Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Demographics, pathology, and outcomes of 7 patellar tumors, including 2 giant cell tumors, 2 chondroblastomas, 1 osteoid osteoma, 1 osteitis fibrosa cystica, and 1 case of myelomatous infiltration, are described. Five male and 2 female patients with a mean age of 42.5 years were followed for an average of 3.5 years. Anterior knee pain was the main presenting symptom. Two patients presented with pathologic fracture. One patient with chondroblastoma underwent curettage only; the second patient underwent curettage and bone grafting. Both patients with giant cell tumors underwent total patellectomy. Patients with osteoblastoma and osteitis fibrosa cystica underwent excision of the lesion. The patient with myeloma underwent radiotherapy. Patellar tumors represent special management problems because of their subcutaneous location, relationship to the extensor mechanism, and difficulties in interpretation of radiographs. A satisfactory outcome can be expected in the majority because of the predominantly benign nature of the lesions and straightforward operative intervention after diagnosis.
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PMID:Presentation and outcome of primary tumors of the patella. 1868 83

Predicting prognosis is the key factor in selecting the proper treatment modality for patients with spinal metastases. Therefore, various assessment systems have been designed in order to provide a basis for deciding the course of treatment. Such systems have been proposed by Tokuhashi, Sioutos, Tomita, Van der Linden, and Bauer. The scores differ greatly in the kind of parameters assessed. The aim of this study was to evaluate the prognostic value of each score. Eight parameters were assessed for 69 patients (37 male, 32 female): location, general condition, number of extraspinal bone metastases, number of spinal metastases, visceral metastases, primary tumour, severity of spinal cord palsy, and pathological fracture. Scores according to Tokuhashi (original and revised), Sioutos, Tomita, Van der Linden, and Bauer were assessed as well as a modified Bauer score without scoring for pathologic fracture. Nineteen patients were still alive as of September 2006 with a minimum follow-up of 12 months. All other patients died after a mean period of 17 months after operation. The mean overall survival period was only 3 months for lung cancer, followed by prostate (7 months), kidney (23 months), breast (35 months), and multiple myeloma (51 months). At univariate survival analysis, primary tumour and visceral metastases were significant parameters, while Karnofsky score was only significant in the group including myeloma patients. In multivariate analysis of all seven parameters assessed, primary tumour and visceral metastases were the only significant parameters. Of all seven scoring systems, the original Bauer score and a Bauer score without scoring for pathologic fracture had the best association with survival (P < 0.001). The data of the present study emphasize that the original Bauer score and a modified Bauer score without scoring for pathologic fracture seem to be practicable and highly predictive preoperative scoring systems for patients with spinal metastases. However, decision for or against surgery should never be based alone on a prognostic score but should take symptoms like pain or neurological compromise into account.
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PMID:Predictive value of seven preoperative prognostic scoring systems for spinal metastases. 1881 57

The authors present a rare case of plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma in a 42-year-old woman. The lesion was surgically removed and analyzed. Histopathological examination with immunostaining revealed it to be positive for immunoglobulin G and Kappa chains, demonstrating monoclonality. However, no abnormality was observed on serum electrophoresis, skeletal survey and bone marrow aspiration. Therefore, the tumor was diagnosed solitary plasmacytoma of bone. The patient was treated with external beam radiotherapy and has remained disease free for 5 years and 6 months until 2007, when she presented a pathological fracture due to multiple myeloma. Extensive medical work-up to rule out multiple myeloma or other malignant lymphoproliferative conditions involving orbit or ocular adnexa is needed when the diagnosis of solitary plasmacytoma of bone is suspected because treatment and prognosis are very different.
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PMID:Plasmacytoma of the orbit involving lacrimal gland with secondary transformation into multiple myeloma: case report. 1946 36

Instability of the high cervical spine, particularly C1 and C2, is commonly treated via a posterior approach. Access to this region via transoral approaches is often avoided due to the high risk of wound contamination, limited exposure, and lack of experience on the part of the surgeon. We present a 48-year-old man exhibiting complete C2 vertebral body involvement by multiple myeloma with a pathologic fracture, which we treated via the anterolateral/retropharyngeal approach to the high cervical spine. The anterolateral/retropharyngeal approach provides relatively easy access to the anterior arch of C1 and to the vertebral bodies of C2-4 and can be applied to a variety of different conditions. In addition, this approach may be a viable alternative to the transoral route and its associated morbidities.
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PMID:Retropharyngeal/anterolateral approach for C2 corpectomy. 1977 39

Multiple myeloma is characterized by clonal proliferation of plasma cells usually of the B cell type. The skeletal manifestations are usually osteolytic lesions whose differential diagnosis includes primary and secondary bone tumor. This tumor is characterized by the presence of abnormal paraprotein 8 in blood and urine. However, one to five per cent of the cases do not have any protein. Hence they are termed nonsecretory. It often poses a diagnostic dilemma when it is presented to orthopedic surgeons with no clear features of the disease. Our case report exemplifies such a diagnostic dilemma. A high index of suspicion must be borne in mind when excluding multiple myeloma as a cause of pain, pathological fracture or lytic lesion.
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PMID:Nonsecretory multiple myeloma. 1983 94

Multiple myeloma is a malignancy of plasma cells. The (18)F-FDG PET findings of multiple myeloma have been reported previously. However, the (11)C-acetate PET findings have not been clarified. Here, we report a case of multiple myeloma detected with (11)C-acetate PET in a 51-year-old male patient with known hepatocellular carcinoma. The patient was admitted for management of a pathologic fracture of the right tibia. Imaging workup including X-ray, magnetic resonance image, bone scintigraphy; (18)F-FDG led to a suspicion of metastatic bony lesions. Further, these lesions showed increased uptake on (11)C-acetate PET. Wide excision of the right tibia was performed, and histopathological examination of the lesion confirmed multiple myeloma. This case illustrates the characteristic (11)C-acetate PET findings of multiple myeloma.
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PMID:Incidental finding of an 11C-acetate PET-positive multiple myeloma. 2001 59

Bone disease (BD) is the hall-mark clinical feature of multiple myeloma (MM), accounting up to 60% of patients with bone pain at diagnosis and 60% with a pathologic fracture during the course of their disease. Experimental models, which recapitulate in vivo the human bone marrow microenvironment (HBMM) in immunodeficient mice have been recently developed as valuable tool for the study of MM pathophysiology as well as the experimental treatment of BD. At present, bisphosphonates are the mainstay treatment of MM-related BD. The growing information on the cellular and molecular bases of BD as well as the availability of novel anti-resorptive agents, such as the IgG1-anti-RANKL (AMG 161) Denosumab, are now depicting a new scenario where the treatment will be afforded by the use of different agents. Furthermore the availability of highthroughput molecular profiling approaches, including DNA microarrays and proteomics, is likely to provide new platforms for patients stratification and treatment individualization on specific targets. It is now the right time for a therapeutical approach which is rationally based on the complexity of the biopathology of MM-related BD.
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PMID:Challenging the current approaches to multiple myeloma-related bone disease: from bisphosphonates to target therapy. 2002 73

Skeletal lesions in multiple myeloma are predominantly lytic and when non-union of pathological fractures occur it is typically atrophic. We report a lady of 61 years of age with myeloma who presented with a pathological fracture through an ulnar myeloma deposit. The fracture was immobilised initially then irradiated. Nine months later she re-presented with marked forearm pain particularly on rotation. Radiographs demonstrated a hypertrophic non-union of a pathological fracture with a typical elephant's hoof appearance. The fracture was immobilised using an ulnar nail. Whilst non-unions in metastatic malignancy are typically atrophic, just occasionally hypertrophic non-unions can occur. Management principles remain the same with stabilisation of the entire bone and early mobilisation being appropriate.
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PMID:Hypertrophic non-union of a pathological forearm fracture secondary to multiple myeloma: a case report. 2040 18

Appropriate imaging modalities for screening, staging, and surveillance of patients with suspected and documented metastatic disease to bone include (99m)Tc bone scanning, MRI, CT, radiography, and 2-[(18)F]fluoro-2-deoxyglucose-PET. Clinical scenarios reviewed include asymptomatic stage 1 breast carcinoma, symptomatic stage 2 breast carcinoma, abnormal bone scan results with breast carcinoma, pathologic fracture with known metastatic breast carcinoma, asymptomatic well-differentiated and poorly differentiated prostate carcinoma, vertebral fracture with history of malignancy, non-small-cell lung carcinoma staging, symptomatic multiple myeloma, osteosarcoma staging and surveillance, and suspected bone metastasis in a pregnant patient. No single imaging modality is consistently best for the assessment of metastatic bone disease across all tumor types and clinical situations. In some cases, no imaging is indicated. The recommendations contained herein are the result of evidence-based consensus by the ACR Appropriateness Criteria((R)) Expert Panel on Musculoskeletal Radiology.
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PMID:ACR appropriateness criteria on metastatic bone disease. 2052 92

Many patients with solid tumors, especially breast and prostate cancers, and with multiple myeloma will develop bone metastases or other skeletal complications. The management of bone loss and symptomatic bone metastases is an important issue in the care and maintenance of quality of life for these patients. Morbidity caused by skeletal complications include pain (bone metastases are known as the most common cause of cancer-related pain), hypercalcemia, pathologic fracture, compression of the spinal cord or cauda equine, and spinal instability. Currently, the only Food and Drug Administration-approved therapy for metastatic bone disease is bisphosphonate therapy. A greater understanding of the biomolecular pathways that govern the bone continuum of cancer has helped identify novel targets for drug development. New therapeutic options are currently being investigated for the treatments of bone loss and symptomatic bone metastases. Some of these new drugs and modalities are in advanced stages of clinical development and may soon reach the clinic.
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PMID:Bone continuum of cancer. 2052 89


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