3a. Multiple Myeloma (Primary Neoplasms)

Question 1

Of the 2500 new cases of primary sarcomas of bone a year, what is MC?

Answer 1

Osteosarcoma (40%)

Question 2

4 MC primary malignancies of bone?

Answer 2

• Multiple Myeloma (50-70)
• Osteosarcoma (10-25)
• Chondrosarcoma (40-60)
• Ewing’s Sarcoma (10-25)

Question 3

T or F: Multiple Myeloma is rare before 60

Answer 3

F (rare before 40)

Question 4

Is Multiple Myeloma MC in males or females?

Answer 4

Males

Question 5

Multiple Myeloma occurs in the ___.

Answer 5

Plasma cell matrix

Question 6

MC sites for Multiple Myeloma?

Answer 6

Similar to mets sites, plus humerus and femur diaphyses

Question 7

T or F: Multiple Myeloma can cause anemia

Answer 7

T, normocytic normochromic anemia (due to proliferating plasma cells)

Question 8

Multiple Myeloma: Lytic or Blastic destruction of bone?

Answer 8

Lytic

Question 9

Multiple Myeloma: Lab findings/changes?

Answer 9

• Abnormal serum protein and urinary protein (due to low fluid levels)
• Thrombocytopenia (increased nose bleeds)
• Normocytic, normochromic anemia
• Hyperuricemia, hypercalcemia
• Protein electrophoresis “M-spike”
• Bence-Jones protein in urine
• Rouleaux formation
• Bone marrow aspirate strongly diagnostic

Question 10

Two MC causes of death in multiple myeloma patients?

Answer 10

Renal failure and bacterial pneumonia

Question 11

Multiple Myeloma: Pattern of pain

Answer 11

• Intermittent, then continuous with increasing severity
• Worse during the day
• Aggravated by exercise and weight bearing
• Better at night and with rest
• Pathological Fx is common (20%)

Question 12

Multiple Myeloma: Signs and Symptoms

Answer 12

• Weight Loss
• Fever
• Cachexia (aka wasting syndrome: A general state of ill health involving marked weight loss and muscle loss)
• Osteoporosis
• Amyloidosis (globs of protein goo)
• Bacterial infections (esp. respiratory)

Question 13

What will you see on a protein electrophoresis in multiple myeloma?

Answer 13

M-spike

Question 14

What will you see in the urine in multiple myeloma?

Answer 14

Bence Jones protein

Question 15

Does multiple myeloma lead to increase or decreased osteoclastic activity?

Answer 15

Increased (will make the bone not rebuild itself, sings it a “lullaby”)

Question 16

What is myeloma kidney?

Answer 16

Precipitation of protein in tubules (leads to renal failure; 2nd MC cause of death in MM patients)

Question 17

When would you see blastic lesions in a MM patient?

Answer 17

• Very small percentage of patients will have blastic lesions initially (3%)
• However, commonly seen when being treated for MM

Question 18

Most frequent sites for MM?

Answer 18

Bones with active hematopoietic tissue (same as mets)

Question 19

Would a bone scan be negative or positive in MM?

Answer 19

Usually negative (10% would be positive)

Question 20

Better advanced imaging choice for MM?

Answer 20

MRI (very sensitive to marrow changes)

Question 21

MM prognosis?

Answer 21

Very poor, more palliative care

Question 22

What is Solitary Plasmacytoma?

Answer 22

Basically same as MM, but just one lesion and occurs in younger patients.

Question 23

Favored sites for Solitary Plasmacytoma?

Answer 23

Flat Bones: Mandible, Ilium, vertebrae, ribs, proximal femur, scapula

Question 24

Common plain film findings in Solitary Plasmacytoma?

Answer 24

Geographic, lytic, highly expansile, “soap bubbly”

Question 25

What do most patients with Solitary Plasmacytoma develop within 5 years?

Answer 25

Multiple Myeloma