Multiple Myeloma




CLINICAL SUMMARY


Multiple myeloma presents as a proliferation of plasma cells in the marrow and is the most common primary malignancy of bone. Like other round cell tumors, myeloma lesions are quite radiosensitive. Therefore, although skeletal involvement can be extensive, the role for surgery is limited. Although most patients will have a good initial response to chemotherapy, the long-term prognosis remains guarded.




DIAGNOSTIC FEATURES





















History


  • Most common after 40 years of age (average age: 62 years)



  • Bone lesions are commonly painful



  • Laboratory signs can include anemia, elevated erythrocyte sedimentation rate, and abnormal renal function



  • Monoclonal spike on serum protein electrophoresis (SPEP) is diagnostic



  • Beware of acute hypercalcemia

Location


  • In the long bones, diaphyseal, medullary



  • Skull and spine involvement is common

Margins


  • Multiple geographic, lytic lesions with endosteal involvement, sometimes described as “punched out”



  • With advanced disease, destruction can appear motheaten or permeative



  • No periosteal reaction

Matrix


  • No matrix mineralization






IMAGING
























  • A proximal femur lesion demonstrates geographic lysis with deep endosteal scalloping ( left ).



  • Multiple “punched-out” lytic lesions in the skull, typical of multiple myeloma ( right ). Note the mandibular involvement ( arrow ), which is more common in myeloma carcinoma than in metastatic carcinoma.


Get Clinical Tree app for offline access