X-Ray film of skull showing a wide scattering of lytic (also known as osteoclastic or osteolytic) lesions. This typical radiographic appearance of multiple hypointense lesions usually indicates multiple myeloma and is known as a ‘pepper pot’ skull. Osteoclastic cells (cells responsible for the breakdown of bone) release chemicals that produce further destruction and breakdown. This process of lytic bone destruction, with local disappearance of normal bone due to resorption, leads to areas that are thinner and become weakened (these areas appear darker on x-ray), they have a specific characteristic know as a ‘punched out’ appearance; this is clearly illustrated in Image 1 above. Findings: Multiple Myeloma
Myeloma is classed as a haematological disease because it is a cancer of the plasma cells that are found in the bone marrow. Bone marrow is the spongy, soft tissue that is found inside of the bone cavities and produces blood cells. The plasma cells play an important role in the immune system producing antibodies that help fight infections.(1) In multiple myeloma, clusters of abnormal plasma cells collect together in the bone marrow where they prevent, or interfere with, the production of normal blood cells. Due to the production of abnormal plasma cells, paraproteins (or antibodies that don’t fight infection) are found in the blood. A combination of the abnormal plasma cell groups and the paraproteins cause the symptoms of myeloma. These symptoms can be remembered by the acronym of ‘C.R.A.B’,(2) which stands for high levels of Calcium (hypercalcemia) Renal (or kidney) disease, Anaemia (lack of iron in the blood) and Bone damage.
An example of endosteal scalloping (erosion of the inner cortex) in a patient with multiple myeloma. Clearly evident are the lucent, oval-shaped bone marrow shadows that are distinctive to multiple myeloma and are referred to as ‘endosteal scalloping’. This process occurs due to the focal resorption of the inner margin of cortical bones due to slow growing medullary (bone marrow) lesions.
X-Ray of Right femur showing the typical appearance of a solitary plasma cell Myeloma in the interochanteric region. Findings: Single Myeloma.
It is estimated by recent statistics that around 1 in 200 people will develop Myeloma at some point in their life. Men have a slight predilection towards the disease with about 130 men diagnosed to every 100 women. Myeloma tends to affect older people more so; around 80% of all patients are over 65 years old at diagnosis, with the average age being 72 years. Multiple myeloma is rare in those under 40 years old.(3) In the US around 24,050 people are predicted to be diagnosed with Multiple Myeloma in 2014.(4)
1. Raab MS, Podar K, Breitkreutz I, Richardson PG, Anderson KC (July 2009). “Multiple myeloma”. Lancet 374 (9686): 324–39. doi:10.1016/S0140-6736(09)60221-X.PMID 19541364
2. 2.International Myeloma Working Group (2003). “Criteria for the classification of monoclonal gammopathies, multiple myeloma and related disorders: a report of the International Myeloma Working Group”. Br. J. Haematol. 121 (5): 749–57.doi:10.1046/j.1365-2141.2003.04355.x. PMID 12780789.
3. Leukaemia and Lymphoma Research, UK
4. Cancer facts and figures 2014: American Cancer Society