Bone Pathology Database

Teaching Version

 

Text in Italics is general (instructional) information

Return to base page



2nd image
MRI
Third image
MRI

On the MRI images extensive involvement of the bone marrow, (of all bones visualised) with a process giving a mixed signal is seen. There is collapse of T11 and L3 vertebrae.

The Hb was 9 g%
Serum Calcium 3.36 mmol/L
Serum Electrophoresis - M Component 41 g% - IGG band
On Immunofixation a Kappa band was seen - this was also seen in the urine.

The diagnosis is multiple myeloma Stage 3.

Multiple Myeloma

Bone pain,affecting 70% of patients.This patients initial symptom was backache. In Myeloma the pain is made worse by movement, not as in the case of other metastatic malignancies, worse at night.

Clinical Finding
Underlying cause
Pathogenic mechanism
Hypercalcaemia Skeletal destruction Tumour expansion
Renal Failure Light chain proteinuria, urate nephropathy Toxic effects of tumour products
Infection Hypogammaglobulinaemia Suppressed other gamma globulins
Neurlogic symptoms Hyperviscosity, amyloid deposits  
Bleeding Interference with clotting factors Tumor antibodies to clotting factors

Renal failure occurs in 25% myeloma patients. Bacterial infections such as pyelonephritis and bronchopneumonia are common. Renal function was normal in this patient, but he had a raised calcium.

Myeloma patients are often referred to the Orthopaedic surgeon for open reduction and fixation of pathological fractures. A pitfall of surgery is that multiple myeloma patients often have a bleeding tendency. If the platelet count and bleeding time must be checked before on embarking on any surgery.

Diagnosis and staging

The classic triad of myeloma

In plasmacytoma and extramedullary myeloma the M component is seen in less than 30% of cases. These variants have a >10 yr survival and are usually seen in younger patients.

Differential diagnosis of a monoclonal peak is the Benign Monoclonal gammopathy seen in 1% of the population > 50 yr and up to 10% in the > 75 yr old population.

 

Myeloma Staging System
Stage
Criteria

Tumour Burden

X 1012 cells/mm^3

I (low)

All the following:

  1. Hemoglobin >100 g/L (>10 g/dL)    
  2. Serum calcium <3 mmol/L
  3. Normal bone x-ray or solitary lesion 
  4. Low M-component production
    1. IgG level <50 g/L
    2. IgA level <30 g/L
    3. Urine light chains <4g/24 h

 

<0.6 (low)
II (intermediate) Fitting neither I or III 0.6 -1.20

III

(high)

One or more of the following:

  1. Hemoglobin < 8.5 g%
  2. Serum calcium > 3 mmol/L
  3. Advanced lytic bone lesions
  4. High M-component production
    1. IgG level >70 g/L
    2. IgA level >50 g/L
    3. Urine light chains >12 g/24 h
> 1.20

There are multiple sites of involvement, the calcium is raised >3 mmol/L with advanced lytic lesions. This patient is therefore a Stage 3 multiple myeloma.

Multiple myeloma can often be diagnosed without biopsy. No biopsy was done in this patient and he was referred to the haematological oncologists for chemotherapy.





Record 120