MYELOMA LECTURE Flashcards
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What are the stereotypical findings on histology of multiple myeloma?
Bright purple/pink cytoplasmLarge Golgi from producing lots of proteinsNon-symmetrical nucleigreater than 1:20 ratio of plasma cells
Where does multiple myeloma begin?What are plasma cells?Where are they found?
Bone marrowPlasma cells are mature B lymphocytes that produce antibodies
~5% in the bone marrow and throughout lymphoid tissue
Is the disease patchy or continuous?Where does it mostly effect?
Patchy throughoutEffects pelvis, spine, rib cage, skull, shoulders, hips, humerus, femur
What is the most frequent feature of multiple myeloma?
Bone disease is the most common feature of multiple myeloma, approximately 2/3 of patients at diagnosis and in nearly all patients during the course of the disease.Evidence of bone disease is an indication to srat treatment (occasionally solitary plasmacytoma)
What is the best imaging tool for multiple myeloma?
Core whole body MRI protocol
Clonal plasma cells produce a single immunoglobulin. Monoclonal proteins are termed M-protein or paraprotein. This is an essential cancer marker. What is the difference with a light chain myeloma?
Some myelomas may only produce lambda light chains and not the full immunoglobulin molecule. These light chains are expressed in the urine and in the serum as Bence Jones protein.
How many new cases per year?What is the median age?Which race has the highest preponderance?
300065-70Afro-caribbean
What are the clinical features of myeloma? (CRABI)
C= HypercalcaemiaR= Renal impairmentA= AnaemiaB= Bone pain and destruction (fractures, cord compression)I= Recurrent infections
What are the diagnostic criteria for multiple myeloma?
M-protein serum >30g/L+/- bone marrow plasma cells >10% (excess plasma cells)Related organ damage
What is MGUS?
Monoclonal gammopathy of uncertain significanceIs a benign condition that does not cause symptoms or damage. Pre-malignant forerunner of myeloma, tiny clone of plasma cells.1% risk of progression each year, this does not increase or decrease over time.90% of MGUS’ do not progress to myeloma but 90% of myelomas have had an MGUS stage
{{10 1 0.png}}What is this?How would it be described?
This is a multiple myeloma lytic lesion.Most often when bone is destroyed through cancer there is a white rim around the lesion due to new bone formation (sclerotic), myeloma inhibits new bone formation and so it is referred to as lytic.
WHat causes renal damage in multiple myeloma?
Light chain deposition in renal tubules leading to cast nephropathy. In healthy people the light chain is filtered back via the proximal tubule. In myeloma the light chain precipitates out
What is a plasmocytoma?
A localised deposit of plasma cells. Can be in bony or soft tissue. May be associated with a small monoclonal paraprotein.Treat with radiotherapyRisk of recurrence into myeloma
How is myeloma diagnosed?
Serum electrophoresisBone marrow biopsySkeletal surveyFBCBlood chemistry
