Multiple Myeloma
Multiple Myeloma is characterized by proliferation of bone marrow stem cells resulting in an excess of neoplastic cells with the production of excess abnormal protein, usually immonoglobulins. Identification of these proteins in the blood or urine represents the best diagnostic feature of this disease. The pelvis, spine, ribs and skull are frequently involved.
Persistent unexplained skeletal pain (especially in the back or thorax) renal failure or recurrent bacterial infections, on the most common presenting symptoms. Anemia with weakness and fatigue may predominate in some patients, and few present with manifestations of the hyperviscosity syndrome. Pathologic fractures and vertebral collapse are common; the latter may lead to spinal cord compression and paraplegia.
Physical examination usually is not helpful unless bone pain is present. X-Ray of the bones may show the typical punched-out lytic lesions or a diffuse osteoporosis. The bone marrow usually contains increased numbers of plasma cells at various stages of maturation; rarely, the number of plasma cells is normal. Although sheets and clusters of plasma cells are diagnostic of marrow tumors, myeloma is a patchy disease and often only modest nonspecific plasmacytosis is observed.
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