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  • Plasma cell myeloma
  • Kahler’s disease

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  • 140-239 Neoplasms
  • 200-209 Malignant neoplasm of lymphatic and hematopoietic tissue
  • 203 Multiple myeloma and immunoproliferative neoplasms
  • 203.0 Multiple myeloma
  • 203.00 Multiple myeloma without remission
  • 203.01 Multiple myeloma in remission
  • 203.02 Multiple myeloma, in relapse

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  • C90.00 Multiple myeloma not having achieved remission
  • C90.01 Multiple myeloma in remission
  • C90.02 Multiple myeloma in relapse

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Description

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  • Multiple small tumors in the bone marrow
  • Overgrowth of plasma cells in bone marrow
  • Plasma decreases
  • RBCs/WBCs/platelets decrease
  • Primary malignant neoplasm of plasma cells arising in the bone marrow
  • Most common form of plasma cell dyscrasia2
  • Initial weakening of the bones and bone marrow of the vertebrae, ribs, skull, pelvis, and femur
  • Progression causes damage to the kidneys, leads to recurrent infections, and can affect the nervous system

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Essentials of Diagnosis

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  • Major criteria
    • Plasmacytoma by biopsy of tissue
    • Bone marrow shows clonal plasma cells >30%
    • High M-protein (IgG >3.5 g/dl, IgA > 2.0 g/dl)
    • Bence Jones Protein uria > 1.0 g/24 hr
  • Minor Criteria
    • Bone marrow shows clonal plasma cells 10%-30%
    • M-protein less than that for major criteria
    • Lytic bone lesions on x-ray or MRI
    • Reduced levels of nonmonoclonal immunoglobulins (IgM <50 mg/dl, IgA <100 mg/dl, or IgG < 600 mg/dl)

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General Considerations

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  • Spine/pelvis/femur/ribs
    • Compression fractures
    • Pathological fractures
    • Neural compromise

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Demographics

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  • Median age of diagnosis is 68 years for men, 70 years for women
  • More common in men
  • African-American men are affected twice as often as white men

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Signs and Symptoms

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  • Clinicopathologic correlates2
  • Unexplained back pain
  • Anemia due to accelerated red cell destruction, nutritional factors and replacement of marrow2
  • Fractures due to bone marrow involvement
  • Infection due to decreased ability to produce specific antibody2
  • Bone pain2
  • Nerve root compression if in the spine bones
  • Fatigue
  • Arthritis2
  • Neuropathy2
  • Bone loss
    • Pathological fractures
  • Renal disease2
  • Hyperviscosity
  • Frequent urination
  • Muscular weakness
  • Bruises easily
  • Weight loss
  • Radiation side effects
    • Fatigue
    • Secondary neoplasm
    • Integumentary compromise (burns)
    • Radiation fibrosis
  • Chemotherapy side effects
    • Nausea
    • Vomiting
    • Diarrhea
    • Alopecia
    • Mouth sores
    • Conjunctivitis
    • Ulcers
    • Leukopenia
    • Anemia
    • Thrombocytopenia
    • Headaches
    • Dizziness
    • Menstrual irregularities
    • Infertility
    • Peripheral neuropathies

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Functional Implications

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  • Pain with mobility
  • Risk for pathological fractures
  • Decreased independence
  • Impaired performance with ADLs
  • Decreased participation in work and leisure
  • Infection risk
  • Endurance
  • Impaired gait

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Possible Contributing Causes

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  • No precise etiology
  • Possibly genetic
  • Environmental
  • Radiation
  • Infection
  • Chronic inflammation
  • Possible due to exposure to Agent Orange

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Differential Diagnosis

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  • Bone neoplasms
  • Chronic lymphocytic leukemia (plasma cell leukemia)
  • Metastatic cancer (carcinoma)
  • Monoclonal gammopathy of undetermined significance (MGUS)
  • Non-Hodgkin’s lymphoma
  • Other protein disorders such as macroglobulinemia
  • Primary ...

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