Multiple myeloma differential diagnosis: Difference between revisions

Latest revision as of 22:46, 29 July 2020

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2] Haytham Allaham, M.D. [3] Shyam Patel [4]

Overview

Multiple myeloma must be differentiated from other causes of bone lesions such as osteoporosis, osteomalacia, scurvy, osteogenesis imperfecta, and homocystinuria. Each condition has unique causes, features, and treatment.

Differentiating Multiple Myeloma from other Diseases

The table below summarizes how to differentiate multiple myeloma from other conditions that have a similar presentation:^[1]^[2]^[3]^[4]^[5]^[6]^[7]

Differential Diagnosis	Causes	Features	Therapy
Multiple myeloma	Chromosomal aberrations or other genetic insults Malignant transformation of plasma cells Clonal plasma cell proliferation	Diffuse bone pain and tenderness with osteolytic lesions Renal failure Hypercalcemia Anemia	Induction chemotherapy with bortezomib, lenalidomide, and dexamethasone Bisphosphonates RANK ligand inhibitors (denosumab) Autologous stem cell transplantation
Monoclonal gammopathy of undetermined significance (MGUS)	Chromosomal aberrations or other genetic insults Clonal plasma cell proliferation	Asymptomatic Serum M protein of <30 g/L Fewer than 10% plasma cells in the bone marrow No evidence of bone or organ damage	Observation
Asymptomatic Plasma Cell Myeloma (Smoldering and Indolent plasma cell myeloma)	Chromosomal aberrations or other genetic insults Malignant transformation of plasma cells Clonal plasma cell proliferation	Asymptomatic Serum M protein of >30 g/L Greater than 10% plasma cells in the bone marrow No evidence of bone or organ damage	Observation
Plasma Cell Leukemia	Chromosomal aberrations or other genetic insults Malignant transformation of plasma cells	Renal failure Hypercalcemia Cytopenias No bone lesions	Chemotherapy
Plasmacytoma	Chromosomal aberrations or other genetic insults Malignant transformation of plasma cells	Solitary bone plasmacytoma (bone) Extramedullary plasmacytoma (soft tissues) Clinical manifestations related to tumor mass and compression symptoms	Surgery
Osteoporosis	Imbalance between bone resorption and bone formation Preceded by osteopenia Decreased bone mineral density	Acute musculoskletal pain if fractures develop Severe decrease in BMD on dual-energy X-ray absorptiometry (DEXA) test T score less than -2.5 on DEXA scan	Calcium and vitamin D supplementation Bisphosphonates Weight-bearing exercise Teriparatide RANK ligand inhibitors (denosumab)
Osteomalacia	Inadequate mineralization of bone Deficiency of vitamin D calcium, or phosphorus Renal tubular acidosis Malabsorption	Diffuse bone pain, fatigue, and fractures Low bone mineral density (BMD) Hypocalcemia	Vitamin D3 supplementation
Scurvy	Vitamin C deficiency Malabsorption Hemodialysis	Gum disease such as gum bleeding Loose teeth Easy bruising Impaired immune response Impaired wound healing	Vitamin C supplementation Citrus fruits
Osteogenesis imperfecta	Mutations in COL1A1 or COL1A2 Impaired type I collagen synthesis	Short stature, scoliosis, and propensity for fractures Blue discoloration of sclera	Bisphosphonates Physical therapy Surgical fixation of brittle bones Genetic counseling for offspring
Homocystinuria	Deficiency of cystathionine beta synthase Deficiency of folate, vitamin B12, or vitamin B6	Diffuse bone pain and musculoskeletal symptoms	High-dose vitamin B6 supplementation Betaine supplementation

References

↑ "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
↑ Zuo QY, Wang H, Li W, Niu XH, Huang YH, Chen J; et al. (2017). "Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors: retrospective review of 12 patients". BMC Musculoskelet Disord. 18 (1): 403. doi:10.1186/s12891-017-1756-1. PMC 5609032. PMID 28934935.
↑ Shaker JL, Albert C, Fritz J, Harris G (2015). "Recent developments in osteogenesis imperfecta". F1000Res. 4 (F1000 Faculty Rev): 681. doi:10.12688/f1000research.6398.1. PMC 4566283. PMID 26401268.
↑ Kumar A, Palfrey HA, Pathak R, Kadowitz PJ, Gettys TW, Murthy SN (2017). "The metabolism and significance of homocysteine in nutrition and health". Nutr Metab (Lond). 14: 78. doi:10.1186/s12986-017-0233-z. PMC 5741875. PMID 29299040.
↑ Soh KT, Tario JD, Wallace PK (December 2017). "Diagnosis of Plasma Cell Dyscrasias and Monitoring of Minimal Residual Disease by Multiparametric Flow Cytometry". Clin. Lab. Med. 37 (4): 821–853. doi:10.1016/j.cll.2017.08.001. PMC 5804349. PMID 29128071.
↑ Kyle RA, Rajkumar SV (January 2009). "Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma". Leukemia. 23 (1): 3–9. doi:10.1038/leu.2008.291. PMC 2627786. PMID 18971951.
↑ Rajkumar SV, Landgren O, Mateos MV (May 2015). "Smoldering multiple myeloma". Blood. 125 (20): 3069–75. doi:10.1182/blood-2014-09-568899. PMC 4432003. PMID 25838344.

[seer-1] "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.

[pmid28934935-2] Zuo QY, Wang H, Li W, Niu XH, Huang YH, Chen J; et al. (2017). "Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors: retrospective review of 12 patients". BMC Musculoskelet Disord. 18 (1): 403. doi:10.1186/s12891-017-1756-1. PMC 5609032. PMID 28934935.

[pmid26401268-3] Shaker JL, Albert C, Fritz J, Harris G (2015). "Recent developments in osteogenesis imperfecta". F1000Res. 4 (F1000 Faculty Rev): 681. doi:10.12688/f1000research.6398.1. PMC 4566283. PMID 26401268.

[pmid29299040-4] Kumar A, Palfrey HA, Pathak R, Kadowitz PJ, Gettys TW, Murthy SN (2017). "The metabolism and significance of homocysteine in nutrition and health". Nutr Metab (Lond). 14: 78. doi:10.1186/s12986-017-0233-z. PMC 5741875. PMID 29299040.

[pmid29128071-5] Soh KT, Tario JD, Wallace PK (December 2017). "Diagnosis of Plasma Cell Dyscrasias and Monitoring of Minimal Residual Disease by Multiparametric Flow Cytometry". Clin. Lab. Med. 37 (4): 821–853. doi:10.1016/j.cll.2017.08.001. PMC 5804349. PMID 29128071.

[pmid18971951-6] Kyle RA, Rajkumar SV (January 2009). "Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma". Leukemia. 23 (1): 3–9. doi:10.1038/leu.2008.291. PMC 2627786. PMID 18971951.

[pmid25838344-7] Rajkumar SV, Landgren O, Mateos MV (May 2015). "Smoldering multiple myeloma". Blood. 125 (20): 3069–75. doi:10.1182/blood-2014-09-568899. PMC 4432003. PMID 25838344.

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@@ Line 1: / Line 1: @@
 __NOTOC__
-{{Multiple myeloma}}
+[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Multiple_myeloma]]
-{{CMG}} {{AE}} {}HMHJ} {AE} {{HL}} {{shyam}}
+{{CMG}} {{AE}} {{HMHJ}} {{HL}} {{shyam}}
 ==Overview==
@@ Line 8: / Line 8: @@
 ==Differentiating Multiple Myeloma from other Diseases==
-*The table below summarizes how to differentiate multiple myeloma from other conditions that have a similar presentation:<ref name="seer">{{Cite web  | last =  | first =  | title = Myeloma - SEER Stat Fact Sheets | url = http://seer.cancer.gov/statfacts/html/mulmy.html | publisher =  | date =  | accessdate = 17 February 2014 }}</ref>
+*The table below summarizes how to differentiate multiple myeloma from other conditions that have a similar presentation:<ref name="seer">{{Cite web  | last =  | first =  | title = Myeloma - SEER Stat Fact Sheets | url = http://seer.cancer.gov/statfacts/html/mulmy.html | publisher =  | date =  | accessdate = 17 February 2014 }}</ref><ref name="pmid28934935">{{cite journal| author=Zuo QY, Wang H, Li W, Niu XH, Huang YH, Chen J et al.| title=Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors: retrospective review of 12 patients. | journal=BMC Musculoskelet Disord | year= 2017 | volume= 18 | issue= 1 | pages= 403 | pmid=28934935 | doi=10.1186/s12891-017-1756-1 | pmc=5609032 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28934935  }} </ref><ref name="pmid26401268">{{cite journal| author=Shaker JL, Albert C, Fritz J, Harris G| title=Recent developments in osteogenesis imperfecta. | journal=F1000Res | year= 2015 | volume= 4 | issue= F1000 Faculty Rev | pages= 681 | pmid=26401268 | doi=10.12688/f1000research.6398.1 | pmc=4566283 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26401268  }} </ref><ref name="pmid29299040">{{cite journal| author=Kumar A, Palfrey HA, Pathak R, Kadowitz PJ, Gettys TW, Murthy SN| title=The metabolism and significance of homocysteine in nutrition and health. | journal=Nutr Metab (Lond) | year= 2017 | volume= 14 | issue=  | pages= 78 | pmid=29299040 | doi=10.1186/s12986-017-0233-z | pmc=5741875 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29299040  }} </ref><ref name="pmid29128071">{{cite journal |vauthors=Soh KT, Tario JD, Wallace PK |title=Diagnosis of Plasma Cell Dyscrasias and Monitoring of Minimal Residual Disease by Multiparametric Flow Cytometry |journal=Clin. Lab. Med. |volume=37 |issue=4 |pages=821–853 |date=December 2017 |pmid=29128071 |pmc=5804349 |doi=10.1016/j.cll.2017.08.001 |url=}}</ref><ref name="pmid18971951">{{cite journal |vauthors=Kyle RA, Rajkumar SV |title=Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma |journal=Leukemia |volume=23 |issue=1 |pages=3–9 |date=January 2009 |pmid=18971951 |pmc=2627786 |doi=10.1038/leu.2008.291 |url=}}</ref><ref name="pmid25838344">{{cite journal |vauthors=Rajkumar SV, Landgren O, Mateos MV |title=Smoldering multiple myeloma |journal=Blood |volume=125 |issue=20 |pages=3069–75 |date=May 2015 |pmid=25838344 |pmc=4432003 |doi=10.1182/blood-2014-09-568899 |url=}}</ref>
-{| align="center"
-|-
+{|
-|
-{| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align="center&quot;" "
-| valign="top" |
-|+
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}}
 ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Causes}}
@@ Line 36: / Line 32: @@
 *[[Autologous bone marrow transplantation|Autologous stem cell transplantation]]
 |-
-|'''[[Monoclonal gammopathy of undetermined significance]] ([[MGUS]])'''
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Monoclonal gammopathy of undetermined significance]] ([[MGUS]])'''
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
 *Clonal [[plasma cell]] proliferation
-|
+| style="padding: 5px 5px; background: #F5F5F5;" |
 * [[Asymptomatic]]
-* serum M protein of less than 30 g/L with fewer
+* [[Serum]] [[M protein]] of <30 g/L
+* Fewer than 10% [[plasma cells]] in the [[bone marrow]]
+* No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage
 *
-|Observation
+| style="padding: 5px 5px; background: #F5F5F5;" |Observation
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Asymptomatic Plasma Cell Myeloma'''
+('''Smoldering''' and '''Indolent plasma cell myeloma''')
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
+*[[Malignant]] transformation of [[plasma cells]]
+*Clonal [[plasma cell]] proliferation
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* [[Asymptomatic]]
+* [[Serum]] [[M protein]] of >30 g/L
+* Greater than 10% [[plasma cells]] in the [[bone marrow]]
+* No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage
+| style="padding: 5px 5px; background: #F5F5F5;" |Observation
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Plasma cell leukemia|Plasma Cell Leukemia]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* [[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
+* [[Malignant]] transformation of [[plasma cells]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Renal failure]]
+*[[Hypercalcemia]]
+*[[Cytopenias]]
+*No [[bone]] lesions
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Chemotherapy]]
+|-
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Plasmacytoma]]'''
+| style="padding: 5px 5px; background: #F5F5F5;" |
+*[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
+*[[Malignant]] transformation of [[plasma cells]]
+| style="padding: 5px 5px; background: #F5F5F5;" |
+* Solitary bone [[plasmacytoma]] ([[bone]])
+* Extramedullary [[plasmacytoma]] ([[Soft tissue|soft tissues]])
+* Clinical manifestations related to [[tumor]] mass and compression [[symptoms]]
+| style="padding: 5px 5px; background: #F5F5F5;" |[[Surgery]]
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteoporosis]]'''
@@ Line 62: / Line 94: @@
 *[[RANKL|RANK ligand]] inhibitors ([[denosumab]])
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteomalacia]]'''<ref name="pmid28934935">{{cite journal| author=Zuo QY, Wang H, Li W, Niu XH, Huang YH, Chen J et al.| title=Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors: retrospective review of 12 patients. | journal=BMC Musculoskelet Disord | year= 2017 | volume= 18 | issue= 1 | pages= 403 | pmid=28934935 | doi=10.1186/s12891-017-1756-1 | pmc=5609032 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28934935  }} </ref>
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteomalacia]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Inadequate [[mineralization of bone]]
@@ Line 90: / Line 122: @@
 *Citrus fruits
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteogenesis imperfecta]]'''<ref name="pmid26401268">{{cite journal| author=Shaker JL, Albert C, Fritz J, Harris G| title=Recent developments in osteogenesis imperfecta. | journal=F1000Res | year= 2015 | volume= 4 | issue= F1000 Faculty Rev | pages= 681 | pmid=26401268 | doi=10.12688/f1000research.6398.1 | pmc=4566283 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26401268  }} </ref>
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteogenesis imperfecta]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *[[Mutations]] in ''[[COL1A1]]'' or ''[[COL1A2]]''
@@ Line 103: / Line 135: @@
 *Genetic counseling for offspring
 |-
-| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Homocystinuria]]'''<ref name="pmid29299040">{{cite journal| author=Kumar A, Palfrey HA, Pathak R, Kadowitz PJ, Gettys TW, Murthy SN| title=The metabolism and significance of homocysteine in nutrition and health. | journal=Nutr Metab (Lond) | year= 2017 | volume= 14 | issue=  | pages= 78 | pmid=29299040 | doi=10.1186/s12986-017-0233-z | pmc=5741875 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29299040  }} </ref>
+| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Homocystinuria]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Deficiency of [[Cystathionine-beta-synthase|cystathionine ''beta'' synthase]]
@@ Line 113: / Line 145: @@
 *[[Betaine]] supplementation
 |}
-|}
 ==References==
-{{reflist|2}}
+{{Reflist|2}}
-[[Category:Disease]]
+[[Category:Medicine]]
-[[Category:Types of cancer]]
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-{{WikiDoc Help Menu}}
-{{WikiDoc Sources}}
- [[Category:Up-To-Date]]
-[[Category:Oncology]]
-[[Category:Medicine]]
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+[[Category:Oncology]]
+[[Category:Up-To-Date]]
+[[Category:Surgery]]
+[[Category:Differential diagnosis]]

Multiple myeloma differential diagnosis: Difference between revisions

Latest revision as of 22:46, 29 July 2020

Overview

Differentiating Multiple Myeloma from other Diseases

References

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