Multiple myeloma differential diagnosis: Difference between revisions

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Revision as of 15:11, 1 November 2018

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]


Differential Diagnosis	Causes	Features	Therapy

Multiple myeloma	Chromosomal aberrations or other genetic insults Malignant transformation of plasma cells Clonal plasma cell proliferation	Diffuse bone pain and tenderness with osteolytic lesions Renal failure Hypercalcemia Anemia	Induction chemotherapy with bortezomib, lenalidomide, and dexamethasone Bisphosphonates RANK ligand inhibitors (denosumab) Autologous stem cell transplantation
Monoclonal gammopathy of undetermined significance (MGUS)	Chromosomal aberrations or other genetic insults Clonal plasma cell proliferation	Asymptomatic serum M protein of less than 30 g/L with fewer	Observation
Osteoporosis	Imbalance between bone resorption and bone formation Preceded by osteopenia Decreased bone mineral density	Acute musculoskletal pain if fractures develop Severe decrease in BMD on dual-energy X-ray absorptiometry (DEXA) test T score less than -2.5 on DEXA scan	Calcium and vitamin D supplementation Bisphosphonates Weight-bearing exercise Teriparatide RANK ligand inhibitors (denosumab)
Osteomalacia^[2]	Inadequate mineralization of bone Deficiency of vitamin D calcium, or phosphorus Renal tubular acidosis Malabsorption	Diffuse bone pain, fatigue, and fractures Low bone mineral density (BMD) Hypocalcemia	Vitamin D3 supplementation
Scurvy	Vitamin C deficiency Malabsorption Hemodialysis	Gum disease such as gum bleeding Loose teeth Easy bruising Impaired immune response Impaired wound healing	Vitamin C supplementation Citrus fruits
Osteogenesis imperfecta^[3]	Mutations in COL1A1 or COL1A2 Impaired type I collagen synthesis	Short stature, scoliosis, and propensity for fractures Blue discoloration of sclera	Bisphosphonates Physical therapy Surgical fixation of brittle bones Genetic counseling for offspring
Homocystinuria^[4]	Deficiency of cystathionine beta synthase Deficiency of folate, vitamin B12, or vitamin B6	Diffuse bone pain and musculoskeletal symptoms	High-dose vitamin B6 supplementation Betaine supplementation

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.

Template:WikiDoc Sources

[seer-1] "Myeloma - SEER Stat Fact Sheets". Retrieved 17 February 2014.

[pmid28934935-2] 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.

[pmid26401268-3] 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.

[pmid29299040-4] 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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@@ Line 22: / Line 22: @@
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Multiple myeloma]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Chromosomal aberrations or other 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;" |
 *Diffuse [[bone]] pain and [[tenderness]] with [[osteolytic]] lesions
-*Renal failure
+*[[Renal failure]]
-*Hypercalcemia
+*[[Hypercalcemia]]
-*Anemia
+*[[Anemia]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Induction chemotherapy with bortezomib, lenalidomide, and dexamethasone
+*Induction [[chemotherapy]] with [[bortezomib]], [[lenalidomide]], and [[dexamethasone]]
-*Bisphosphonates
+*[[Bisphosphonates]]
-*RANK ligand inhibitors (denosumab)
+*[[RANKL|RANK ligand]] inhibitors ([[denosumab]])
-*Autologous stem cell transplantation
+*[[Autologous bone marrow transplantation|Autologous stem cell transplantation]]
+|-
+|'''[[Monoclonal gammopathy of undetermined significance]] ([[MGUS]])'''
+|
+*[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
+*Clonal [[plasma cell]] proliferation
+|
+* [[Asymptomatic]]
+* serum M protein of less than 30 g/L with fewer
+*
+|Observation
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Osteoporosis]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Imbalance between bone resorption and bone formation
+*Imbalance between [[bone resorption]] and [[bone]] formation
-*Preceded by osteopenia
+*Preceded by [[osteopenia]]
 *Decreased bone mineral density
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Acute musculoskletal pain if [[bone fractures|fractures]] develop
-*Severe decrease in [[bone mineral density|BMD]] on dual-energy X-ray absorptiometry (DEXA) test
+*Severe decrease in [[bone mineral density|BMD]] on [[Dual energy X-ray absorptiometry|dual-energy X-ray absorptiometry]] ([[DEXA scan|DEXA]]) test
-*T score less than -2.5 on DEXA scan
+*T score less than -2.5 on [[DEXA scan|DEXA]] scan
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Calcium and vitamin D supplementation
+*[[Calcium]] and [[vitamin D]] supplementation
-*Bisphosphonates
+*[[Bisphosphonate|Bisphosphonates]]
 *Weight-bearing exercise
-*Teriparatide
+*[[Teriparatide]]
-*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: #F5F5F5;" |
-*Inadequate mineralization of bone
+*Inadequate [[mineralization of bone]]
-*Deficiencies in vitamin D, calcium, or phosphorus
+*Deficiency of [[vitamin D]] [[calcium]], or [[phosphorus]]
-*Renal tubular acidosis
+*[[Renal tubular acidosis]]
-*Malabsorption
+*[[Malabsorption]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Diffuse [[bone]] pain, fatigue, and [[fractures]]
@@ Line 63: / Line 73: @@
 *[[Hypocalcemia]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Vitamin D3 supplementation
+*[[Vitamin D3]] supplementation
 |-
 | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Scurvy]]'''
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Vitamin C deficiency
+*[[Vitamin C]] deficiency
-*Malabsorption
+*[[Malabsorption]]
-*Hemodialysis
+*[[Hemodialysis]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Gum disease
+*[[Gum disease]] such as gum [[bleeding]]
-*Loose teeth
+*Loose [[teeth]]
-*Easy bruising
+*Easy [[bruising]]
+*Impaired [[immune]] response
+*Impaired [[wound]] healing
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Vitamin C supplementation
+*[[Vitamin C]] supplementation
 *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: #F5F5F5;" |
-*Mutations in ''COL1A1'' or ''COL1A2''
+*[[Mutations]] in ''[[COL1A1]]'' or ''[[COL1A2]]''
-*Impaired type I collagen synthesis
+*Impaired [[Type I collagen|type I collagen synthesis]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *[[Short stature]], [[scoliosis]], and propensity for [[Bone fracture|fractures]]
-*Blue discoloration of sclera
+*Blue discoloration of [[sclera]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*Bisphosphonates
+*[[Bisphosphonates]]
-*Physical therapy
+*[[Physical therapy]]
-*Surgical fixation of brittle bones
+*Surgical fixation of brittle [[bones]]
 *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: #F5F5F5;" |
-*Deficiency of cystathione ''beta'' synthase
+*Deficiency of [[Cystathionine-beta-synthase|cystathionine ''beta'' synthase]]
-*Deficiency of folate, vitamin B12, or vitamin B6
+*Deficiency of [[folate]], [[vitamin B12]], or [[vitamin B6]]
 | style="padding: 5px 5px; background: #F5F5F5;" |
 *Diffuse [[bone]] [[pain]] and [[musculoskeletal]] symptoms
 | style="padding: 5px 5px; background: #F5F5F5;" |
-*High-dose vitamin B6 supplementation
+*High-dose [[vitamin B6]] supplementation
-*Betaine supplementation
+*[[Betaine]] supplementation
 |}
 |}

Multiple myeloma differential diagnosis: Difference between revisions

Revision as of 15:11, 1 November 2018

Overview

Differentiating Multiple Myeloma from other Diseases

References

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