Multiple myeloma (MM) is a B cell malignancy characterized by enhanced bone loss that commonly associated with diffuse osteopenia, focal lytic lesions, pathologic fractures, and bone pain. The key mechanism of bone damage in myeloma is the abnormal regulation in bone metastasis, with increased osteoclast function and decreased osteoblast activity. This article reviewed the factors implicated, such as receptor activator of nuclear factor-kappaB (RANK), receptor activator of nuclear factor-kappaB ligand (RANKL), osteoprotegerin (OPG), macrophage inflammatory protein-1alpha (MIP-1alpha), SDF-1 and Wnt pathway. Further understanding of the regulation system of bone homeostasis helps to offer possible targets for future therapy.
Bone Diseases ; etiology ; Bone and Bones ; pathology ; Humans ; Multiple Myeloma ; complications ; pathology ; Osteoblasts ; pathology ; Osteoclasts ; pathology

Female ; Humans ; Middle Aged ; Multiple Myeloma ; complications ; Pulmonary Embolism ; etiology ; pathology ; Venous Thrombosis ; etiology

POEMS syndrome is a multisystem disorder associated with polyneuropathy, organomegaly, endocrinopathy, a monoclonal protein (M-protein), and skin changes. The authors describe a patient with POEMS syndrome who had osteosclerotic myeloma confirmed by open bone biopsy. Magnetic resonance imaging (MRI) showed discrete lesions of low signal intensity in both T1 and T2-weighted images. This patient is now being successfully treated with melphalan and prednisone with much improvement in skin thickening and sensory change in the lower extremities.
Adult ; Biopsy ; Femur Neck/pathology ; Humans ; Magnetic Resonance Imaging ; Male ; Multiple Myeloma/complications/pathology ; POEMS Syndrome/complications/*diagnosis

Humans ; Herpesvirus 4, Human ; Epstein-Barr Virus Infections/complications* ; Multiple Myeloma/complications* ; Lymphoma, Large B-Cell, Diffuse/pathology*

Aged ; Ascites ; etiology ; pathology ; Humans ; Immunoglobulin kappa-Chains ; metabolism ; Leukocyte Common Antigens ; metabolism ; Male ; Multiple Myeloma ; complications ; metabolism ; pathology

While pleural effusion in multiple myeloma is relatively infrequent, myelomatous pleural effusion is extremely rare. We experienced a 61-year-old woman with IgD-lambda multiple myeloma and pleural effusion. The diagnosis was made originally by pleural biopsy, pleural fluid cytology and immunoelectropheresis of pleural fluid. Transient improvement of the pleural effusion was observed after administration of combination chemotherapy of vincristine, melphalan, cyclophosphamide, prednisone (VMCP)/vincristine, cyclophosphamide, adriamycin, prednisone (VCAP). Two months later, myelomatous pleural effusion recurred and no response to salvage therapy was observed. We reviewed the clinical feature of this case and literature concerning myelomatous pleural effusion.
Antineoplastic Agents, Combined/administration & dosage* ; Case Report ; Cyclophosphamide/administration & dosage ; Female ; Human ; Melphalan/administration & dosage ; Middle Age ; Multiple Myeloma/pathology ; Multiple Myeloma/drug therapy* ; Multiple Myeloma/complications* ; Plasma Cells/pathology ; Pleural Effusion/radiography ; Pleural Effusion/pathology ; Pleural Effusion/etiology* ; Prednisone/administration & dosage ; Tomography, X-Ray Computed ; Vincristine/administration & dosage

While pleural effusion in multiple myeloma is relatively infrequent, myelomatous pleural effusion is extremely rare. We experienced a 61-year-old woman with IgD-lambda multiple myeloma and pleural effusion. The diagnosis was made originally by pleural biopsy, pleural fluid cytology and immunoelectropheresis of pleural fluid. Transient improvement of the pleural effusion was observed after administration of combination chemotherapy of vincristine, melphalan, cyclophosphamide, prednisone (VMCP)/vincristine, cyclophosphamide, adriamycin, prednisone (VCAP). Two months later, myelomatous pleural effusion recurred and no response to salvage therapy was observed. We reviewed the clinical feature of this case and literature concerning myelomatous pleural effusion.
Antineoplastic Agents, Combined/administration & dosage* ; Case Report ; Cyclophosphamide/administration & dosage ; Female ; Human ; Melphalan/administration & dosage ; Middle Age ; Multiple Myeloma/pathology ; Multiple Myeloma/drug therapy* ; Multiple Myeloma/complications* ; Plasma Cells/pathology ; Pleural Effusion/radiography ; Pleural Effusion/pathology ; Pleural Effusion/etiology* ; Prednisone/administration & dosage ; Tomography, X-Ray Computed ; Vincristine/administration & dosage

We report here on a rare case of primary AL hepatic amyloidosis associated with multiple myeloma in a 64-year-old woman. The patient was referred for evaluating her progressive jaundice and right upper quadrant pain. 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) showed diffusely and markedly increased 18F-FDG uptake in the liver. Although there have been several case studies showing positive 18F-FDG uptake in pulmonary amyloidosis, to the best of our knowledge, the 18F-FDG PET/CT findings of hepatic amyloidosis or primary hepatic amyloidosis associated with multiple myeloma have not been reported previously.
Amyloidosis/complications/pathology/*radionuclide imaging ; Biopsy, Needle ; Female ; Fluorodeoxyglucose F18/*diagnostic use ; Humans ; Liver/pathology ; Liver Diseases/complications/pathology/*radionuclide imaging ; Middle Aged ; Multiple Myeloma/*complications ; *Positron-Emission Tomography and Computed Tomography ; Radiopharmaceuticals/*diagnostic use

OBJECTIVETo analyze the clinical and laboratory features and risk factors of multiple myeloma (MM) with extramedullary disease (EM) and its extraosseous localizations at diagnosis and during the course of MM.

METHODSThe clinical features, survival rate and prognostic factors were retrospectively analyzed in 40 patients having EM from a total of 418 MM patients hospitalized in Changzheng Hospital from 1993 to 2006.

RESULTSAmong the 40 patients, the first three localizations of EM involved soft tissue, pleura or peritoneum and central nervous system (CNS). Median duration of follow-up was 30 months. The median overall survival (OS) was 28 months. Twenty-five patients (6%) were found to have EM at diagnosis (group A), and their median OS was 16 months and 15 patients (3.6%) developed EM during the course of the disease (group B), and their expected median OS was 72 months. There was a significant difference between group A and B (P = 0.0045) for OS. Compared with those in group A, patients in group B had a higher percentage of plasmacytes (P = 0.022) and plasmablasts (P = 0.029) in bone marrow, and less advanced stage for international staging system (ISS) (P = 0.027). Log-rank univariate analysis showed that higher CRP level, higher serum LDH, Stage II and III for ISS, Hb < 110 g/L at diagnosis were poor prognostic factors. However, multivariate analysis with COX model showed none of them were statistically significant.

CONCLUSIONEM tumors are not a rare manifestation of MM. Soft tissue in the commonest area involved. Higher serum CRP and LDH level, more advanced stage for ISS, anemia and having EM are poor prognostic factors of MM.

Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Male ; Middle Aged ; Multiple Myeloma ; complications ; pathology ; therapy ; Prognosis ; Retrospective Studies ; Risk Factors ; Survival Analysis

No abstract available.
Blood Cell Count ; Bone Marrow Cells/metabolism/pathology ; Humans ; Leukemia, Promyelocytic, Acute/complications/*diagnosis/pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Multiple Myeloma/complications/*diagnosis/pathology ; Paraproteinemias/diagnosis ; Syndecan-1/metabolism