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Query: UMLS:C0026764 (multiple myeloma)
 36,148 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The specific emphasis in this article has been directed toward the diagnosis of prevalent shoulder pathology in a young athletic population; however, as the interest in sports has blossomed in recent years now encompassing a larger age range, the physician must not neglect common pathologic conditions of the older athletes. Fastidious adherence to complete history, physical examination, and a high level of suspicion for uncommon disorders is paramount. Arthritides such as osteo, rheumatoid, septic, and lyme as well as the hematologic disorders of multiple myeloma, lymphomas, leukemia, hemophilia, and Gaucher's disease can all present with shoulder pain. Thoracic outlet syndrome, scalene syndrome, supra-scapular nerve syndrome, and quadrilateral space syndrome comprise a group of nerve compression syndromes that are becoming more apparent as our diagnostic skills improve. Yet, the most pervasive disorders in the young athlete are due to lack of shoulder stability. By understanding the delicate balance in normal shoulder between mobility and stability, the clinician is better able to conceptualize the etiology and progression of the problem, and design the optimal treatment program.
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PMID:The diagnosis and nonoperative treatment of shoulder injuries in athletes. 267 Feb 66

Bone pain, especially back pain, is a common presenting feature of myeloma patients. We report three multiple myeloma patients with exacerbations of back pain and referred shoulder pain resulting from vertebral infections. Two patients were treated with surgery, and one patient had computerized tomography-guided percutaneous needle aspiration for diagnostic purposes. All three patients received a prolonged course of antibiotics. Vertebral infection resolved with this treatment in all three patients without any recurrence. Previous dexamethasone therapy, together with an episode of bacteraemia, appears to be a predisposing factor for vertebral infection. Magnetic resonance imaging enabled the diagnosis in all three patients.
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PMID:Infection--an underappreciated cause of bone pain in multiple myeloma. 1264 75

Inspite the new informations about the physiology and biochemistry of pain, it remains true that pain is only partially understood. Cancer pain is often experienced as several different types of pain, with combined somatic and neuropathic types the most frequently. If the acute cancer pain does not subside with initial therapy, patients experience pain of more constant nature, the characteristics of wich vary with the cause and the involved sites. Chronic pain related to cancer can be considered as tumor-induced pain, chemotherapy-induced pain, and radiation therapy-induced pain. Certain pain mechanisms are present in cancer patients. These include inflammation due to infection, such as local sepsis or the pain of herpes zoster, and pain due to the obstruction or occlusion of a hollow organ, such as that caused by large bowel in cancer of colon. Pain also is commonly due to destruction of tissue, such as is often seen with bony metastases. Bony metastases also produce pain because of periostal irritation, medullary pressure, and fractures. Pain may be produced by the growth of tumor in a closed area richly supplied with pain receptors (nociceptors). Examples are tumors growing within the capsule of an organ such as the pancreas. Chest pain occurring after tumor of the lung or the mediastinum due to invasion of the pleura. Certain tumors produce characteristic types of pain. For example, back pain is seen with multiple myeloma, and severe shoulder pain and arm pain is seen with Pancoast tumors.
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PMID:Cancer pain (classification and pain syndromes). 1601 3

Xanthomas are rare bone tumors that occur more often in the appendicular skeleton and typically appear radiographically benign, with a narrow zone of transition and a sclerotic rim. We report the case of a 57-year-old woman with hyperlipidemia presenting with bilateral shoulder pain after minor trauma. Radiographic and histopathologic investigation demonstrated intraosseous xanthoma with atypical features, including multifocality, a wide zone of transition and pathologic fractures-characteristics more commonly associated with aggressive lesions such as multiple myeloma or metastasis. The diagnosis, imaging, and histological appearance of xanthoma of bone are reviewed.
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PMID:Bilateral primary xanthoma of the humeri with pathologic fractures: A case report. 2419 13

Multiple myeloma (MM) is characterized by progressive proliferation of malignant plasma cells, usually initiating in the bone marrow. MM can affect any organ; a total of 7 - 18% of patients with MM demonstrate extramedullary involvement at diagnosis. Non-secretory multiple myeloma (NSMM) is a rare variant that accounts for 1 - 5% of all cases of multiple myeloma. The disease is characterized by the absence of monoclonal gammopathy in serum and urine electrophoresis. Our case report highlights the diagnostic challenge of a case of NSMM with extensive extramedullary involvement in a young female patient who initially presented with right shoulder pain and bilateral breasts lumps. Skeletal survey showed multiple lytic bony lesions. The initial diagnosis was primary breast carcinoma with osseous metastases. No monoclonal gammopathy was found in the serum or urine electrophoresis. Bone marrow and breast biopsies revealed marked plasmacytosis. The diagnosis was delayed for a month in view of the lack of clinical suspicion of multiple myeloma in a young patient and scant biochemical expression of non-secretory type of multiple myeloma.
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PMID:Non Secretory Multiple Myeloma With Extensive Extramedullary Plasmacytoma: A Diagnostic Dilemma. 2652 83

A 59-year-old man presented with a 7-month history of increasing left shoulder pain. The initial plain films showed near absence of the left scapula and scattered lucent changes in the left humerus. A CT scan confirmed the presence of widespread lytic bony lesions, with a large soft-tissue mass centered around the left scapula. An isotope bone scan demonstrated marked uptake of MDP in the stomach and nasal mucosa. Further laboratory investigations revealed marked hypercalcemia and the presence of Bence-Jones protein in the urine. An ultrasound-guided biopsy of the soft-tissue mass confirmed the diagnosis of multiple myeloma.
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PMID:Marked gastric uptake of Tc-99m methylene diphosphonate (MDP) in a patient with myeloma and hypercalcemia. 2733 May 91

Idiopathic Brachial Neuritis (IBN), is a rare brachial plexopathy with an unknown aetiology. Multiple myeloma is a neoplastic plasma cell disease characterised by bone lesions. In this article, we present the case of a 59-year-old male patient with IBN associated with multiple myeloma, who was admitted to our clinic with right shoulder pain and right arm weakness. He experienced muscle weakness and atrophy in his right arm after a sudden onset of pain attack in the shoulder. Plexus and cervical vertebral MRI showed no pathology. Electrodiagnostic studies showed upper and middle trunk plexopathies. Laboratory analysis revealed anaemia, hypercalcaemia, renal dysfunction and monoclonal gammopathy in immunoglobulin electrophoresis. A bone marrow biopsy established the diagnosis of IgG kappa multiple myeloma. This is the first case report that presents the association of multiple myeloma and IBN.
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PMID:Idiopathic Brachial Neuritis in a Patient with Multiple Myeloma. 2876 28

Solitary plasmacytoma is a rare form of plasma cell neoplasm defined by local neoplastic accumulation of monoclonal plasma cells in the absence of systemic proliferative plasma cell disease. In this case report, a 65-year-old female with remote past medical history of papillary thyroid cancer presented with shoulder pain and radiographs showing an aggressive osteolytic lesion presumed to represent an osseous metastasis. The subsequent MRI and CT examinations demonstrated diffuse intralesional macroscopic fat without a nonlipogenic soft tissue component or focal, nodular mass-like enhancement. The presence of macroscopic fat in an untreated osseous lesion suggested a benign lesion with the favored diagnosis an intraosseous lipoma with non-displaced pathological fracture. Therefore, the decision was made to forego image-guided percutaneous biopsy and instead proceed directly to open surgical biopsy and partial distal claviculectomy. Pathology of the resected specimen showed focally dense infiltration of plasma cells within the marrow space and scant hematopoiesis compatible with a plasma cell neoplasm. To the best of our knowledge, this is first case report of solitary plasmacytoma of bone, or any untreated plasma cell neoplasm, containing macroscopic fat upon imaging. The decision to forego image-guided percutaneous biopsy had significant treatment implications as the primary therapy for patients with SPB is not surgical, but localized radiation therapy. Based on this case, solitary plasmacytoma of bone may be included as one of the rare fat containing malignant bone lesions and imaging guided percutaneous biopsy should be considered in symptomatic fat-containing bone lesions.
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PMID:Untreated plasmacytoma of bone containing macroscopic intralesional fat and mimicking intraosseous lipoma: A case report and review of the literature. 3220 79

Although solitary plasmacytomas may occasionally present as collar bone swellings or fractures, multiple myeloma involving clavicle is extremely rare. Ten to forty per cent of multiple myeloma cases are asymptomatic and are incidental diagnoses. Our case report describes an entirely benign presentation like chronic shoulder pain masquerading advanced myeloma, thereby posing a significant diagnostic dilemma. We present a 48-year-old man who presented with chronic bilateral shoulder pain with no history of trauma and was eventually diagnosed with advanced multiple myeloma and pathologic fracture of the right clavicle. It is, therefore, evident that a low threshold for suspicion can lead to early diagnosis and initiation of treatment and better survival.
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PMID:Advanced myeloma masquerading as chronic shoulder pain in a 48-year-old man: a diagnostic dilemma. 3246 14

Multiple myeloma (MM) is a malignant tumor originating from plasma cells that synthesize immunoglobulin in an abnormal amount and invade the bone marrow. The presenting symptoms have usually been severe bone pain, osteolytic bone damage and pathologic fractures, hypercalcemia, kidney damage, compromised immune function, and anemia. The patient age is typically over 40, with the majority of the cases diagnosed between ages 50 and 70. MM occurs in hematopoietic locations with red marrows; most common locations include the vertebrae, ribs, skull, pelvis, and proximal long bones. It often has extensive bone destruction with no reactive bone formation and a large soft tissue component similar to the lesion. In the literature, the presence of pathological fracture in the humerus is generally seen as the first clinical manifestation of MM. In this report, it is presented a case with MM occurring in the right humerus after strain and presenting only shoulder pain without pathologic fracture.
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PMID:Presentation of multiple myeloma occurring in the humerus after strain: a case report. 3261 89


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