Multiple myeloma differential diagnosis

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

Overview

Multiple myeloma must be differentiated from monoclonal gammopathy of undetermined significance (MGUS), isolated plasmacytoma of the bone, and extramedullary plasmacytoma.

Differentiating Multiple Myeloma from other Diseases

• The table below summarizes how to differentiate multiple myeloma from other conditions that cause similar presentation:

Plasma Cell Neoplasm	M Protein Type	Pathology	Clinical Presentation
MGUS	IgG kappa or lambda; or IgA kappa or lambda	<10% plasma cells in bone marrow	Asymptomatic, with minimal evidence of disease (aside from the presence of an M protein)
Isolated plasmacytoma of bone	IgG kappa or lambda; or IgA kappa or gamma	Solitary lesion of bone; <10% plasma cells in marrow of uninvolved site	Asymptomatic or symptomatic
Extramedullary plasmacytoma	IgG kappa or lambda; or IgA kappa or gamma	Solitary lesion of soft tissue in the nasopharynx, tonsils, or sinuses	Asymptomatic or symptomatic
Multiple myeloma	IgG kappa or lambda; or IgA kappa or gamma	Often multiple lesions of bone	Symptomatic

• Another important differential diagnosis is that of widespread bony metastases. Findings that favor the diagnosis of bony metastases over that of multiple myeloma include:

• Bone metastases more commonly affect the vertebral pedicles rather than vertebral bodies.
• Bone metastases rarely involve mandible and distal axial skeleton.
• Although both entities have variable bone scan appearances (both hot and cold) unlike multiple myeloma, extensive bony metastases rarely have a normal appearance.

• Multiple myeloma must also be differentiated from other causes of bone pain and fatigue such as:

• Waldenstrom Hypergammaglobulinemia
• Bone fracture
• Fibrous dysplasia
• Enchondroma
• Eosinophilic granuloma
• Giant cell tumor
• Osteoblastoma
• Aneurysmal bone cyst
• Solitary bone cyst
• Hyperparathyroidism
• Infection
• Chondroblastoma
• Chondromyxoid Fibroma
• Reactive plasmacytosis
• Macroglobulinemia

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