Diffuse osteoporosis

Introduction Diffuse osteoporosis is one of the symptoms of myeloma. Myeloma (also known as plasmacytoma) is a malignant tumor originating from plasma cells in the bone marrow and is a relatively common malignant tumor. There are single and multiple points, the latter are more common. Multiple myeloma (Multiple myeloma, MM for short) is a malignant transformation of plasma cells with synthetic and secretory immunoglobulins. A large number of monoclonal malignant plasma cells proliferate easily to affect soft tissues, and can be extensive in the late stage. Metastasis, but few lung metastases. More common in the ridge, accounting for 10% of the primary tumor of the spine, more common in the lumbar vertebrae. The age of men and women over 40 years old is about 2:1. Mostly in men over the age of 40, the most common sites are spine, ribs, skull, sternum and so on. X-ray bone examination: The affected bone shows a circular piercing defect, which is typical of the skull. Diffuse osteoporosis and decalcification can also be seen.

Cause

Diffuse osteoporosis is mostly caused by myeloma. The main symptom of myeloma is persistent spinal pain, which is progressively worse. Multiple people have a wide range of pain. About 40% to 50% of patients have pathological fractures. It is prone to paraplegia and nerve root compression symptoms. Myeloma has an asymptomatic period of varying lengths, with a few patients with back pain as the first symptom, accompanied by anemia and cachexia. There are also patients who come to see a doctor because of a pathological fracture. X-ray bone examination, the affected bone shows a circular piercing defect, which is typical of the skull. Diffuse osteoporosis and decalcification can also be seen.

an examination

Related inspection

Calcitonin bone marrow analysis of urinary calcium (Ca2+, Ca)

Myeloma is a malignant intramedullary tumor that occurs in middle-aged and late years (40-60 years). The vertebral body, ribs, sternum, skull and pelvis are good sites. In the advanced stage, the femur and tibia can also be tired, but the bones below the knee and elbow rarely occur. The main symptom is pain, which is intermittent at the beginning, followed by persistence, and the pain is very severe. The nerves may be oppressed, causing radiation pain or paraplegia. Once the tumor is discovered, most patients gradually develop progressive anemia and cachexia. However, metastases are rarely produced and the lungs are rarely tired.

The main symptom of myeloma is persistent spinal pain, which is progressively worse. Multiple people have a wide range of pain. About 40% to 50% of patients have pathological fractures. It is prone to paraplegia and nerve root compression symptoms.

There is generally progressive anemia, and the erythrocyte sedimentation rate increases significantly. Some patients have elevated serum calcium, often accompanied by secondary hyperparathyroidism. The total serum protein level is increased. Increased globulin, albumin decreased or normal. Most of the serum protein electrophoresis has abnormal immunoglobulin peaks. Urinary protein is often positive, but the positive rate of this-week protein is not high, about 30% to 60%. At the same time, calcium oxalate crystals and alkaline phosphate in the urine increased. Bone marrow smears showed proliferative bone marrow, and the number of plasma cells accounted for at least 8% of nucleated cells.

Myeloma has an asymptomatic period of varying lengths, with a few patients with back pain as the first symptom, accompanied by anemia and cachexia. There are also patients who come to see a doctor because of a pathological fracture.

X-ray bone examination: The affected bone shows a circular piercing defect, which is typical of the skull. Diffuse osteoporosis and decalcification can also be seen.

Skeletal osteolysis in patients with myeloma

X-rays are mainly characterized by multiple osteolytic lesions and extensive osteoporosis.

In the x-ray examination, most osteolytic perforation defects can be found in the affected bone, and there is no reactive new bone hyperplasia around, which is characteristic of myeloma. Therefore, there are more pathological fractures. When the vertebral body is diagnosed, a compression fracture is produced. When a pathological fracture occurs in the extremities, it can cause a small amount of periosteal reactive new bone hyperplasia. The typical x-ray signs of myeloma in the parietal bone are irregularly distributed multiple chimeral defects that can be identified at a glance. However, the bone destruction is sometimes different when the long bones are affected. It cannot be distinguished from osteolytic osteosarcoma or metastases according to the x-ray.

Differential diagnosis

The diagnosis of a typical multiple myeloma case is not difficult. Abnormal plasma cell infiltration was found mainly by bone marrow biopsy. X-ray film found bone destructive changes, and serum protein electrophoresis detected M protein or/and the presence of light chain in urine. Diagnostic diagnosis should also be done at the same time.

1. A large number of myeloma cells were found in bone marrow biopsy. This is the most important diagnostic basis. However, the increase of plasma cells can also be seen in rheumatoid arthritis, tumor metastasis, chronic inflammation and other diseases in the bone marrow, but in the above diseases, the plasma cells generally do not exceed 10%, and there is no abnormality in morphology.

2, bone destruction changes this need to differentiate from tumor bone metastasis, senile osteoporosis, hyperparathyroidism.

3, hyperglobulinemia is mainly M protein and / or proteinuria (urine can detect this week's protein), but M protein and this week's protein can still be found in other diseases such as metastatic cancer, macroglobulinemia, multiple Sarcoma and so on.

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