|
|
(8 intermediate revisions by the same user not shown) |
Line 1: |
Line 1: |
| __NOTOC__ | | __NOTOC__ |
| {{Wild-type (senile) amyloidosis}}
| | [[Image:Home_logo1.png|right|250px|link=https://www.wikidoc.org/index.php/Wild-type_(senile)_amyloidosis]] |
| {{CMG}}{{AE}}{{Sab}} | | {{CMG}}{{AE}}{{Sab}}{{HK}} |
|
| |
|
| ==Overview== | | ==Overview== |
| | Wild-type (senile) amyloidosis can be differentiated from other conditions that present with [[heart failure]], [[polyneuropathy]], and [[organomegaly]]. |
|
| |
|
| ==Differentiating Wild-type (Senile) Amyloidosis from other Diseases== | | ==Differentiating Wild-type (Senile) Amyloidosis from other Diseases== |
| ==== Differentials Based on Cardiac Involvement (Heart Failure) ==== | | ==== Differentials Based on Cardiac Involvement (Heart Failure) ==== |
| Wild-type (senile) amyloidosis should be differentiated from other causes of heart failure: | | Wild-type (senile) amyloidosis should be differentiated from other causes of [[heart failure]]: |
| {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center | | {| style="border: 0px; font-size: 90%; margin: 3px; width: 1000px" align=center |
| |valign=top| | | |valign=top| |
Line 175: |
Line 176: |
|
| |
|
| {| | | {| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Organ System Involvement}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Differential Diagnosis}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Causes}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Clinical Features}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Laboratory Findings}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Gold Standard Test}}
| |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Therapy}}
| |
| |-
| |
| ! rowspan="8" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Nephrotic Syndrome and Renal Failure
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Primary (AL) Amyloidosis
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Monoclonal]] [[plasma cell]] proliferation
| |
| * Extracellular [[amyloid]] [[fibril]] deposition
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Anasarca]]
| |
| *[[Bleeding tendency]]
| |
| * Swelling of [[lower limbs]]
| |
| * Frothy [[urine]]
| |
| *[[Chest pain]]
| |
| *[[Numbness]] or [[tingling]]
| |
| *[[Early satiety]]
| |
| *[[Joint pains]]
| |
| *[[Macroglossia|Enlarged tongue]]
| |
| *[[Taste loss]]
| |
| *[[Hoarseness|Hoarseness of voice]]
| |
| *[[Alopecia|Hair loss <br />]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Increased [[erythrocyte sedimentation rate]] ([[ESR]])
| |
| * Increased [[Alanine aminotransferase|alanine aminotrasnferase]] ([[Alanine transaminase|ALT]]) and [[Aspartate aminotransferase|aspartate aminotrasnferase]] ([[Aspartate transaminase|AST]])
| |
| * Increased [[Cardiac troponin I (cTnI) and T (cTnT)|cardiac troponins]]
| |
| * Increased [[brain natriuretic peptide]] ([[BNP]])
| |
| * Increased [[blood urea nitrogen]] ([[BUN]]) and [[creatinine]]
| |
| *[[Proteinuria]]
| |
| * Urinary [[Hyaline cast|hyaline]] and fatty casts
| |
| *[[Hypercholesterolemia]]
| |
|
| |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| ** Diffuse glomerular deposition of amorphous [[hyaline]] material (nodular pattern - 8 to15 nm in diameter), in [[mesangium]] (weakly staining with [[Periodic acid-Schiff stain|periodic acid-Schiff]] ([[Periodic acid-Schiff stain|PAS]])
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Melphalan]]-[[prednisone]]/[[dexamethasone]]
| |
| *[[Dexamethasone]] plus [[Cyclophosphamide]]-[[thalidomide]]
| |
| *[[Stem cell transplantation]]
| |
| *[[Kidney transplantation]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Diabetic nephropathy|Diabetic Nephropathy]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Hyperfiltration
| |
| * Constriction of [[efferent arteriole]]
| |
| *[[Microalbuminuria]]
| |
| *[[Mesangial cell|Mesangial]] proliferation
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Nocturia]]
| |
| *[[Fatigue]]
| |
| *[[Pruritis]]
| |
| *[[Peripheral edema]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Hyperglycemia]] (random plasma glucose ≥200 mg/dL)
| |
| *[[Proteinuria]]
| |
| *[[Glucosuria]]
| |
| *[[Glycosylated hemoglobin|HbA1C]] ≥6.5% (48 mmol/mol). <br />
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| **[[Periodic acid-Schiff stain|PAS]] positive [[Kimmelstiel-Wilson syndrome|Kimmelstiel-Wilson nodules]]
| |
| **[[Glomerulosclerosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[ACE inhibitor|ACE inhibitors]]
| |
| *[[Angiotensin receptor blockers]]
| |
| *[[Glycemic]] control
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Minimal change disease|Minimal Change Disease]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Upper respiratory tract infection]]
| |
| *[[Allergy]] to bee sting
| |
| *[[Non-steroidal anti-inflammatory drug|NSAID]]
| |
| *[[Gold]]
| |
| *[[Penicillamine]]
| |
| *[[Ampicillin]]
| |
| *[[Mercury (element)|Mercury]]
| |
| *[[Hodgkin's lymphoma|Hodgkin's]] and [[Non-Hodgkin lymphoma|non-Hodgkin's lymphoma]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Peripheral edema]]
| |
| *[[Hypertension]]
| |
| *[[Peripheral edema]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Proteinuria]]
| |
| *[[Hypertension]]
| |
| *[[Hyperlipidemia]]
| |
| *[[Hypoalbuminemia]]
| |
| *[[Microscopic hematuria]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| ** Fused [[podocytes]]/effacement
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Prednisone]] with taper
| |
| *[[ACE inhibitor|ACE inhibitors]]
| |
| *[[Angiotensin receptor blockers]]
| |
| * Salt restriction
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Focal segmental glomerulosclerosis|Focal Segmental Glomerulosclerosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[HIV]]
| |
| *[[Parvovirus B19]]
| |
| *[[Cytomegalovirus]]
| |
| *[[Heroin]]
| |
| *[[Interferon alpha]]
| |
| *[[Lithium]]
| |
| *[[Pamidronate]]/aledronate
| |
| *[[Anabolic steroids]]
| |
| *[[Diabetes mellitus]]
| |
| *[[Hypertension]]
| |
| *[[Obesity]]
| |
| *[[Congenital heart disease cyanotic|Cyanotic congenital heart disease]]
| |
| *[[Sickle cell anemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Peripheral edema]]
| |
| *[[Hypertension]]
| |
| *[[Peripheral edema]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Proteinuria]]
| |
| *[[Hypertension]]
| |
| *[[Hyperlipidemia]]
| |
| *[[Hypoalbuminemia]]
| |
| *[[Microscopic hematuria]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| **[[Podocytes|Podocyte]] foot process effacement
| |
| **[[Capillary]] lumen abolished by the segmental increase in matrix <br />
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Prednisone]]
| |
| *[[Calcineurin inhibitor|Calcineurin inhibitors]] ([[Cyclosporine|Cyclosporin]], [[tacrolimus]])
| |
| *[[Rituximab]]
| |
| *[[Cyclophosphamide]]/[[chlorambucil]]
| |
| *[[Mycophenolate|Mycophenolate motefil]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Fabry's disease|Fabry's Disease]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Deficient alpha galactosidase A
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Abdominal pain]]
| |
| *[[Arthralgia]]
| |
| *[[Febrile]] episodes
| |
| *[[Angiokeratomas]]
| |
| * Burning pain and tingling ([[Peripheral neuropathy|peripheral neuropathy)]]
| |
| *[[Hypohidrosis]]
| |
| *[[X-linked recessive]] inheritance
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Deficient alpha galactosidase A
| |
| * Increased ceramide trihexoside ([[Globotriaosylceramide 3-beta-N-acetylgalactosaminyltransferase|globotriaosylceramide]])
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Alpha-galactosidase A activity
| |
| *[[GLA|GLA gene]] analysis for [[Heterozygote|heterozygotes]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Enzyme replacement therapy
| |
| *[[ACE inhibitor|ACE inhibitors]]
| |
| *[[Gabapentin]], [[carbamazepine]]
| |
| *[[Migalastat]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Light Chain Deposition Disease
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Multiple myeloma]]
| |
| *[[Waldenström's macroglobulinemia]]
| |
| *[[Monoclonal gammopathy of undetermined significance]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Asymptomatic]]
| |
| *[[Fatigue]]
| |
| *[[Weight loss]]
| |
| *[[Dyspnea]]
| |
| *[[Peripheral edema]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Proteinuria]]
| |
| *[[Portal hypertension]]
| |
| * Increased [[Alanine transaminase|ALT]], [[Aspartate transaminase|AST]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| ** Non-amyloid granules
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Bortezomib]]
| |
| * Autologous [[stem cell transplantation]]
| |
| * Immunomodulatory drugs
| |
| *[[Kidney transplantation|Kidney transplant]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |[[Membranous glomerulonephritis|Membranous Glomerulonephritis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Hepatitis B]] and [[Hepatitis C|C]]
| |
| *[[HIV]]
| |
| *[[Non-Hodgkin lymphoma|Non-Hodgkin`s lymphoma]]
| |
| *[[Chronic lymphocytic leukemia]]
| |
| *[[Hodgkin lymphoma|Hodgkin`s lymphoma]]
| |
| * Solid tissue tumors
| |
| *[[Schistosomiasis]]
| |
| *[[Leprosy]]
| |
| *[[Hydatid disease]]
| |
| *[[Loaiasis]] (filaria)
| |
| *[[Malaria|Quartan malaria]]
| |
| *[[Systemic lupus erythematosis]] ([[SLE]]) <br />
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |<br />
| |
|
| |
| *[[Headache]]
| |
| *[[Edema]] affecting any area of the body
| |
| * Foamy appearance of urine
| |
| *[[Weight gain]]
| |
| *[[Poor appetite]]
| |
| *[[Nocturia]]
| |
| *[[Fatigue]]
| |
| *[[Hematuria]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Proteinuria]]
| |
| *[[Hypertension]]
| |
| *[[Hyperlipidemia]]
| |
| *[[Hypoalbuminemia]]
| |
| * Microscopic or gross hematuria
| |
| *[[Hypoalbuminemia]]
| |
| *[[Antinuclear antibodies|ANA]] and [[Anti-dsDNA antibody|anti-dsDNA]] positivity
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| **[[Immunoglobulin G|IgG]] and [[C3 (complement)|C3]] deposits with thickened [[basement membrane]] with spikes and vacuolization
| |
| **[[Glomerulosclerosis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Prednisone]]
| |
| *[[Methylprednisolone]] with [[cyclophosphamide]]
| |
| *[[Tacrolimus]] with a six-month taper
| |
| *[[Rituximab]]
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Fibrillary-Immunotactoid Glomerulopathy
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Idiopathic]]
| |
| *[[Hepatitis C]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Microscopic or [[Hematuria|gross hematuria]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Proteinuria]]
| |
| *[[Hypertension]]
| |
| *Increased [[blood urea nitrogen]] ([[Blood urea nitrogen|BUN]]) and [[creatinine]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Biopsy:
| |
| ** Polycloncal [[Immunoglobulin G|IgG]] deposits
| |
| ** Infiltration of glomerular structures by amorphous acellular material (nonbranching fibrils 12-24nm in diameter)
| |
| ** Ig heavy-chain and one light-chain subclass
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| |- | | |- |
| ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Organ System Involvement}} | | ! style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Organ System Involvement}} |
Line 425: |
Line 185: |
| ! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|Therapy}} | | ! style="background: #4479BA; width: 300px;" |{{fontcolor|#FFF|Therapy}} |
| |- | | |- |
| | rowspan="6" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''Polyneuropathy''''' | | | rowspan="7" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''Polyneuropathy''''' |
| | | |
| | | |
| | | |
| | | |
| | | |
| | | |
| | |- |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[POEMS syndrome]] (Demyelinating)''' | | | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[POEMS syndrome]] (Demyelinating)''' |
| | style="padding: 5px 5px; background: #F5F5F5;" | | | | style="padding: 5px 5px; background: #F5F5F5;" | |
Line 1,034: |
Line 801: |
| * Supporting findings can include elevation of inflammatory markers ([[C-reactive protein (CRP)|C-reactive protein]], [[Erythrocyte sedimentation rate|ESR]], [[white blood cell count]]), and evidence of pericardial inflammation on imaging([[Computed tomography|CT scan]] and [[cardiac MRI]]). | | * Supporting findings can include elevation of inflammatory markers ([[C-reactive protein (CRP)|C-reactive protein]], [[Erythrocyte sedimentation rate|ESR]], [[white blood cell count]]), and evidence of pericardial inflammation on imaging([[Computed tomography|CT scan]] and [[cardiac MRI]]). |
| | style="padding: 5px 5px; background: #F5F5F5;" | | | | style="padding: 5px 5px; background: #F5F5F5;" | |
| |-
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Organ System Involvement'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Differential Diagnosis'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Causes'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Features'''}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Laboratory Findings}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|Gold Standard Test}}
| |
| | style="background: #4479BA; width: 200px;" |{{fontcolor|#FFF|'''Therapy'''}}
| |
| |-
| |
| | rowspan="4" style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''''Plasma Cell Dyscrasias'''''
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Multiple myeloma]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
| |
| *[[Malignant]] transformation of [[plasma cells]]
| |
| *Clonal [[plasma cell]] proliferation
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *Diffuse [[bone]] pain and [[tenderness]] with [[osteolytic]] lesions
| |
| *[[Renal failure]]
| |
| *[[Hypercalcemia]]
| |
| *[[Anemia]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Anemia]]
| |
| *[[Thrombocytopenia]]
| |
| *[[Leukopenia]]
| |
| * Decreased albumin (reversed albumin:globulin ratio)
| |
| * Increased serum creatinine, urea
| |
| * Hypercalcemia
| |
| * Elevated ESR
| |
| * Normal-low alkaline phosphatase
| |
| * RBC rouleaux formation
| |
| * Bence-Jones proteins in urine
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Clonal plasma cells on bone marrow exam greater than equal to 10%
| |
|
| |
| AND
| |
|
| |
| * Any one of the following:
| |
| ** Evidence of end-organ damage
| |
| ** Hypercalcemia (>11 mg/dl)
| |
| ** Renal insufficiency
| |
| ** Anemia (Hb < 10 mg/dl)
| |
| ** Bone lesions
| |
| ** Greater than 1 lesions on MRI
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *Induction [[chemotherapy]] with [[bortezomib]], [[lenalidomide]], and [[dexamethasone]]
| |
| *[[Bisphosphonates]]
| |
| *[[RANKL|RANK ligand]] inhibitors ([[denosumab]])
| |
| *[[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: #F5F5F5;" |
| |
| *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
| |
| *Clonal [[plasma cell]] proliferation
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Asymptomatic]]
| |
| *
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Serum]] [[M protein]] of <3 g/L
| |
| * Fewer than 10% [[plasma cells]] in the [[bone marrow]]
| |
| * No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Serum M protein (IgG or IgA) <3g/dl
| |
|
| |
| AND
| |
|
| |
| * Clonal bone marrow plasma cells < 10%
| |
|
| |
| AND
| |
|
| |
| * No end-organ damage
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Observation
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Multiple Myeloma|Asymptomatic Plasma Cell Myeloma]]'''
| |
| [[Multiple Myeloma|('''Smoldering''' and '''Indolent plasma cell myeloma''')]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
| |
| *[[Malignant]] transformation of [[plasma cells]]
| |
| *Clonal [[plasma cell]] proliferation
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Asymptomatic]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Serum]] [[M protein]] of greater than equal to 3 g/L
| |
| * Greater than 10% [[plasma cells]] in the [[bone marrow]]
| |
| * No evidence of [[bone]] or [[Organ (anatomy)|organ]] damage
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Serum M protein (IgG or IgA greater than equal to 3 g/dl
| |
|
| |
| OR
| |
|
| |
| * Urinary M protein greater than equal to 500 mg/24 h
| |
|
| |
| AND/OR
| |
|
| |
| * Clonal bone marrow plasma cells 10-60%
| |
|
| |
| AND
| |
|
| |
| * No end-organ damage
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Observation
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Plasmacytoma]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Chromosomal aberration|Chromosomal aberrations]] or other [[Genetics|genetic]] insults
| |
| *[[Malignant]] transformation of [[plasma cells]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Solitary bone [[plasmacytoma]] ([[bone]])
| |
| * Extramedullary [[plasmacytoma]] ([[Soft tissue|soft tissues]])
| |
| * Clinical manifestations related to [[tumor]] mass and compression [[symptoms]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * On biopsy:
| |
| ** Solitary infiltrate of clonal plasma cells in bone (SBP) or soft tissue (EMP).
| |
| ** No evidence of infiltration by clonal plasma cells.
| |
| * Negative skeletal survey plus MRI/CT spine and pelvis except for the solitary lesion.
| |
| * Lack of hypercalcemia, renal insuffieciency, anemia, multiple bone lesions which would suggest MM
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Diagnosis of exclusion
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| * Radiotherapy
| |
| |-
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |Skin Changes
| |
| | style="padding: 5px 5px; background: #DCDCDC; font-weight: bold; text-align:center;" |'''[[Scurvy]]'''
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Vitamin C]] deficiency
| |
| *[[Malabsorption]]
| |
| *[[Hemodialysis]]
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Gum disease]] such as gum [[bleeding]]
| |
| *Loose [[teeth]]
| |
| *Easy [[bruising]]
| |
| *Impaired [[immune]] response
| |
| *Impaired [[wound]] healing
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| | style="padding: 5px 5px; background: #F5F5F5;" |
| |
| *[[Vitamin C]] supplementation
| |
| *Citrus fruits
| |
| |} | | |} |
|
| |
|