Difference between revisions of "IPLab:Lab 6:Multiple Myeloma"

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== Clinical Summary ==
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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.
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== Surgical Pathology Findings ==
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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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== Images ==
 
== Images ==
 
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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>
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== Virtual Microscopy ==
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<peir-vm>IPLab6MM</peir-vm>
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== Study Questions ==
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* <spoiler text="What class of amyloid is this?">AL - Immunocyte dyscrasias - primary amyloidosis.</spoiler>
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* <spoiler text="What is the chemical nature of this type of amyloid?">Immunoglobulin light chains, usually lambda.</spoiler>
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* <spoiler text="What is the usual organ distribution of amyloid in this class of amyloidosis?">Heart, gastrointestinal tract, peripheral nerves, skin, and tongue.</spoiler>
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== Additional Resources ==
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=== Reference ===
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* [http://emedicine.medscape.com/article/204369-overview eMedicine Medical Library: Multiple Myeloma]
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* [http://www.merckmanuals.com/professional/hematology_and_oncology/plasma_cell_disorders/multiple_myeloma.html Merck Manual: Multiple Myeloma]
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=== Journal Articles ===
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* 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.
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=== Images ===
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* [{{SERVER}}/library/index.php?/tags/327-multiple_myeloma PEIR Digital Library: Multiple Myeloma Images]
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* [{{SERVER}}/library/index.php?/tags/65-amyloidosis PEIR Digital Library: Amyloidosis Images]
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* [http://library.med.utah.edu/WebPath/HEMEHTML/HEMEIDX.html#6 WebPath: Myeloma]
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== Related IPLab Cases ==
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* [[IPLab:Lab 6:Amyloidosis|Lab 6: Liver: Amyloidosis]]
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* [[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

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]

Images[edit]

Related IPLab Cases[edit]

Lab 6: Immunopathology

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.

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