Abnormal radiological features in a multiple myeloma patient: a case report and radiological review of myelomas

Ghosh, Suchandra; Wadhwa, Pankaj; Kumar, Atin; Pai, Keerthilatha M.; Seshadri, Shubha; Manohar, Chethan

doi:10.1259/dmfr/74265829

Cited by 25 publications

(32 citation statements)

References 22 publications

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“…With respect to the present case, an expansile lytic lesion in a 74-year-old female is an uncommon presentation for osteosarcoma. Ewing’s sarcoma is commonly observed in young individuals, with 80% of cases recorded in patients <20 years of age ( 5 ); this condition was almost ruled out in the present case. Another relatively common malignant tumor that occurs in the sternum is lymphoma, which usually demonstrates permeated or moth-eaten bony destruction with an extensive apparent mass.…”

Section: Discussionmentioning

confidence: 59%

“…Around the periphery of the lesion, there were straight bony spicules extending outward from the cortex that resembled sunrays in appearance. To the best of our knowledge, there have only been a few previous case studies with bony spicules forming the appearance of sunrays ( 5 – 12 ). The majority of these cases occurred in the mandible, while other involved sites consisted of the orbit, vertebral body and skull vault ( 5 – 12 ).…”

Section: Discussionmentioning

confidence: 99%

“…To the best of our knowledge, there have only been a few previous case studies with bony spicules forming the appearance of sunrays ( 5 – 12 ). The majority of these cases occurred in the mandible, while other involved sites consisted of the orbit, vertebral body and skull vault ( 5 – 12 ). The majority of these cases were multiple myeloma; only two of the cases were SP ( 6 , 11 ).…”

Section: Discussionmentioning

confidence: 99%

“…Radiologically, SP of the bone typically appears as an osteolytic lesion; the tumor usually destroys the cortex in several places and invades the soft tissues ( 2 , 4 ). In rare cases, the radiological findings may take unusual forms, for example, they can manifest as bony spicules on the surface of the bone, which resemble the appearance of sunrays ( 5 – 12 ). The sites of bony spiculation in the lesions previously described in the literature are the mandible, orbit, vertebral body and skull vault ( 5 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

“…In rare cases, the radiological findings may take unusual forms, for example, they can manifest as bony spicules on the surface of the bone, which resemble the appearance of sunrays ( 5 – 12 ). The sites of bony spiculation in the lesions previously described in the literature are the mandible, orbit, vertebral body and skull vault ( 5 – 12 ).…”

Section: Introductionmentioning

confidence: 99%

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Solitary plasmacytoma of the sternum with a spiculated periosteal reaction: A case report

Zhao

et al. 2014

Oncology Letters

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Solitary plasmacytomas (SPs) represent ≤5% of all plasma cell neoplasms and mostly occur in the spine, pelvis, ribs and pectoral girdle, while rarely occurring in the sternum. The tumors typically appear as osteolytic lesions. In rare cases, SPs can manifest as bony spicules on the surface of the bone. The present study reports the case of a 74 year-old female with an osteolytic tumor localized in the sternum. The tumor displayed extensive bony destruction, with a large quantity of thick straight spicules on the surface of the bone, resembling a sunray in appearance. The imaging, laboratory and pathological examinations of the patient met the diagnostic criteria of SP. The patient was initially treated with radiotherapy at a dose of 45 Gy. Six months later, chemotherapy consisting of vindesine, Adriamycin and dexamethasone was administered. Vindesine and Adriamycin were administered at a dose of 2 and 15 mg/day, respectively on days 1–4 in a 20-day cycle. Dexamethasone was administered at a dose of 20 mg/day on days 1–4, 9–12 and 17–20 in the 20-day cycle. In total, the patient underwent 6 cycles of chemotherapy, with a total duration of 7 months. The patient was followed-up for two years after beginning therapy. At present, the patient is well, without any evidence of progressive disease or multiple myeloma. To the best of our knowledge, this is the first case in the English literature of SP in the sternum, with an unusual sunray periosteal reaction on radiological imaging. The sites of bony spiculation in the lesions that have previously been described in the literature are the mandible, orbit, vertebral body and skull vault. To the best of our knowledge, the current study presents the first case of a SP of the sternum with a unusual spiculated periosteal reaction on radiological imaging to be reported in the English literature.

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Section: Discussionmentioning

confidence: 59%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Solitary plasmacytoma of the sternum with a spiculated periosteal reaction: A case report

Zhao

et al. 2014

Oncology Letters

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Sclerotic lesions of the spine: MRI assessment

Mugera

Suh

Huisman

et al. 2013

Magnetic Resonance Imaging

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Sclerotic (T2 dark) lesions of the spine are infrequent and, as a result, these are often missed or misdiagnosed. Plain films may not be always available during magnetic resonance imaging (MRI) readout. Knowledge of such lesions and their imaging appearances on MRI evaluation is essential for a reader. Additionally, a systematic approach is important to accurately diagnose these lesions. In this article we discuss the various causes of spinal sclerotic lesions, describe their MRI characteristics with relevant case examples, and outline a systematic approach to their evaluation.

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Sclerotic multiple myeloma with an unusual sunburst periosteal reaction occurring in the sternum

Zhang

et al. 2014

Skeletal Radiol

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Multiple myeloma is a disseminated neoplastic monoclonal gammopathy that usually affects the skull, clavicle, rib, pelvis, spinal column, and proximal portions of the humerus and femur. The initial manifestation of multiple myeloma in the sternum is rare. The classic radiological presentations of multiple myeloma are multiple "punched-out" areas of bone destruction, expansile lytic lesions, and generalized osteoporosis. Primary sclerotic presentation is rare and occurs in only 3 % of cases. A sclerotic multiple myeloma with a sunburst periosteal reaction occurring in the sternum has not been reported in the English literature. We report a case of sclerotic multiple myeloma of a 49-year-old woman. In the sternum, the lesion displayed extensive sclerosis mixed with mottled lytic areas with a sunburst periosteal reaction occurring in the periphery, which radiologically mimicked an osteosarcoma. Multiple focal areas of sclerosis were also found in the right clavicle, pelvis, multiple ribs, and vertebrae.

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Abnormal radiological features in a multiple myeloma patient: a case report and radiological review of myelomas

Cited by 25 publications

References 22 publications

Solitary plasmacytoma of the sternum with a spiculated periosteal reaction: A case report

Solitary plasmacytoma of the sternum with a spiculated periosteal reaction: A case report

Sclerotic lesions of the spine: MRI assessment

Sclerotic multiple myeloma with an unusual sunburst periosteal reaction occurring in the sternum

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