Multiple myeloma

Case contributed by Subash Thapa
Diagnosis certain


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

Patient Data

Age: 50 yrs
Gender: Male

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 generalized reduction of bone density.


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


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 favor 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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