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Age / Sex : 67 / F
C.C.: Pain in the left arm
1) What is your impression?
2) A first impression and three or less differential diagnoses are acceptable.
Courtesy : Seoung-Oh Yang, MD., Eulji University College of Medicine
Diagnosis: multiple myeloma (plasmablastic type)
Discussion
Findings:
1) Osteolytic lesion in the left radial shaft and both clavicle (fractured right clavicle).
2) MRI: intramedullary mass with cortical erosion and heterogenous intermediate SI on T1WI and T2WI in the midshaft of the left radius.
3) PET/CT shows abnormal FDG uptakes in the left radial shaft, both clavicle and L 1, 2 vertebral bodies.
Differential Diagnosis:
- Multiple myeloma, - Metastasis, - Langerhans cell histicytosis (Histiocytosis-X)
Diagnosis: Multiple myeloma
Discussion:
Myeloma is cancer of the plasma cells in the bone marrow and destroys bone, causing pain or the collapse of bones. It is well known that standard bone scanning (with Tc-99m methylene diphosphonate) is relatively insensitive in the detection of the lesions of multiple myeloma compared with standard radiography. Durie and colleagues examined the utility of FDG-PET scanning in distinguishing multiple myeloma from MGUS. Of the untreated patients with known multiple myeloma, 21 of 21 had positive FDG studies, including 5 patients who had negative radiographs and 5 in whom new sites of extramedullary hematopoiesis were found. PET scans were believed to be particularly useful in patients with nonsecretory variants of myeloma. Skull radiography taken after PET/CT with suspicion of multiple myeolma revealed several characteristic punched-out lesions.
References:
1. Durie BG, Waxman AD, D'Agnolo A, et al. Whole body FDG-PET scanning identifies high risk myeloma. J Nucl Med. 2002;43:31P.
2. M. A. Bredella, L. Steinbach, G. Caputo, G. Segall, and R. Hawkins. Value of FDG PET in the Assessment of Patients with Multiple Myeloma Am. J. Roentgenol.. 2005; 184: 1199 - 1204
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