Multiple myeloma differential diagnosis: Difference between revisions

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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>
{| align="center"
{| align="center"
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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
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* 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]]'''
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*[[RANKL|RANK ligand]] inhibitors ([[denosumab]])
*[[RANKL|RANK ligand]] inhibitors ([[denosumab]])
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteomalacia]]'''<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>
| 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]]
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*Citrus fruits
*Citrus fruits
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteogenesis imperfecta]]'''<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>
| 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]]''
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*Genetic counseling for offspring
*Genetic counseling for offspring
|-
|-
| style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Homocystinuria]]'''<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>
| 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]]

Revision as of 15:54, 1 November 2018

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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1] Associate Editor(s)-in-Chief: {}HMHJ} {AE} Haytham Allaham, M.D. [2] Shyam Patel [3]

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]
Differential Diagnosis Causes Features Therapy
Multiple myeloma
Monoclonal gammopathy of undetermined significance (MGUS) Observation
Asymptomatic Plasma Cell Myeloma

(Smoldering and Indolent plasma cell myeloma)

Observation
Plasma Cell Leukemia Chemotherapy
Plasmacytoma Surgery
Osteoporosis
Osteomalacia
Scurvy
Osteogenesis imperfecta
Homocystinuria

References

  1. "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.
  2. 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.
  3. 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.
  4. 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.


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