Multiple Myeloma

Question 1

What is a multiple myeloma ?

Answer 1

Neoplasm of plasma cells in bone marrow

May secret IG or IG Fragments

Question 2

What’s the difference between multiple myeloma and plasmacytoma ?

Answer 2

MM has a diffuse infiltration of the bone marrow

Plasmacytoma is subgroup , which presents with a extramedullay mass affecting bone (axial ) or soft tissue

Question 3

Name 3 types of multiple myeloma .

Answer 3

IgG (25%)
IgA (25%)
Bence jones ( feee light chains excretes in urine )

Question 4

What’s the Patho physiology of Multiple myeloma ?

Answer 4

1) proliferation of plasma cells
–> infiltration of bone marrow –> loss of hematopoesis –> low RBC, WBC, thrombocytes
And cell proliferation leads to ostelysis –> hypercalcaemia

2) overproduction of non functional Ig –> deficiency of functional Ines plus hyperviscosity

Question 5

What are typical clinical features of Multiple myeloma?

Answer 5

Bone pain 
Osteoporosis, spontan fracture 
Hypercalcaemia 
Renal failure (obstruction of tubules)
Foamy urine
Infection 
Anaemia

Question 6

A foamy urine is suggestive of which type of Multiple myeloma ?

Answer 6

Bence jones

Question 7

Which clinical feature helps you to differentiate lymphomas from multiple myeloma ?

Answer 7

No lymphadenopathy in MM

Question 8

Name 2 crucial investigations in a patient suspicious of multiple myeloma and their characteristic findings .

Answer 8

Protein electrophoresis 
(Best initial test )
--> peak in gamma globulin ( m protein) 
Bone marrow biopsy 
( confirms diagnosis )
--> cluster of plasma cells

Question 9

Name 4 complications of multiple myeloma and plasmacytoma .

Answer 9

Hypercalcaemic crisis
–> Dehydration, fever, psychosis

AL amyloidosis

Renal disease : cast nephropathy

Secondary plasma cell leukaemia

Hyperviscosity