3. SOEPEL
• S- A 25 years old Saudi female. She complained of pain in her left leg when she
walk for long distance from one week ago.
• O- taking history and physical examination
• E- DVT, baker cyst and septic thrombophlebitis.
• P- cbc, pt, INR and duplex ultrasound
• E- anticoagulant” warfrien “
• L- multiple myeloma
5. DEFINITION AND INCIDENCE
• Myeloma is a neoplasm of the plasma cells, which are derived from B
lymphocytes.
• It is an uncommon neoplasm, accounting for approximately 1% of adult cancers
in the united states.
• The incidence of myeloma increases with advancing age and is twice as common
in blacks. Approximately and less common in Asians
• the annual incidence is 4 per 100,000.
• 20,000 new cases of multiple myeloma are diagnosed each year in the united
states.
6. EATIOLOGY AND PATHOLOGY
• A. Although no specific underlying causes have been proven, genetic factors, as
well as exposure To petroleum, asbestos, metals, and radiation, may increase
the risk of developing myeloma.
• B. Benign monoclonal gammopathies can progress to multiple myeloma,
although most do not.
• C. Myeloma cells are characterized by genetic instability, and karyotype analysis
often reveals Multiple abnormalities, which can provide prognostic information.
Multiple myeloma is a type of mature B cell lymphoid neoplasm characterized by
accumulation of malignant plasma cells in the bone marrow compartment.
7. CLINICAL FEATURES
• A. Weakness, fatigue, infection, and bleeding due to marrow failure.
• B. Osteolytic lesions
• C. Recurrent infections
• D. Renal abnormalities
• E. Hypercalcemia
• F. Hyperviscosity
• G. Compression of the spinal cord
8. INVISTIGATION
• CBC, creatinine, calcium, β2-microglobulin, LDH.
• SPEP with immunofixation electrophoresis (IFE), UPEP with IFE: to Identify the M spike. Not all serum
paraproteins are detectable in urine And vice versa.
• Bone marrow aspirate and biopsy.
• Skeletal bone plain film survey: lytic lesions are seen in 60–90% of patients.
• Myeloma is characterized by purely osteolytic lesions, so bone scan is And alkaline phosphatase is normal.
• If other findings are consistent, the presence of the jak2 mutation is Highly suggestive of the diagnosis.
9.
10.
11. • Myeloma affecting the skull. Note the rounded lytic translucencies produced by
infiltration of the skull with myeloma cells.
