Multiple myeloma differential diagnosis

Multiple myeloma Microchapters
Home
Patient Information
Overview
Historical Perspective
Classification
Pathophysiology
Causes
Differentiating Multiple Myeloma from other Diseases
Epidemiology and Demographics
Risk Factors
Screening
Natural History, Complications and Prognosis
Diagnosis
Diagnostic Criteria
Staging
History and Symptoms
Physical Examination
Laboratory Findings
Electrocardiogram
X Ray
Echocardiograph and Ultrasound
CT
MRI
Other Imaging Findings
Other Diagnostic Studies
Treatment
Medical Therapy
Surgery
Primary Prevention
Secondary Prevention
Future or Investigational Therapies
Case Studies
Case #1
Multiple myeloma differential diagnosis On the Web
Most recent articles
Most cited articles
Review articles
CME Programs
Powerpoint slides
Images
American Roentgen Ray Society Images of Multiple myeloma differential diagnosis All Images X-rays Echo and Ultrasound CT Images MRI
Ongoing Trials at Clinical Trials.gov
US National Guidelines Clearinghouse
NICE Guidance
FDA on Multiple myeloma differential diagnosis
CDC on Multiple myeloma differential diagnosis
Multiple myeloma differential diagnosis in the news
Blogs on Multiple myeloma differential diagnosis
Directions to Hospitals Treating Multiple myeloma
Risk calculators and risk factors for Multiple myeloma differential diagnosis

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
• Osteoporosis (osteoporotic fracture)
• Idiopathic transient osteoporosis of hip
• Osteomalacia
• Osteogenesis imperfecta
• Multiple myeloma
• Homocystinuria
• Hypermetabolic resorptive osteoporosis.

Differential Diagnosis Similar Features Differentiating Features Multiple myeloma On physical examination, demonstrates diffuse bone pain and tenderness On imaging studies, demonstrates osteolytic lesions in the bones - Osteoporosis On physical examination, demonstrates acute musculoskletal pain, if fracture happened On imaging studies, demonstrates severe decrease in BMD On laboratory studies, not demonstrates monoclonal IgM overload in electrophoresis, and also Bence-Jones protein in urine Idiopathic transient osteoporosis of hip On physical examination, demonstrates acute hip pain On imaging studies, demonstrates sub-chondoral cortical loss and diffuse osteopenia of the femoral neck On history, demonstrates mostly involvement of pregnant women and young men On history, demonstrates to be self-limiting in 6-8 months Osteomalacia On physical examination, demonstrates diffuse bone pain, fatigue, and fractures are the common symptoms On imaging studies, demonstrates low bone mineral density (BMD) On imaging studies, demonstrate the brief bone mass loss in bones Scurvy On physical examination, demonstrates bone pain and frequent fractures due to brittle bone On imaging studies, demonstrates low bone mineral density (BMD) On physical examination, demonstrates other mucosal disruption symptoms, such as bleeding gums On imaging studies, demonstrates normal bone mineral density (BMD) Osteogenesis imperfecta On physical examination, demonstrates Short stature, scoliosis, and propensity for fractures On physical examination, demonstrates tooth defects, hearing defects, and blue sclera On laboratory studies, demonstrates near normal bone mineral density (BMD) Homocystinuria On physical examination, demonstrates diffuse bone pain and musculoskeletal symptoms On physical examination, demonstrates visual impairment On laboratory studies, demonstrates high amounts of homocysteine in urine

References

Template:WikiDoc Sources