IPLab:Lab 6:Multiple Myeloma: Difference between revisions - Pathology Education Instructional Resource

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== Clinical Summary ==

This 63-year-old female presented with the complaint of left chest pain of approximately 4 months duration. Physical examination revealed that the pain was along the distribution of the left sixth intercostal nerve. Chest film showed a posterior mediastinal mass with partial collapse of T6. A lytic lesion of the right distal clavicle was noted on subsequent radiological examination. A bone scan revealed increased uptake in thoracic vertebrae. Serum alkaline phosphatase was elevated slightly (143 U/L). Serum protein electrophoresis was normal, while urine protein electrophoresis showed a monoclonal spike in the Gamma region. A bone marrow study was non-diagnostic.

A thoracotomy was performed after the unsuccessful needle biopsy. At thoracotomy, a 3-cm posterior mediastinal mass was identified that extended to within 1-2 mm of the aorta and into the interspace between the ribs.

== Images ==

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File:IPLab6MM4.jpg|This is a photograph of the vertebral column from this patient at autopsy. Notice the collapsed vertebra (1). There are multiple variably-sized white nodules (2) within the bone marrow. These are accumulations of malignant plasma cells in this case of multiple myeloma.

</gallery>

== Virtual Microscopy ==

<peir-vm>IPLab6MM</peir-vm>

== Study Questions ==

* <spoiler text="What class of amyloid is this?">AL - Immunocyte dyscrasias - primary amyloidosis.</spoiler>

* <spoiler text="What is the chemical nature of this type of amyloid?">Immunoglobulin light chains, usually lambda.</spoiler>

* <spoiler text="What is the usual organ distribution of amyloid in this class of amyloidosis?">Heart, gastrointestinal tract, peripheral nerves, skin, and tongue.</spoiler>

== Additional Resources ==

=== Reference ===

* [http://emedicine.medscape.com/article/204369-overview eMedicine Medical Library: Multiple Myeloma]

* [http://www.merckmanuals.com/professional/hematology_and_oncology/plasma_cell_disorders/multiple_myeloma.html Merck Manual: Multiple Myeloma]

=== Journal Articles ===

* Rodon P, Linassier C, Gauvain JB, Benboubker L, Goupille P, Maigre M, Luthier F, Dugay J, Lucas V, Colombat P. [http://www.ncbi.nlm.nih.gov/pubmed/11168502 Multiple myeloma in elderly patients: presenting features and outcome]. ''Eur J Haematol'' 2001 Jan;66(1):11-7.

=== Images ===

* [{{SERVER}}/library/index.php?/tags/327-multiple_myeloma PEIR Digital Library: Multiple Myeloma Images]

* [{{SERVER}}/library/index.php?/tags/65-amyloidosis PEIR Digital Library: Amyloidosis Images]

* [http://library.med.utah.edu/WebPath/HEMEHTML/HEMEIDX.html#6 WebPath: Myeloma]

== Related IPLab Cases ==

* [[IPLab:Lab 6:Amyloidosis|Lab 6: Liver: Amyloidosis]]

* [[IPLab:Lab 6:Senile Amyloidosis|Lab 6: Heart: Senile Amyloidosis]]

[[Category: IPLab:Lab 6]]

@@ Line 1: / Line 1: @@
+== Clinical Summary ==
+This 63-year-old female presented with the complaint of left chest pain of approximately 4 months duration. Physical examination revealed that the pain was along the distribution of the left sixth intercostal nerve. Chest film showed a posterior mediastinal mass with partial collapse of T6. A lytic lesion of the right distal clavicle was noted on subsequent radiological examination. A bone scan revealed increased uptake in thoracic vertebrae. Serum alkaline phosphatase was elevated slightly (143 U/L). Serum protein electrophoresis was normal, while urine protein electrophoresis showed a monoclonal spike in the Gamma region. A bone marrow study was non-diagnostic.
+A thoracotomy was performed after the unsuccessful needle biopsy. At thoracotomy, a 3-cm posterior mediastinal mass was identified that extended to within 1-2 mm of the aorta and into the interspace between the ribs.
 == Images ==
 <gallery heights="250px" widths="250px">
@@ Line 6: / Line 11: @@
 File:IPLab6MM4.jpg|This is a photograph of the vertebral column from this patient at autopsy. Notice the collapsed vertebra (1). There are multiple variably-sized white nodules (2) within the bone marrow. These are accumulations of malignant plasma cells in this case of multiple myeloma.
 </gallery>
+== Virtual Microscopy ==
+<peir-vm>IPLab6MM</peir-vm>
+== Study Questions ==
+* <spoiler text="What class of amyloid is this?">AL - Immunocyte dyscrasias - primary amyloidosis.</spoiler>
+* <spoiler text="What is the chemical nature of this type of amyloid?">Immunoglobulin light chains, usually lambda.</spoiler>
+* <spoiler text="What is the usual organ distribution of amyloid in this class of amyloidosis?">Heart, gastrointestinal tract, peripheral nerves, skin, and tongue.</spoiler>
+== Additional Resources ==
+=== Reference ===
+* [http://emedicine.medscape.com/article/204369-overview eMedicine Medical Library: Multiple Myeloma]
+* [http://www.merckmanuals.com/professional/hematology_and_oncology/plasma_cell_disorders/multiple_myeloma.html Merck Manual: Multiple Myeloma]
+=== Journal Articles ===
+* Rodon P, Linassier C, Gauvain JB, Benboubker L, Goupille P, Maigre M, Luthier F, Dugay J, Lucas V, Colombat P.  [http://www.ncbi.nlm.nih.gov/pubmed/11168502 Multiple myeloma in elderly patients: presenting features and outcome].  ''Eur J Haematol'' 2001 Jan;66(1):11-7.
+=== Images ===
+* [{{SERVER}}/library/index.php?/tags/327-multiple_myeloma PEIR Digital Library: Multiple Myeloma Images]
+* [{{SERVER}}/library/index.php?/tags/65-amyloidosis PEIR Digital Library: Amyloidosis Images]
+* [http://library.med.utah.edu/WebPath/HEMEHTML/HEMEIDX.html#6 WebPath: Myeloma]
+== Related IPLab Cases ==
+* [[IPLab:Lab 6:Amyloidosis|Lab 6: Liver: Amyloidosis]]
+* [[IPLab:Lab 6:Senile Amyloidosis|Lab 6: Heart: Senile Amyloidosis]]
 {{IPLab 6}}
 [[Category: IPLab:Lab 6]]