From the case:
Multiple myeloma
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Bony lytic lesions in skull are well defined, as if 'punched out'.
Case Discussion
Multiple myeloma is the most common primary malignant bone neoplasm in adults and results in a wide range of radiographic abnormalities.
Multiple myeloma may simulate carcinomatosis radiologically, but is distinguishable from it by the absence of a known primary lesion and the presence of Bence-Jones proteins in the urine, an abnormal serum electrophoretic pattern with an excess of gamma globulin, and myeloma cells in a marrow biopsy sample.
Four main radiological patterns are recognized 9:
- type 1: solitary - similar in appearance to bone cysts
- type 2: multiple osteolytic lesions without marginal sclerosis
- central
- peripheral
- type 3: diffuse osteoporosis with generalized involvement
- type 4: diffuse osteosclerosis