Multiple Myeloma: Flashcards
1
Q
Multiple Myeloma:
Commonly characterized by:
A
- Multiple myeloma (MM) is typically characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin.
- The plasma cells proliferate in the bone marrow and can result in extensive skeletal destruction with hypercalcemia, renal dysfunction, anemia, osteolytic lesions, osteopenia, and/or pathologic fractures.
- Because the neoplasm develops from a single cell, all of the daughter cells that comprise the lesional tissue have the same genetic makeup and produce the same proteins
- These proteins are the immunoglobulin components that the plasma cell would normally produce, although in the case of this malignant tumor the immunoglobulins are not normal or functional
2
Q
Multiple Myeloma:
Bone lesions:
A
Commonly, bone lesions may be represented by diffuse or localized osteolytic lesions, named plasmacytomas, or by a ‘punched-out’ pattern
3
Q
Multiple Myeloma:
Conditions associated with ML:
A
- Fever may be present as a result of neutropenia with Petechial hemorrhages of the skin and oral mucosa may be increased susceptibility to infection seen if platelet production has been affected
- Metastatic calcifications may involve the soft tissues and are thought to be caused by hypercalcemia secondary to tumor- related osteolysis
- Renal failure may be a presenting sign in these patients because the kidneys become overburdened with the excess circulating light chain proteins of the tumor cells. These light chain products, which are found in the urine of 30% to 50% of patients with multiple myeloma, are called Bence Jones proteins
4
Q
Multiple Myeloma:
CRAB:
A
The acronym “CRAB” is sometimes used to remember myeloma-defining events that are used in the diagnosis of MM:
- Calcium elevation
- Renal insufficiency
- Anemia
- Bone disease
5
Q
Multiple Myeloma:
Oral Signs and Symptoms:
A
- A variety of oral manifestations in MM have been described
- Up to 35% of patients will have involvement of the mandible with associated swelling, pain, paresthesias, and tooth loss
- Additionally, gingival bleeding or oral petechiae may be causes thrombocytopenia seen, if bone marrow infiltration by malignant plasma cells
- In rare instances, MM can produce extramedullary
- plasmacytomas. When located in the oral cavity, these lesions are most commonly found on the gingivae or hard palate and appear as dome-shaped masses that have a tendency to ulcerate
6
Q
Multiple Myeloma:
Radiographic Features:
A
- Multiple well-defined, punched-out radiolucencies or ragged radiolucent lesions
- These may be especially evident on a skull film
- Although any bone may be affected, the jaws have been reported to be involved
- in as many as 35% of cases
- The radiolucent areas of the bone contain the abnormal plasma cell proliferations that characterize multiple myeloma
