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.[1]
Differentiating Multiple Myeloma from other Diseases
- The table below summarizes how to differentiate multiple myeloma from other conditions that cause similar presentation:[1]
| 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:[2]
- 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:
References
- ↑ 1.0 1.1 "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
- ↑ Multiple myeloma. Radiopaedia (2015)http://radiopaedia.org/articles/multiple-myeloma-1 Accessed on September, 20th 2015