Multiple Myeloma Flashcards Preview

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Flashcards in Multiple Myeloma Deck (27):
1

what is a multiple myeloma?

neoplasm of antibody secreting B cells (plasma cells)

2

what are plasma cells?

terminally differentiated B cells that secrete antibodies

3

immunophenotype of plasma cells

CD19+, CD138+, CD56-

4

where do normal plasma cells reside?

lymph nodes and bone marrow

5

morphologic features of normal plasma cells

eccentric nuclei, clumped clockface nuclear chromatin, perinuclear clear zone for golgi, abundant gray cytoplasm

6

CD138

syndecan. indicative of plasma cells

7

CD56

NCAM. cell adhesion molecule expressed by neoplastic plasma cells. allows them to home in on bone marrow rather than accumulate in medullary zone of lymph nodes

8

epidemiology of multiple myeloma

common in african americans, affects age 70+,

9

clinical features of multiple myeloma

multifocal, osteolytic lesions and successive fractures, trabecular destruction leading to hypercalcemia, anemia via marrow destruction and renal failure (EPO)

10

where are the osteolytic lesions of multiple myeloma most commonly found?

axial skeleton, particularly the vertebrae/ribs/skull

11

soft tissue tumors of multiple myeloma

plasmacytomas. commonly found in vertebral column, which is an emergency since they cause cord compression

12

morphology of multiple myeloma

hyper cellular marrow: clusters or sheets of monoclonal plasma cells, replacement of marrow elements, destruction and resorption of bone. VARIABLE MORPHOLOGY

13

flame cell

IgA expressing plasma cells with pink border

14

Mott cells

look bubbly. have accumulated globules of intracytoplasmic monoclonal Ig

15

M protein/paraprotein

unique homogenous monoclonal Ig secreted by plasma cells

16

MGUS

monoclonal gammopathy of undetermined significance. low grade asymptomatic proliferation that isn't clearly neoplastic. most likely won't progress to multiple myeloma, but some do

17

what can the kidney filter in terms of Ig?

light chains can pass through the glomerulus

18

difference in Ig production of normal and neoplastic plasma cells

neoplastic cells: unbalanced production--> excess light or heavy chains.

19

Bence Jones Protein

excess light chains in urine. can be used to diagnose multiple myeloma

20

most common paraproteins

IgG and kappa

21

why are patients with multiple myeloma immunodeficient and anemic?

increase in monoclonal Ig leads to a decrease in other types. Same goes for types of cells in the bone marrow

22

name for immunodeficiency of multiple myeloma

humoral immune paresis

23

two main causes of deaths in MM patients

immunodeficiency (recurrent bacterial infections) & renal failure (myeloma kidney)

24

myeloma kidney

due to cast nephropathy, proximal tubulopathy, hypercalcemia, amyloidosis

25

cast nephropathy

excess light chains settle out in aggregates in the distal nephron, forming obstructive casts

26

consequences of paraprotein

serum hyper viscosity with rouleaux formation. causes vascular complications like visual impairment, neurological problems, and bleeding. Cryoglobulinemia (Raynauds phenomenon), amyloidosis.

27

MM prognosis

variable (1-many years) without a cure