52 y/o woman with fatigue
Publication Date: 6 November 2003
The skull image shows multiple round, punched-out lytic areas. A prominent lytic lesion is noted in the left femur on the next image and one in the right ischium on the third. The fourth image shows a small lesion in the posteriorlateral 5th rib. Note the lack of sclerotic margin.
Laboratory values included anemia, thrombocytopenia, elevated serum calcium and a gamma monoclonal band with an elevated IgG of 8430 (n= 700-1800). IgM was normal. A bone marrow biopsy showed plasma cells in the bone marrow. Physical exam showed no lymphadenopathy or organomegally.
Multiple myeloma is one of the plasma cell neoplasms which also include Waldenstrom's macroglobulinemia. Lytic bone lesions were once thought to distinguish multiple myeloma from Waldenstrom's, however cases of lytic lesions in the latter have been discribed as well. Waldenstrom's is associated with lymphadenopathy and splenomegally with an IgM spike on electrophoresis. Myleoma is not associated with organomegally and shows an IgG spike.