| disease | Myeloma |
Myeloma is a malignant tumor originating from plasma cells in the bone marrow and is a relatively common type of malignancy. It can be classified as solitary or multiple, with the latter being more prevalent. It tends to affect soft tissues, and in advanced stages, it may lead to widespread metastasis, although lung metastasis is rare. It is more frequently observed in the spine, accounting for 10% of primary spinal tumors, with the lumbar region being the most commonly affected. The disease predominantly occurs in individuals over the age of 40, with a male-to-female ratio of approximately 2:1.
bubble_chart Pathological Changes
The tumor is richly vascularized, appearing dark red or deep red, and is relatively fragile and soft. Microscopically, the tumor is primarily composed of a large number of densely packed tumor cells with very little stroma. The tumor cells are mostly round or oval in shape but exhibit varying degrees of immaturity. Based on differences in differentiation, they can be classified into two types: well-differentiated (small cell type) and poorly differentiated (large cell type). The former is more mature in differentiation, small in size, with round and eccentrically located nuclei, and chromatin arranged in a wheel-like pattern, also known as plasma cell type myeloma; the latter is poorly differentiated, large in size, sometimes with binucleation, prominent nucleoli, and frequent mitotic figures, also known as reticular cell type myeloma.
bubble_chart Clinical Manifestations
The main symptom is persistent spinal pain, which progressively worsens. In multiple cases, the pain covers a wide area. Approximately 40-50% of patients are accompanied by pathological fractures. There is a high risk of paraplegia and symptoms of nerve root compression.
Generally, there is progressive anemia, and the erythrocyte sedimentation rate (ESR) is significantly increased. Some patients have elevated serum calcium, often accompanied by secondary hyperparathyroidism. The total serum protein is increased. Globulins are increased, while albumin is decreased or normal. Serum protein electrophoresis mostly shows abnormal immunoglobulin peaks. Urine protein is often positive, but the positivity rate of Bence Jones protein is not high, about 30-60%. At the same time, calcium oxalate crystals and alkaline phosphates in the urine are increased. Bone marrow smears show a hyperplastic bone marrow image, with plasma cells accounting for at least 8% of nucleated cells.
X-ray examination of myeloma patients: it can appear normal, accounting for about 10%. The main manifestations are widespread osteoporosis and multiple bone destruction. Methodical reduction in bone density can be seen, with bone trabeculae becoming thinner and sparser, and the bone cortex thinning. Localized bone destruction can manifest as oval or irregular bone defects, and a few may also show soap bubble-like expansion or sclerotic changes. The tumor generally does not invade the intervertebral disc, so the intervertebral space is normal. Because the tumor can be seen at the foramen magnum of the occipital bone, MRI should be performed for those whose neurological examination suggests higher segment involvement.
bubble_chart Treatment Measures
Generally, a comprehensive treatment approach is adopted, primarily involving radiotherapy and chemotherapy, with surgical treatment as an adjunct.
Radiotherapy: Myeloma is grade II sensitive to radiation, and the radiation dose for palliative treatment differs from that for curative treatment.
Surgical Treatment: If there is spinal cord or nerve root compression, decompression surgery should be performed, accompanied by chemotherapy.
The prognosis of the disease is generally poor, with most patients dying within one year. Comprehensive treatment can extend life expectancy.
