Multiple Myeloma

FACTS

  • Generally can occur in calvarium, skull base, and spine (causing myelopathy and radiculopathy). intraparenchymal mets are extremely rare.
  • raises susceptibility to infection (plasma cells interfere with normal immune system)
  • overproduction of proteins by plasma cells may lead to hyperviscosity syndrome, amyloidosis, and renal failure
  • bony involvement usually restricted to sites of red marrow: ribs, sternum, spine, clavicles, skull, proximal extremities

HPI

Bloodwork: 24h urine for kappa Bence-Jones protein, SPEP w/ reflex IFE, FLC, CBC w/ anemia

PHYSICAL EXAM

complete spine exam
evaluate for carpal tunnel syndrome (deposition of amyloid within flexor reinaculum of wrist)

IMAGING

XRAY: multiple "punched out" lytic lesions (Sharply demarcated)
A/P
  1. Radio-surgery is generally first line treatment (can allows fx to heal, even effective in spinal cord compression 2/2 tumor)
  1. Operative: perc kyphoplasty for pain, surgery for stabilization if absolutely needed
  1. For carpal tunnel syndrome: surgical division of transverse carpal ligemant indicated since median nerve itself not involved with amyloidosis.
  1. Medical treatment per oncologists
Figure 1: pathologic anterior arch of R C1 fx 
Figure 1: pathologic anterior arch of R C1 fx