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There
are two important variants of
myeloma,
solitary bone plasmacytoma
extramedullary plasmacytoma
Solitarybone plasmacytoma is a
single lytic bone lesion without
marrow plasmacytosis
Extramedullary plasmacytomas
usually involve the submuscosal
lymphoid tissue of the nasopharynx
or paranasal sinuses without marrow
plasmacytosis.
The cause of myeloma is not known
Common translocations
t(11;14)(q13;q32) and
t(4;14)(p16;q32)
Overexpression of myc or ras
genes has been noted in some
cases
Plasmacytoma 16 cases in 5
years, average of 3 per year
Multiplemyeloma cells bind via cell
surface adhesion molecules to bone
marrow stromal cells and
extracellular matrix.
This
triggers multiple myeloma cell
growth, survival, drug resistance and
migration in the bone marrow milieu
Thecell effect is due to direct
multiple myeloma and bone marrow
stromal cell interaction , as well as
induction of cytokines
secretion
of cell products-
immunoglobulins, lymphokines
Recurrent infections
Hypogammaglobulinaemia, low cd4
count, decreased neutrophil
migration
Neurologicsymptoms
Hyper viscosity, croglobulinemia,
Hypercalcaemia, nerve
compression, POEMS syndrome
Nauseaand vomiting
Renal failure, Hypercalcaemia
The classic triad of myeloma is
i. Marrow plasmacytosis
(>10%)- CD138+, monoclonal
ii. Lytic bone lesions
iii. Serum and/ or urine M
component
Monoclonal gammopathies of
uncertain significance
1% go on to develop myeloma
M protein in serum<30g/l
Bone marrow clonal plasma
cells<10%
No evidence of other B cell
proliferative disorder
Clinical
evaluation of patients with
myeloma includes a careful physical
examination searching for tender
bones and masses.
These are
smallround blue cells
clock face nuclei
abundant cytoplasm
perinuclear clearing or halo
A 24 hr urine specimen
quantitate protein excretion
concentrated aliquot is used for
electrophoresis and immunologic
typing of any M component
The serum M component will be IgG
in 53%, IgA in 25%, and IgD in 1%.
ESR is elavated
Internal
fixation augmented with
methacrylate