3a. Multiple Myeloma (Primary Neoplasms) Flashcards
Of the 2500 new cases of primary sarcomas of bone a year, what is MC?
Osteosarcoma (40%)
4 MC primary malignancies of bone?
- Multiple Myeloma (50-70)
- Osteosarcoma (10-25)
- Chondrosarcoma (40-60)
- Ewing’s Sarcoma (10-25)
T or F: Multiple Myeloma is rare before 60
F (rare before 40)
Is Multiple Myeloma MC in males or females?
Males
Multiple Myeloma occurs in the ___.
Plasma cell matrix
MC sites for Multiple Myeloma?
Similar to mets sites, plus humerus and femur diaphyses
T or F: Multiple Myeloma can cause anemia
T, normocytic normochromic anemia (due to proliferating plasma cells)
Multiple Myeloma: Lytic or Blastic destruction of bone?
Lytic
Multiple Myeloma: Lab findings/changes?
- 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
Two MC causes of death in multiple myeloma patients?
Renal failure and bacterial pneumonia
Multiple Myeloma: Pattern of pain
- 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%)
Multiple Myeloma: Signs and Symptoms
- 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)
What will you see on a protein electrophoresis in multiple myeloma?
M-spike
What will you see in the urine in multiple myeloma?
Bence Jones protein
Does multiple myeloma lead to increase or decreased osteoclastic activity?
Increased (will make the bone not rebuild itself, sings it a “lullaby”)
What is myeloma kidney?
Precipitation of protein in tubules (leads to renal failure; 2nd MC cause of death in MM patients)
When would you see blastic lesions in a MM patient?
- Very small percentage of patients will have blastic lesions initially (3%)
- However, commonly seen when being treated for MM
Most frequent sites for MM?
Bones with active hematopoietic tissue (same as mets)
Would a bone scan be negative or positive in MM?
Usually negative (10% would be positive)
Better advanced imaging choice for MM?
MRI (very sensitive to marrow changes)
MM prognosis?
Very poor, more palliative care
What is Solitary Plasmacytoma?
Basically same as MM, but just one lesion and occurs in younger patients.
Favored sites for Solitary Plasmacytoma?
Flat Bones: Mandible, Ilium, vertebrae, ribs, proximal femur, scapula
Common plain film findings in Solitary Plasmacytoma?
Geographic, lytic, highly expansile, “soap bubbly”
What do most patients with Solitary Plasmacytoma develop within 5 years?
Multiple Myeloma
