Multiple myeloma pathophysiology: Difference between revisions
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==Pathophysiology== | ==Pathophysiology== | ||
* Multiple myeloma develops in post-germinal center [[B lymphocytes]]. | * Multiple myeloma develops in post-germinal center [[B lymphocytes]]. | ||
* A [[chromosomal translocation]] between the immunoglobulin heavy chain gene (on the fourteenth [[chromosome]], locus 14q32) and an [[oncogene]] (often 11q13, 4p16.3, 6p21, 16q23 and 20q11<ref name="Kyle">Kyle RA, Rajkumar SV. ''Multiple myeloma.'' [[N Engl J Med]] 2004;351:1860-73. PMID 15509819.</ref>) is frequently observed in patients with multiple myeloma. | * A [[chromosomal translocation]] between the immunoglobulin heavy chain gene (on the fourteenth [[chromosome]], locus 14q32) and an [[oncogene]] (often 11q13, 4p16.3, 6p21, 16q23 and 20q11<ref name="Kyle">Kyle RA, Rajkumar SV. ''Multiple myeloma.'' [[N Engl J Med]] 2004;351:1860-73. PMID 15509819.</ref>) is frequently observed in patients with multiple myeloma. | ||
* This mutation results in dysregulation of the oncogene which is thought to be an important initiating event in the pathogenesis of myeloma. | |||
Production of [[cytokine]]s (especially [[Interleukin 6|IL-6]]) by the plasma cells causes much of their localised damage, such as [[osteoporosis]], and creates a microenvironment in which the malignant cells thrive. [[Angiogenesis]] (the attraction of new blood vessels) is increased. | * The result is proliferation of a plasma cell clone and genomic instability that leads to further mutations and translocations. | ||
* The chromosome 14 abnormality is observed in about 50% of all cases of myeloma. Deletion of (parts of) the thirteenth chromosome is also observed in about 50% of cases. | |||
The produced antibodies are deposited in various organs, leading to renal failure, polyneuropathy and various other myeloma-associated symptoms. | * Production of [[cytokine]]s (especially [[Interleukin 6|IL-6]]) by the plasma cells causes much of their localised damage, such as [[osteoporosis]], and creates a microenvironment in which the malignant cells thrive. [[Angiogenesis]] (the attraction of new blood vessels) is increased. | ||
* The produced antibodies are deposited in various organs, leading to renal failure, polyneuropathy and various other myeloma-associated symptoms. | |||
===Gross Pathology=== | ===Gross Pathology=== |
Revision as of 17:52, 24 September 2012
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]
Overveiw
Pathophysiology
- Multiple myeloma develops in post-germinal center B lymphocytes.
- A chromosomal translocation between the immunoglobulin heavy chain gene (on the fourteenth chromosome, locus 14q32) and an oncogene (often 11q13, 4p16.3, 6p21, 16q23 and 20q11[1]) is frequently observed in patients with multiple myeloma.
- This mutation results in dysregulation of the oncogene which is thought to be an important initiating event in the pathogenesis of myeloma.
- The result is proliferation of a plasma cell clone and genomic instability that leads to further mutations and translocations.
- The chromosome 14 abnormality is observed in about 50% of all cases of myeloma. Deletion of (parts of) the thirteenth chromosome is also observed in about 50% of cases.
- Production of cytokines (especially IL-6) by the plasma cells causes much of their localised damage, such as osteoporosis, and creates a microenvironment in which the malignant cells thrive. Angiogenesis (the attraction of new blood vessels) is increased.
- The produced antibodies are deposited in various organs, leading to renal failure, polyneuropathy and various other myeloma-associated symptoms.
Gross Pathology
Microscopic Pathology
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Multiple Myeloma [2]
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Bone marrow aspiration in multiple myeloma.
(Image courtesy of Melih Aktan M.D.) -
Bone marrow biopsy in multiple myeloma.
(Image courtesy of Melih Aktan M.D.) -
Bone marrow in multiple myeloma.
(Image courtesy of Melih Aktan M.D.) -
Bone marrow in multiple myeloma.
(Image courtesy of Melih Aktan M.D.)
References
- ↑ Kyle RA, Rajkumar SV. Multiple myeloma. N Engl J Med 2004;351:1860-73. PMID 15509819.
- ↑ http://picasaweb.google.com/mcmumbi/USMLEIIImages