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Myeloma : Bone Lesions

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The vast majority of plasma cell myeloma cases have lytic bone lesions, osteoporosis, or pathologic fractures at the time of diagnosis. The bones most commonly involved (in decreasing order of frequency) include vertebral column, ribs, skull, pelvis, femur, proximal humerus, clavicle, and scapula. The lesions are initially centered around the medullary cavity. Eventually, they destroy the cancellous bone and erode into the cortex increasing the risk of pathologic fractures.

This skull x-ray is from a 50 y/o male with plasma cell myeloma who presented with weakness, fatigue, backache, weight loss and anemia. It shows multiple small, uniform, sharply demarcated “punched out” lytic lesions with no sclerotic margin or periosteal new bone formation involving the skull. There were areas of osteolysis involving the mandible. There was also a generalised reduction of bone density. Case courtesy of Dr Subash Thapa, Radiopaedia.org. From the case rID: 40195

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