【双语病例】多发性骨髓瘤继发病理性骨折一例

11 8月

History

A 70-year-old woman presents with shoulder pain.

70岁女性,肩关节疼痛。

【双语病例】Pathologic fracture secondary to multiple myeloma

【双语病例】Pathologic fracture secondary to multiple myeloma

1.The salient abnormality is localized to which anatomical region?

Shoulder

Humerus

Elbow

Soft tissue

2.What is the salient abnormality?

Osteomyelitis 骨髓炎

Osteoporosis 骨质疏松

Pathologic fracture 病理性骨折

Radiation changes 放射性损伤

【双语病例】Pathologic fracture secondary to multiple myeloma

Additional Questions

3.The fracture occurs at the insertion site of the subscapularis tendon.

骨折位于肩胛下肌肌腱附着点处。

True

False

4.There are multiple blastic lesions around the fracture site.

骨折周围可见多发成骨性病变区。

True

False

【双语病例】Pathologic fracture secondary to multiple myeloma

Additional Images

【双语病例】Pathologic fracture secondary to multiple myeloma

【双语病例】Pathologic fracture secondary to multiple myeloma

Findings and Diagnosis

Findings

  • There is a minimally displaced transverse fracture in the proximal diaphysis of the humerus, with multiple small lytic lesions involving the proximal humerus.肱骨骨干近段骨折,断端轻度横向移位。肱骨近段可见多发溶骨性骨质破坏。
  • The glenohumeral and acromioclavicular joints are congruent.盂肱关节、肩锁关节对位良好。
  • There are multiple (more than 15) lytic lesions throughout the skull.颅骨可见多发(超过15个)溶骨性骨质破坏区。
Differential Diagnosis

  • Pathologic fracture 病理性骨折
  • Metastases 转移瘤
  • Multiple myeloma 多发性骨髓瘤
  • Leukemia 白血病
  • Primary lymphoma of bone 原发性骨淋巴瘤
DiagnosisPathologic fracture secondary to multiple myeloma多发性骨髓瘤继发病理性骨折

【双语病例】Pathologic fracture secondary to multiple myeloma

Additional Questions

5.Multiple myeloma is LEAST likely to involve which of the following?

多发性骨髓瘤最发生于下列哪个部位?

Skull 颅骨

Vertebral body 椎体

Femur 股骨

Calcaneus 跟骨

6.Patients with multiple myeloma can, less commonly, present with diffuse osteopenia.

多发性骨髓瘤患者一般较少表现为弥漫性骨质疏松。

True

False

7.Bisphosphonates are often administered to patients with multiple myeloma to help prevent pathologic fractures.

多发性骨髓瘤患者常采用磷酸盐治疗,以防止病理性骨折。

True

False

【双语病例】Pathologic fracture secondary to multiple myeloma

【双语病例】Pathologic fracture secondary to multiple myeloma

选择题答案:

  1. Humerus

  2. Pathologic fracture
  3. False There is a minimally displaced transverse fracture in the proximal diaphysis of the humerus.
  4. False There are multiple, small lytic lesions involving the proximal humerus.
  5. Calcaneus
  6. True
  7. True

【双语病例】Pathologic fracture secondary to multiple myeloma

Discussion

Clinical presentationPatients often present with bone pain due to bone lesions with or without pathologic bone fracture. Other common findings include hypercalcemia, normocytic anemia , proteinemia , renal failure , and infections.
患者多表现为病变区疼痛,伴有或不伴有病理性骨折。其他常见表现包括血钙增多、正常红细胞性贫血、蛋白血症、肾衰、感染。

Imaging featuresOn radiographs, multiple myeloma typically presents as well-defined intramedullary lytic lesions, which are characteristically described as having a “punched out” appearance. The lesions can vary in size and can be focal or diffuse. Multiple myeloma commonly affects the axial skeleton (vertebrae are the most common sites of involvement), but it can affect the proximal appendicular skeleton (it rarely affects the distal appendicular skeleton). Patients less commonly present with diffuse osteopenia, often with vertebral compression fracture(s).X线片,多发性骨髓瘤典型表现为骨髓内溶骨性病变,呈“穿凿样”。病灶大小不一,可单发,也可弥漫性分布。多发性骨髓瘤多累及中轴骨(椎体是最好发部位),也可发生于四肢近端(极少发生于四肢远端)。患者很少发生弥漫性骨质疏松,可伴有椎体压缩性骨折。

On MRI or PET/CT, there is multifocal or diffuse infiltration of bone marrow, and an intramedullary soft-tissue mass is often visualized.

MRI或PET/CT上,可见多灶性或弥漫性骨髓浸润,常可见骨髓腔内软组织肿块。

Note: There is a sclerotic form of multiple myeloma, sclerosing myelomatosis, which is the most severe variant. It is uncommon and associated with polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome.

注:硬化型骨髓瘤是多发性骨髓瘤的一种少见的亚型。硬化型骨髓瘤可合并多发性神经病、器官巨大症、内分泌病变、单克隆免疫球蛋白病、皮肤改变,及POEMS综合征

Differential diagnoses (for multiple focal lytic lesions)

  • Metastases 转移瘤
  • Leukemia 白血病
  • Primary lymphoma of bone 原发性骨淋巴瘤

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