Pathology Cheat Sheet
See the Myeloma Pattern
Multiple myeloma for NEET-PG: clonal marrow plasma cells, lytic skull lesions, rouleaux, M spike, Bence Jones cast nephropathy, and beta-2 microglobulin.
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See the Myeloma Pattern
Multiple myeloma for NEET-PG: clonal marrow plasma cells, lytic skull lesions, rouleaux, M spike, Bence Jones cast nephropathy, and beta-2 microglobulin.
The pathology, laboratory findings and complications of multiple myeloma, the malignant plasma cell neoplasm of bone marrow.
High-yield lines
- Multiple myeloma is a malignant clonal proliferation of plasma cells in the bone marrow.
- The bone marrow shows over ten percent clonal plasma cells, often in sheets.
- Myeloma produces lytic punched-out bone lesions, most classically in the skull.
- Bone destruction is driven by RANK-ligand activation of osteoclasts and causes hypercalcaemia.
- The peripheral smear shows rouleaux formation from the high paraprotein.
- Serum protein electrophoresis shows a monoclonal M spike, most commonly IgG.
- Urine contains Bence Jones free light chains that cause cast nephropathy and myeloma kidney.
- Renal failure in myeloma results from light chain cast nephropathy, hypercalcaemia, and amyloidosis.
- Anaemia is common due to marrow replacement, and infections occur from impaired normal immunoglobulin production.
- AL amyloidosis complicates myeloma when light chains form beta-pleated-sheet fibrils.
- The International Staging System uses serum beta-2 microglobulin and albumin.
- Myeloma classically presents in older adults with bone pain, anaemia, renal impairment, and recurrent infection.
Mapped competency codes
- PA20.1
Continue into the full chapter
This summary maps to PA20-plasma-cell-disorders.
Frequently Asked Questions
What are the classic bone findings in multiple myeloma?
Multiple lytic punched-out lesions, most characteristically in the skull, caused by osteoclast activation through the RANK-ligand pathway.
Why does myeloma cause renal failure?
Through light chain cast nephropathy, hypercalcaemia, and AL amyloidosis, all resulting from the excess monoclonal light chains.
What smear finding accompanies myeloma?
Rouleaux formation, in which red cells stack like coins because the high monoclonal protein reduces the negative surface charge on red cells.
Which markers are used in the International Staging System for myeloma?
Serum beta-2 microglobulin and serum albumin, which together stratify prognosis.
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