Multiple myeloma differential diagnosis: Difference between revisions
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__NOTOC__ | __NOTOC__ | ||
[[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Multiple_myeloma]] | |||
{{CMG}} {{AE}} { | {{CMG}} {{AE}} {{HMHJ}} {{HL}} {{shyam}} | ||
==Overview== | ==Overview== | ||
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==Differentiating Multiple Myeloma from other Diseases== | ==Differentiating Multiple Myeloma from other Diseases== | ||
*The table below summarizes how to differentiate multiple myeloma from other conditions that have a similar presentation:<ref name="seer">{{Cite web | last = | first = | title = Myeloma - SEER Stat Fact Sheets | url = http://seer.cancer.gov/statfacts/html/mulmy.html | publisher = | date = | accessdate = 17 February 2014 }}</ref> | *The table below summarizes how to differentiate multiple myeloma from other conditions that have a similar presentation:<ref name="seer">{{Cite web | last = | first = | title = Myeloma - SEER Stat Fact Sheets | url = http://seer.cancer.gov/statfacts/html/mulmy.html | publisher = | date = | accessdate = 17 February 2014 }}</ref><ref name="pmid28934935">{{cite journal| author=Zuo QY, Wang H, Li W, Niu XH, Huang YH, Chen J et al.| title=Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors: retrospective review of 12 patients. | journal=BMC Musculoskelet Disord | year= 2017 | volume= 18 | issue= 1 | pages= 403 | pmid=28934935 | doi=10.1186/s12891-017-1756-1 | pmc=5609032 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=28934935 }} </ref><ref name="pmid26401268">{{cite journal| author=Shaker JL, Albert C, Fritz J, Harris G| title=Recent developments in osteogenesis imperfecta. | journal=F1000Res | year= 2015 | volume= 4 | issue= F1000 Faculty Rev | pages= 681 | pmid=26401268 | doi=10.12688/f1000research.6398.1 | pmc=4566283 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=26401268 }} </ref><ref name="pmid29299040">{{cite journal| author=Kumar A, Palfrey HA, Pathak R, Kadowitz PJ, Gettys TW, Murthy SN| title=The metabolism and significance of homocysteine in nutrition and health. | journal=Nutr Metab (Lond) | year= 2017 | volume= 14 | issue= | pages= 78 | pmid=29299040 | doi=10.1186/s12986-017-0233-z | pmc=5741875 | url=https://www.ncbi.nlm.nih.gov/entrez/eutils/elink.fcgi?dbfrom=pubmed&tool=sumsearch.org/cite&retmode=ref&cmd=prlinks&id=29299040 }} </ref><ref name="pmid29128071">{{cite journal |vauthors=Soh KT, Tario JD, Wallace PK |title=Diagnosis of Plasma Cell Dyscrasias and Monitoring of Minimal Residual Disease by Multiparametric Flow Cytometry |journal=Clin. Lab. Med. |volume=37 |issue=4 |pages=821–853 |date=December 2017 |pmid=29128071 |pmc=5804349 |doi=10.1016/j.cll.2017.08.001 |url=}}</ref><ref name="pmid18971951">{{cite journal |vauthors=Kyle RA, Rajkumar SV |title=Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma |journal=Leukemia |volume=23 |issue=1 |pages=3–9 |date=January 2009 |pmid=18971951 |pmc=2627786 |doi=10.1038/leu.2008.291 |url=}}</ref><ref name="pmid25838344">{{cite journal |vauthors=Rajkumar SV, Landgren O, Mateos MV |title=Smoldering multiple myeloma |journal=Blood |volume=125 |issue=20 |pages=3069–75 |date=May 2015 |pmid=25838344 |pmc=4432003 |doi=10.1182/blood-2014-09-568899 |url=}}</ref> | ||
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! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}} | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Differential Diagnosis}} | ||
! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Causes}} | ! style="background: #4479BA; width: 200px;" | {{fontcolor|#FFF|Causes}} | ||
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*[[Autologous bone marrow transplantation|Autologous stem cell transplantation]] | *[[Autologous bone marrow transplantation|Autologous stem cell transplantation]] | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Monoclonal gammopathy of undetermined significance]] ([[MGUS]])''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Monoclonal gammopathy of undetermined significance]] ([[MGUS]])''' | ||
|style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults | *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults | ||
*Clonal [[plasma cell]] proliferation | *Clonal [[plasma cell]] proliferation | ||
|style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* [[Asymptomatic]] | * [[Asymptomatic]] | ||
* [[Serum]] [[M protein]] of <30 g/L | * [[Serum]] [[M protein]] of <30 g/L | ||
| Line 46: | Line 42: | ||
* No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage | * No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage | ||
* | * | ||
|style="padding: 5px 5px; background: #F5F5F5;" |Observation | | style="padding: 5px 5px; background: #F5F5F5;" |Observation | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Asymptomatic Plasma Cell Myeloma''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''Asymptomatic Plasma Cell Myeloma''' | ||
('''Smoldering''' and '''Indolent plasma cell myeloma''') | ('''Smoldering''' and '''Indolent plasma cell myeloma''') | ||
|style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults | *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults | ||
*[[Malignant]] transformation of [[plasma cells]] | *[[Malignant]] transformation of [[plasma cells]] | ||
*Clonal [[plasma cell]] proliferation | *Clonal [[plasma cell]] proliferation | ||
|style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* [[Asymptomatic]] | * [[Asymptomatic]] | ||
* [[Serum]] [[M protein]] of >30 g/L | * [[Serum]] [[M protein]] of >30 g/L | ||
* Greater than 10% [[plasma cells]] in the [[bone marrow]] | * Greater than 10% [[plasma cells]] in the [[bone marrow]] | ||
* No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage | * No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage | ||
|style="padding: 5px 5px; background: #F5F5F5;" |Observation | | style="padding: 5px 5px; background: #F5F5F5;" |Observation | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Plasma cell leukemia|Plasma Cell Leukemia]]''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Plasma cell leukemia|Plasma Cell Leukemia]]''' | ||
|style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* [[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults | * [[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults | ||
* [[Malignant]] transformation of [[plasma cells]] | * [[Malignant]] transformation of [[plasma cells]] | ||
|style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Renal failure]] | *[[Renal failure]] | ||
*[[Hypercalcemia]] | *[[Hypercalcemia]] | ||
*[[Cytopenias]] | *[[Cytopenias]] | ||
*No [[bone]] lesions | *No [[bone]] lesions | ||
|style="padding: 5px 5px; background: #F5F5F5;" |[[Chemotherapy]] | | style="padding: 5px 5px; background: #F5F5F5;" |[[Chemotherapy]] | ||
|- | |- | ||
|style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Plasmacytoma]]''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Plasmacytoma]]''' | ||
|style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults | *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults | ||
*[[Malignant]] transformation of [[plasma cells]] | *[[Malignant]] transformation of [[plasma cells]] | ||
|style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
* Solitary bone [[plasmacytoma]] ([[bone]]) | * Solitary bone [[plasmacytoma]] ([[bone]]) | ||
* Extramedullary [[plasmacytoma]] ([[Soft tissue|soft tissues]]) | * Extramedullary [[plasmacytoma]] ([[Soft tissue|soft tissues]]) | ||
* Clinical manifestations related to [[tumor]] mass and compression [[symptoms]] | * Clinical manifestations related to [[tumor]] mass and compression [[symptoms]] | ||
|style="padding: 5px 5px; background: #F5F5F5;" |[[Surgery]] | | style="padding: 5px 5px; background: #F5F5F5;" |[[Surgery]] | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteoporosis]]''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteoporosis]]''' | ||
| Line 98: | Line 94: | ||
*[[RANKL|RANK ligand]] inhibitors ([[denosumab]]) | *[[RANKL|RANK ligand]] inhibitors ([[denosumab]]) | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteomalacia]]''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteomalacia]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Inadequate [[mineralization of bone]] | *Inadequate [[mineralization of bone]] | ||
| Line 126: | Line 122: | ||
*Citrus fruits | *Citrus fruits | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteogenesis imperfecta]]''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteogenesis imperfecta]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*[[Mutations]] in ''[[COL1A1]]'' or ''[[COL1A2]]'' | *[[Mutations]] in ''[[COL1A1]]'' or ''[[COL1A2]]'' | ||
| Line 139: | Line 135: | ||
*Genetic counseling for offspring | *Genetic counseling for offspring | ||
|- | |- | ||
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Homocystinuria]]''' | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Homocystinuria]]''' | ||
| style="padding: 5px 5px; background: #F5F5F5;" | | | style="padding: 5px 5px; background: #F5F5F5;" | | ||
*Deficiency of [[Cystathionine-beta-synthase|cystathionine ''beta'' synthase]] | *Deficiency of [[Cystathionine-beta-synthase|cystathionine ''beta'' synthase]] | ||
| Line 149: | Line 145: | ||
*[[Betaine]] supplementation | *[[Betaine]] supplementation | ||
|} | |} | ||
==References== | ==References== | ||
{{ | {{Reflist|2}} | ||
[[Category: | [[Category:Medicine]] | ||
[[Category:Hematology]] | [[Category:Hematology]] | ||
[[Category:Neurology]] | [[Category:Neurology]] | ||
[[Category:Neurosurgery]] | [[Category:Neurosurgery]] | ||
[[Category:Oncology]] | |||
[[Category:Up-To-Date]] | |||
[[Category:Surgery]] | |||
[[Category:Differential diagnosis]] | |||
Latest revision as of 22:46, 29 July 2020
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: Hannan Javed, M.D.[2] Haytham Allaham, M.D. [3] Shyam Patel [4]
Overview
Multiple myeloma must be differentiated from other causes of bone lesions such as osteoporosis, osteomalacia, scurvy, osteogenesis imperfecta, and homocystinuria. Each condition has unique causes, features, and treatment.
Differentiating Multiple Myeloma from other Diseases
- The table below summarizes how to differentiate multiple myeloma from other conditions that have a similar presentation:[1][2][3][4][5][6][7]
References
- ↑ "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
- ↑ Zuo QY, Wang H, Li W, Niu XH, Huang YH, Chen J; et al. (2017). "Treatment and outcomes of tumor-induced osteomalacia associated with phosphaturic mesenchymal tumors: retrospective review of 12 patients". BMC Musculoskelet Disord. 18 (1): 403. doi:10.1186/s12891-017-1756-1. PMC 5609032. PMID 28934935.
- ↑ Shaker JL, Albert C, Fritz J, Harris G (2015). "Recent developments in osteogenesis imperfecta". F1000Res. 4 (F1000 Faculty Rev): 681. doi:10.12688/f1000research.6398.1. PMC 4566283. PMID 26401268.
- ↑ Kumar A, Palfrey HA, Pathak R, Kadowitz PJ, Gettys TW, Murthy SN (2017). "The metabolism and significance of homocysteine in nutrition and health". Nutr Metab (Lond). 14: 78. doi:10.1186/s12986-017-0233-z. PMC 5741875. PMID 29299040.
- ↑ Soh KT, Tario JD, Wallace PK (December 2017). "Diagnosis of Plasma Cell Dyscrasias and Monitoring of Minimal Residual Disease by Multiparametric Flow Cytometry". Clin. Lab. Med. 37 (4): 821–853. doi:10.1016/j.cll.2017.08.001. PMC 5804349. PMID 29128071.
- ↑ Kyle RA, Rajkumar SV (January 2009). "Criteria for diagnosis, staging, risk stratification and response assessment of multiple myeloma". Leukemia. 23 (1): 3–9. doi:10.1038/leu.2008.291. PMC 2627786. PMID 18971951.
- ↑ Rajkumar SV, Landgren O, Mateos MV (May 2015). "Smoldering multiple myeloma". Blood. 125 (20): 3069–75. doi:10.1182/blood-2014-09-568899. PMC 4432003. PMID 25838344.