1 comment:

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