"Punched out lesions" in skull without a punching machine...
It's fun to just randomly punch holes in a sheet of paper using a punching machine.
But it ain't fun when the same happens with a person's skull. Here the candidate doing all the punching is "Multiple myeloma."
The disease that affects more than 25,000 people a year, is the third most common type of blood cancer in the world. Although seems like a rare condition, it's incidence has almost doubled in a decade.
The reason for it's increased occurrence could be due to an increase in number of farmers required to feed our growing population. Farmers are more prone to develop the disease as are wood workers, leather product handlers and petroleum product handlers.
One may use the following way to remember the high risk population:
"Farmers do wood work and raise farm animals too. They rear animals for leather and use petrol to clean the leather."
Farmers are mostly men. Similarly the most affected population seems to be men. The most common presentations of the disease are (numbered by the incidence of occurence):
But it ain't fun when the same happens with a person's skull. Here the candidate doing all the punching is "Multiple myeloma."
The disease that affects more than 25,000 people a year, is the third most common type of blood cancer in the world. Although seems like a rare condition, it's incidence has almost doubled in a decade.
The reason for it's increased occurrence could be due to an increase in number of farmers required to feed our growing population. Farmers are more prone to develop the disease as are wood workers, leather product handlers and petroleum product handlers.
One may use the following way to remember the high risk population:
"Farmers do wood work and raise farm animals too. They rear animals for leather and use petrol to clean the leather."
Remembering the chromosomal alterations in multiple myeloma is quite simple I suppose. Number from 11 to 14
11 - 11q abnormalities
12 - Change 2 to 7 (looks similar) - 17p13 deletion
13 - 13q14 deletion
14 - 13q14 deletion
Farmers are mostly men. Similarly the most affected population seems to be men. The most common presentations of the disease are (numbered by the incidence of occurence):
- Bone pain due to osteoclastic lesions dispersed throughout the body.
- Infection prone - Staph, Step and Kleb in lungs (Staphylococcus aureus, Streptococcus pneumoniae, Klebsiella pneumoniae)
- Kidney dysfunction due to hypercalcemia pursues. Increased erosion of calcium from the bones leads to increased serum calcium. The kidney may also be damaged by increase in M protein which is a light chain excreted by the renal tubules. Since the M proteins increase in quantity the renal tubules get damaged. Increase in protein in urine is proteinuria.
Bence Jones proteins are found in 2/3 of the patients.
If dehydrated the kidneys might fail. - Anemia: normocytic and normochromic.
The classical triad of the disease is:
- Marrow plasmacytosis (increased plasma cells in marrow)
- Lytic bone lesions
- Serum/Urine M component (M spikes)
Before starting therapy the stage of the disease has to be ascertained.
Stage 2 and 3 require chemotherapy with either Melphalan, cyclophosphamide or chlorambucil.
Relapsing or resistant cases will have to undergo palliative treatment (high dose glucocorticoids or VAD regime - Vincristine, Doxorubucin, Dexamethasone).
The disease generally has a poor prognosis with a median survival rate of three years. The following factors contribute more to the poor prognosis:
Stage 2 and 3 require chemotherapy with either Melphalan, cyclophosphamide or chlorambucil.
Relapsing or resistant cases will have to undergo palliative treatment (high dose glucocorticoids or VAD regime - Vincristine, Doxorubucin, Dexamethasone).
The disease generally has a poor prognosis with a median survival rate of three years. The following factors contribute more to the poor prognosis:
- Tumor mass
- Hypercalcemia
- Bence Jones proteinemia
- Renal dysfunction
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