Multiple Myeloma

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Multiple Myeloma

• PRESENTED BY
• G. MICHAEL WHITEHEAD, B.S., D.C., D.A.C.B.R.

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MULTIPLE MYELOMA

• General Considerations
• AKA Myeloma, Kahlers disease
• M/C primary osseous malignancy
• Malignant proliferation of plasma cells
• Most often generalized (Multiple myeloma)
• Single osseous focus (Solitary plasmacytoma)

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MULTIPLE MYELOMA

• Signs and Symptoms
• 75 of patients between 50-70 years of age
• Males 21 over females
• Symptoms initially vague
• Fever and fatigue related to anemia
• Pain is progressive in severity and m/c low back
• Aggravated by exercise and wt. bearing
• Pathologic fx? severe pain, neurologic deficits

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MULTIPLE MYELOMA

• Laboratory Features
• Hematology
• Normochromic normocytic anemia
• Thrombocytopenia
• Marked rouleax formation
• Increased ESR

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MULTIPLE MYELOMA

• Laboratory Features
• Biochemical
• Increased serum Ca (30)
• Increased serum uric acid (60)
• Hyperglobulinemia with reverse A/G ratio
• M spike on serum protein electrophoresis
• Bence Jones proteinuria (40)

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MULTIPLE MYELOMA

• Skeletal Locations
• M/C sites Lower thoracic and lumbar spine,
  skull, pelvis and ribs
• Additional sites Clavicle, scapula, diaphysis
  of the proximal long bones
• No bone is exempt

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MULTIPLE MYELOMA

• Advanced Imaging
• Bone scans are unreliable, often showing no
  uptake
• MRI shows diffuse or focal areas of low signal on
  T1 and increased signal on T2
• Skeletal survey still best means for identifying
  sites

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MULTIPLE MYELOMA

• Radiographic (Spine)
• Loss of bone density ?earliest manifestation
• M/C thoracic and lumbar spine
• Pathologic collapse? wrinkled vertebra
• Spares pedicles early? pedicle sign
• ddx. Osteolytic metastasis

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MULTIPLE MYELOMA

• Radiographic (Continued)
• Radiographic hallmark ? sharply circumscribed,
  purely osteolytic, punch-out lesions
• M/C sites Skull ? rain drop skull and long
  bones, pelvis, clavicle scapula and ribs
• Severe and diffuse bone destruction can occur
• M/C sites Pelvis and sacrum
• ddx. Osteolytic metastasis
• Expansion of bone is common
• M/C sites Ribs, long bones, pelvis

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MULTIPLE MYELOMA

• Solitary Plasmacytoma
• Highly expansile, geographic lesion typically a
  soap bubble appearance
• M/C sites Mandible, pelvis,vertebrae, ribs
• ddx Blow-out metastasis, brown tumor, F.D.
  giant-cell

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MULTIPLE MYELOMA

• Treatment/Prognosis
• Chemo and radiation
• Five year survival about 10
• M/C cause of death is pneumonia
• 2nd m/c is renal failure