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Myeloma : Pathologic Fracture

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One of the diagnostic hallmarks of plasma cell myeloma is lytic bone lesions. These lytic lesions are mediated by a complex interplay between factors secreted by neoplastic plasma cells. One such mediator is MIP1 alpha which, after a series of complex interactions, upregulates osteoclastic activity. At the same time, the tumor cells also synthesize modulators of the Wnt pathway that are suppressors of osteoblastic activity. The end result is increased bone resorption which increases the risk of pathologic fractures and also causes hypercalcemia.

This plain radiograph is from 65 y/o male with a known history of plasma cell myeloma who presented with right hip pain. Patient reported hearing a crack before the onset of pain. The radiograph shows right subtrochanteric pathologic fracture. The fracture is posteriorly displaced and mildly impacted. The proximal fracture fragment is laterally angulated. Surrounding the fracture is a lytic lesion, which had been previously demonstrated as a myelomatous deposit. Pathological fracture refers to a fracture through an area of underlying abnormal bone. Although in the vast majority of cases there is an underlying malignant lesion, such as a metastasis or myelomatous deposit, this need not always be the case. Pathological fractures are a common complication of plasma cell myeloma. Case courtesy of Dr Henry Knipe, Radiopaedia.org. From the case rID: 25272

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