Multiple myeloma

Case contributed by Dr Subash Thapa

Presentation

Weakness, fatigue, anemia, weight loss and back pain.

Patient Data

Age: 50 yrs
Gender: Male
X-ray

Multiple small, uniform, sharply demarcated “punched out” lytic lesions with no sclerotic margin or periosteal new bone formation involving the skull and the cervical spine.

There are areas of osteolysis involving the mandible.

There is also a generalised reduction of bone density.

X-ray

There are multiple punched out lytic lesions diffusely involving all the ribs, clavicles, scapula, and the spine with generalized reduction of the bone density.

X-ray

Multiple small lytic lesions involving the pelvis bones, femurs, and the sacrum with generalized decrease bone density. Bone expansion is associated with coarse trabeculation producing a soap bubble appearance

Case Discussion

In this patient, bone marrow aspiration analysis was suggestive of multiple myeloma. Urine analysis was positive for Bence Jones protein.

Multiple myeloma should be differentiated from lytic metastases.

Lytic metastases are less likely to be discrete and uniform in size and do not create the same kind of discrete endosteal scalloping as multiple myeloma.

Metastases favour pedicle and posterior elements, and are positive on bone scan.

Mandible is rarely involved in metastases. 

Numerous characteristic lytic lesions in the clavicle are far more likely to be due to myeloma than metastasis.

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Case information

rID: 40195
Case created: 11th Oct 2015
Last edited: 12th Oct 2015
Inclusion in quiz mode: Included

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