Difference between revisions of "IPLab:Lab 6:Multiple Myeloma"
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This 63-year-old female presented with the complaint of left chest pain of approximately 4 months duration. Physical examination revealed that the pain was along the distribution of the left sixth intercostal nerve. Chest film showed a posterior mediastinal mass with partial collapse of T6. A lytic lesion of the right distal clavicle was noted on subsequent radiological examination. A bone scan revealed increased uptake in thoracic vertebrae. Serum alkaline phosphatase was elevated slightly (143 U/L). Serum protein electrophoresis was normal, while urine protein electrophoresis showed a monoclonal spike in the Gamma region. A bone marrow study was non-diagnostic. | This 63-year-old female presented with the complaint of left chest pain of approximately 4 months duration. Physical examination revealed that the pain was along the distribution of the left sixth intercostal nerve. Chest film showed a posterior mediastinal mass with partial collapse of T6. A lytic lesion of the right distal clavicle was noted on subsequent radiological examination. A bone scan revealed increased uptake in thoracic vertebrae. Serum alkaline phosphatase was elevated slightly (143 U/L). Serum protein electrophoresis was normal, while urine protein electrophoresis showed a monoclonal spike in the Gamma region. A bone marrow study was non-diagnostic. | ||
| − | == | + | == Surgical Pathology Findings == |
A thoracotomy was performed after an unsuccessful needle biopsy. At thoracotomy, a 3-cm posterior mediastinal mass was identified that extended to within 1-2 mm of the aorta and into the interspace between the ribs. | A thoracotomy was performed after an unsuccessful needle biopsy. At thoracotomy, a 3-cm posterior mediastinal mass was identified that extended to within 1-2 mm of the aorta and into the interspace between the ribs. | ||
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File:IPLab6MM4.jpg|This is a photograph of the vertebral column from this patient at autopsy. Notice the collapsed vertebra (1). There are multiple variably-sized white nodules (2) within the bone marrow. These are accumulations of malignant plasma cells in this case of multiple myeloma. | File:IPLab6MM4.jpg|This is a photograph of the vertebral column from this patient at autopsy. Notice the collapsed vertebra (1). There are multiple variably-sized white nodules (2) within the bone marrow. These are accumulations of malignant plasma cells in this case of multiple myeloma. | ||
</gallery> | </gallery> | ||
| + | |||
| + | == Virtual Microscopy == | ||
| + | <peir-vm>IPLab6MM</peir-vm> | ||
| + | |||
| + | == Study Questions == | ||
| + | * <spoiler text="What class of amyloid is this?">AL - Immunocyte dyscrasias - primary amyloidosis.</spoiler> | ||
| + | * <spoiler text="What is the chemical nature of this type of amyloid?">Immunoglobulin light chains, usually lambda.</spoiler> | ||
| + | * <spoiler text="What is the usual organ distribution of amyloid in this class of amyloidosis?">Heart, gastrointestinal tract, peripheral nerves, skin, and tongue.</spoiler> | ||
| + | |||
| + | == Additional Resources == | ||
| + | === Reference === | ||
| + | * [http://emedicine.medscape.com/article/204369-overview eMedicine Medical Library: Multiple Myeloma] | ||
| + | * [http://www.merckmanuals.com/professional/hematology_and_oncology/plasma_cell_disorders/multiple_myeloma.html Merck Manual: Multiple Myeloma] | ||
| + | |||
| + | === Journal Articles === | ||
| + | * Rodon P, Linassier C, Gauvain JB, Benboubker L, Goupille P, Maigre M, Luthier F, Dugay J, Lucas V, Colombat P. [http://www.ncbi.nlm.nih.gov/pubmed/11168502 Multiple myeloma in elderly patients: presenting features and outcome]. ''Eur J Haematol'' 2001 Jan;66(1):11-7. | ||
| + | |||
| + | === Images === | ||
| + | * [{{SERVER}}/library/index.php?/tags/327-multiple_myeloma PEIR Digital Library: Multiple Myeloma Images] | ||
| + | * [{{SERVER}}/library/index.php?/tags/65-amyloidosis PEIR Digital Library: Amyloidosis Images] | ||
| + | * [http://library.med.utah.edu/WebPath/HEMEHTML/HEMEIDX.html#6 WebPath: Myeloma] | ||
| + | |||
| + | == Related IPLab Cases == | ||
| + | * [[IPLab:Lab 6:Amyloidosis|Lab 6: Liver: Amyloidosis]] | ||
| + | * [[IPLab:Lab 6:Senile Amyloidosis|Lab 6: Heart: Senile Amyloidosis]] | ||
{{IPLab 6}} | {{IPLab 6}} | ||
[[Category: IPLab:Lab 6]] | [[Category: IPLab:Lab 6]] | ||
Latest revision as of 16:20, 3 January 2014
Contents
Clinical Summary[edit]
This 63-year-old female presented with the complaint of left chest pain of approximately 4 months duration. Physical examination revealed that the pain was along the distribution of the left sixth intercostal nerve. Chest film showed a posterior mediastinal mass with partial collapse of T6. A lytic lesion of the right distal clavicle was noted on subsequent radiological examination. A bone scan revealed increased uptake in thoracic vertebrae. Serum alkaline phosphatase was elevated slightly (143 U/L). Serum protein electrophoresis was normal, while urine protein electrophoresis showed a monoclonal spike in the Gamma region. A bone marrow study was non-diagnostic.
Surgical Pathology Findings[edit]
A thoracotomy was performed after an unsuccessful needle biopsy. At thoracotomy, a 3-cm posterior mediastinal mass was identified that extended to within 1-2 mm of the aorta and into the interspace between the ribs.
Images[edit]
This is a low-power photomicrograph of the mediastinal mass. The mass is encapsulated and contains cellular areas (blue) and areas of pale red material.
This higher-power photomicrograph shows the junction between an amorphous hyaline-appearing area (amyloid) on the right and cellular areas (plasmacytoid cells) on the left.
This high-power photomicrograph demonstrates the cells that make up this tissue. These cells resemble plasma cells and are the malignant cell of multiple myeloma.
This is a photograph of the vertebral column from this patient at autopsy. Notice the collapsed vertebra (1). There are multiple variably-sized white nodules (2) within the bone marrow. These are accumulations of malignant plasma cells in this case of multiple myeloma.
Virtual Microscopy[edit]
Study Questions[edit]
Additional Resources[edit]
Reference[edit]
Journal Articles[edit]
- Rodon P, Linassier C, Gauvain JB, Benboubker L, Goupille P, Maigre M, Luthier F, Dugay J, Lucas V, Colombat P. Multiple myeloma in elderly patients: presenting features and outcome. Eur J Haematol 2001 Jan;66(1):11-7.
Images[edit]
- PEIR Digital Library: Multiple Myeloma Images
- PEIR Digital Library: Amyloidosis Images
- WebPath: Myeloma
Related IPLab Cases[edit]
Malignant bone lesions are part of the differential for increased uptake of isotope during a bone scan.
A normal alk-phos level is 39 to 117 U/L.
A thoracotomy is a surgical procedure in which an opening is made in the chest wall.
