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Perillo T, Giorgio C, Fico A, Perrotta M, Serino A, Cuocolo R, Manto A. Review of whole-body magnetic resonance imaging in multiple myeloma. Jpn J Radiol 2024:10.1007/s11604-024-01635-y. [PMID: 39088009 DOI: 10.1007/s11604-024-01635-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Accepted: 07/22/2024] [Indexed: 08/02/2024]
Abstract
Multiple Myeloma (MM) is a hematological malignancy affecting bone marrow, most frequently in elderly men. Imaging has a crucial role in this disease. Recently, whole-body MRI has been introduced and it has gained growing interest due to is high sensitivity and specificity in evaluating bone marrow involvement in MM. Diffusion-weighted sequences (DWI) with apparent diffusion coefficient (ADC) maps have emerged as the most sensitive technique to evaluate patients with MM, both in the pre- and post-treatment setting. Aim of this review is to provide an overview of the role and main imaging findings of whole-body MRI in MM.
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Affiliation(s)
- Teresa Perillo
- Neuroradiology Unit, Umberto I" Hospital, Nocera Inferiore, Italy.
| | - Claudia Giorgio
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Fisciano, Italy
| | - Arianna Fico
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Fisciano, Italy
| | | | | | - Renato Cuocolo
- Department of Medicine, Surgery, and Dentistry, University of Salerno, Fisciano, Italy
| | - Andrea Manto
- Neuroradiology Unit, Umberto I" Hospital, Nocera Inferiore, Italy
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Nourallah A, Alshehri A, Alhejazi A, Usman B, ElGohary G, Malhan H, Motabi I, Al Farsi K, Alshuaibi M, Siddiqui M, Ghonema R, Taha RY, Abouzeid T, Ahmed W, Diab M, Alhuraiji A, Rabea M, Chouikrat MZ. Real-World Registry on the Pharmacotherapy of Multiple Myeloma and Associated Renal and Pulmonary Impairments in the Greater Gulf Region: Protocol for a Retrospective Real-World Data Study. JMIR Res Protoc 2024; 13:e49861. [PMID: 38657230 PMCID: PMC11079760 DOI: 10.2196/49861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 10/17/2023] [Accepted: 11/27/2023] [Indexed: 04/26/2024] Open
Abstract
BACKGROUND Multiple myeloma (MM) is the second-most common cancer among hematological malignancies. Patients with active disease may experience several comorbidities, including renal insufficiency and asthma, which may lead to treatment failure. The treatment of relapsed or refractory MM (RRMM) has been associated with multiple factors, causing a decline in progression-free survival as well as overall survival with subsequent lines of therapy. Data about the characteristics of this group of patients in the Greater Gulf region are lacking. OBJECTIVE The primary objective of this study is to describe the disease characteristics and various treatment approaches or regimens used in the management of patients with RRMM in the Greater Gulf region. METHODS We will conduct a regional, retrospective study collecting real-world and epidemiological data on patients with MM in countries of the Greater Gulf region. Medical records will be used to obtain the required data. Around 150 to 170 patients' records are planned to be retrospectively reviewed over 6 months without any cross-sectional or prospective intervention. Cases will be collected from Saudi Arabia, the United Arab Emirates, Kuwait, Oman, and Qatar. Descriptive as well as analytical statistics will be performed on the extracted data. The calculated sample size will allow us to estimate the percentages of RRMM cases with acceptable precision while complying with the challenges in light of data scarcity. We will obtain a comprehensive description of the demographic profile of patients with MM; treatment outcomes; the proportion of patients with MM with renal impairment and asthma, chronic obstructive pulmonary disease, or both at the time of diagnosis and any subsequent point; and data related to treatment lines, regimens, and MM-associated morbidities. RESULTS Patient medical records were reviewed between June 2022 and January 2023 for eligibility and data extraction. A total of 148 patients were eligible for study inclusion, of whom 64.2% (n=95) were male and 35.8% (n=53) were female. The study is currently in its final stages of data analysis. The final manuscript is expected to be published in 2024. CONCLUSIONS Although MM is a predominant hematological disease, data on its prevalence and patients' characteristics in the Greater Gulf region are scarce. Therefore, this study will give us real-world insights into disease characteristics and various management approaches of patients with MM in the Greater Gulf region. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/49861.
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Affiliation(s)
- Abdulnaser Nourallah
- Hematology/Medical Oncology Department, Almana General Hospital, Alkhobar, Saudi Arabia
| | | | - Ayman Alhejazi
- Division of Adult Hematology and Hematopoietic Stem Cell Transplantation, Department of Oncology, King Abdulaziz Medical City, Riyadh, Saudi Arabia
| | - Binyam Usman
- Department of Oncology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia
| | - Ghada ElGohary
- Department of Medicine, Division of Oncology/Hematology, College of Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
| | - Hafiz Malhan
- Department of Adult Hematology, Prince Mohammed bin Nasser Hospital, Jazan, Saudi Arabia
| | - Ibraheem Motabi
- Adult Hematology & Bone Marrow Transplant Department, Comprehensive Cancer Center at King Fahad Medical City, Riyadh, Saudi Arabia
- Alfaisal University, Riyadh, Saudi Arabia
| | - Khalil Al Farsi
- Department of Hematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Mohammed Alshuaibi
- Adult Hematology and Oncology Divisions, Department of Medicine, King Abdul-Aziz Hospital, Alahsa, Saudi Arabia
| | - Mustaqeem Siddiqui
- Hematology & Oncology Division at Sheikh Shakhbout Medical City (SSMC), Abu Dhabi, Saudi Arabia
| | - Rasha Ghonema
- Department of Hematology, Kuwait Cancer Control Center, Kuwait, Kuwait
| | - Ruba Yasin Taha
- Department of Hematology-Bone Marrow Transplantation, National Centre for Cancer Care and Research (NCCCR), Hamad Medical Corporation (HMC), Doha, Qatar
| | - Tarek Abouzeid
- Internal Medicine Department, Almouwasat Hospital, Dammam, Saudi Arabia
| | - Wesam Ahmed
- Cleveland Clinic Abu Dhabi, Oncology Institute, Abu Dhabi, United Arab Emirates
- Cleveland Clinic Florida, Oncology Institute, Florida, FL, United States
| | - Mohanad Diab
- Hemato-oncology Department, Burjeel Hospital, Abu Dhabi, United Arab Emirates
| | - Ahmad Alhuraiji
- Department of Hematology, Kuwait Cancer Control Center, Kuwait, Kuwait
| | - Magdy Rabea
- Medical Affairs Department, Sanofi, Jeddah, Saudi Arabia
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Owosho AA, Aguirre SE, Dayo AF, Omolehinwa TT, Shintaku WH. Radiographic Orofacial Findings of Systemic Diseases. Dent Clin North Am 2024; 68:409-427. [PMID: 38417998 DOI: 10.1016/j.cden.2023.10.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2024]
Abstract
This article discusses the orofacial clinicoradiographic features of systemic diseases that manifest in the orofacial region. The systemic diseases discussed are grouped into the following: autoimmune diseases, endocrine diseases, bone diseases, hematologic diseases, syndromes, and malignancies. The radiographic manifestation ranges from radiolucent bony destruction, increased bone density, calcification, thinning of cortical plate, loss of trabeculation, missing teeth, and supernumerary teeth. It is imperative for clinicians to be cognizant of these findings, as they may be the first manifestation of these systemic diseases.
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Affiliation(s)
- Adepitan A Owosho
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA.
| | - Sarah E Aguirre
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
| | - Adeyinka F Dayo
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Temitope T Omolehinwa
- Department of Oral Medicine, School of Dental Medicine, University of Pennsylvania, PA, USA
| | - Werner H Shintaku
- Department of Diagnostic Sciences, College of Dentistry, The University of Tennessee Health Science Center, Memphis, TN, USA
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Feng Z, Liao M, Bai J, Li Y, Chen Y, Zhang L, Guo X, Li L, Zhang L. Exploring the causal relationship between gut microbiota and multiple myeloma risk based on Mendelian randomization and biological annotation. Front Microbiol 2024; 15:1310444. [PMID: 38410384 PMCID: PMC10895040 DOI: 10.3389/fmicb.2024.1310444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2023] [Accepted: 01/15/2024] [Indexed: 02/28/2024] Open
Abstract
Introduction The microbial genome-wide association studies (mbGWAS) have highlighted significant host-microbiome interactions based on microbiome heritability. However, establishing causal relationships between particular microbiota and multiple myeloma (MM) remains challenging due to limited sample sizes. Methods Gut microbiota data from a GWAS with 18,340 participants and MM summary statistics from 456,348 individuals. The inverse variance-weighted (IVW) method was used as the main bidirectional Mendelian randomization (MR) analysis. To assess the robustness of our results, we further performed supplementary analyses, including MR pleiotropy residual sum and outlier (MR-PRESSO) test, MR-Egger, Weighted median, Simple mode, and Weighted mode. Moreover, a backward MR analysis was conducted to investigate the potential for reverse causation. Finally, gene and gene-set-based analyses were then conducted to explore the common biological factors connecting gut microbiota and MM. Results We discovered that 10 gut microbial taxa were causally related to MM risk. Among them, family Acidaminococcaceae, Bacteroidales family S24-7, family Porphyromonadaceae, genus Eubacterium ruminantium group, genus Parabacteroides, and genus Turicibacter were positively correlated with MM. Conversely, class Verrucomicrobia, family Verrucomicrobiaceae, genus Akkermansia, and order Verrucomicrobiales were negatively correlated with MM. The heterogeneity test revealed no Heterogeneity. MR-Egger and MR-PRESSO tests showed no significant horizontal pleiotropy. Importantly, leave-one-out analysis confirmed the robustness of MR results. In the backward MR analysis, no statistically significant associations were discovered between MM and 10 gut microbiota taxa. Lastly, we identified novel host-microbiome shared genes (AUTS2, CDK2, ERBB3, IKZF4, PMEL, SUOX, and RAB5B) that are associated with immunoregulation and prognosis in MM through biological annotation. Discussion Overall, this study provides evidence supporting a potential causal relationship between gut microbiota and MM risk, while also revealing novel host-microbiome shared genes relevant to MM immunoregulation and clinical prognosis.
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Affiliation(s)
- Zuxi Feng
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Minjing Liao
- Second Clinical Medical College, Lanzhou University, Lanzhou, China
| | - Jun Bai
- Key Laboratory of the Hematology of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yanhong Li
- Key Laboratory of the Hematology of Gansu Province, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Yue Chen
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Li Zhang
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Xuege Guo
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Lijuan Li
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
| | - Liansheng Zhang
- Department of Hematology, Lanzhou University Second Hospital, Lanzhou, China
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Sia T, Bacchus L, Cunningham E, Hsia K, Miller M, Epstein T, Myftija Y, Mousad A, Dinesh YS, Maddisetty H, Chandra V, Guo Z, Gupta A, Johnson S, Logan J, Mawyer E, Scheve A, Yu H, Leung J. Elevated Total Serum Immunoglobulin A Levels in Patients with Suspicion for Celiac Disease. J Clin Med 2023; 12:5101. [PMID: 37568503 PMCID: PMC10419449 DOI: 10.3390/jcm12155101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 07/28/2023] [Accepted: 07/31/2023] [Indexed: 08/13/2023] Open
Abstract
Patients with classic symptoms of celiac disease are often initially tested for serum tissue transglutaminase-immunoglobulin A (tTG-IgA) and total serum immunoglobulin A (IgA) levels concurrently, as IgA deficiency can lead to falsely low tTG-IgA. There are no guidelines for incidental findings of elevated total serum IgA when testing for celiac disease. In our study, we described the proportion of patients with suspicion of celiac disease who had elevated total serum IgA and the factors that may be associated with these findings. We studied the management of these patients with incidental findings of elevated total serum IgA to identify its clinical significance. To investigate, we performed a retrospective chart review of patients who underwent celiac disease serologic testing at a single clinic from January 2017 to June 2022. We reported further laboratory workup and follow-up for patients with incidental findings of elevated total serum IgA by board-certified immunologists. In our chart review, 848 patients were identified, 85 (10.0%) of whom were found to be negative for celiac disease but had elevated total serum IgA levels (median IgA 351 mg/dL, interquartile range 324-382). Out of 85 patients, 73 were further evaluated by immunologists, with 55 patients undergoing additional laboratory workup. None were diagnosed with specific immunologic conditions. Male sex was identified as associated with elevated total serum IgA findings, and constipation was found in a statistically significant greater frequency of patients with normal total serum IgA rather than elevated total serum IgA. To provide external validation of our findings, we created a second patient cohort within the Stanford Research Repository database. Out of 33,875 patients identified, a similarly high proportion of patients were negative for celiac disease but had elevated total serum IgA levels (9.3%, 3140 patients). In this separate patient cohort, male sex was also identified as being associated with elevated total serum IgA. Our study also provides preliminary evidence that patients with incidental findings of elevated total serum IgA may not need further management or workup, as these abnormalities may not be clinically relevant without other clinical suspicions.
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Affiliation(s)
- Twan Sia
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
- Stanford University School of Medicine, Stanford, CA 94305, USA
| | - Leeon Bacchus
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Evan Cunningham
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Katie Hsia
- Division of Internal Medicine, Tufts Medical Center, Boston, MA 02111, USA
| | - Megan Miller
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Taylor Epstein
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Yasmine Myftija
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Albert Mousad
- Tufts University School of Medicine, Boston, MA 02111, USA
| | | | | | - Vinay Chandra
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Ziqi Guo
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Anya Gupta
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | | | - Julia Logan
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Emily Mawyer
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Ally Scheve
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - Haitong Yu
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
| | - John Leung
- Boston Specialists, 65 Harrison Ave #201, Boston, MA 02111, USA
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Akao K, Ishida Y, Kamada S, Sekine S, Ohseto K. Two cases of low back pain of unknown etiology diagnosed as multiple myeloma. SAGE Open Med Case Rep 2023; 11:2050313X231187682. [PMID: 37456925 PMCID: PMC10338723 DOI: 10.1177/2050313x231187682] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 06/26/2023] [Indexed: 07/18/2023] Open
Abstract
We report two cases of patients complaining of lumbar back pain of unknown etiology which were finally diagnosed as multiple myeloma. The first case was a woman in her 80s with a chief complaint of lumbar back pain. The second case was a male in his 70s. He also consulted our institution because his pain did not subside despite receiving increased doses of oral medication and nerve blocks from his previous doctor. Both patients presented with compression fractures on plain radiography, and additionally with cytopenia, hyperproteinemia, and hypoalbuminemia in blood tests. Further tests were conducted due to suspected multiple myeloma, revealing a punched-out legion in the skull and elevated levels of β2 microglobulin and Immunoglobulin G. Subsequently, both patients were transferred to the hematology department. In these two cases, we had predicted the presence of multiple myeloma from the results of initial testing and subsequently successfully provided definitive diagnoses following additional examinations.
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Affiliation(s)
| | - Yusuke Ishida
- Yusuke Ishida, Department of Anesthesiology, Tokyo Medical University Hospital, 6-7-1 Nishishinjuku, Shinjuku-ku, Tokyo 160-0023, Japan.
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Zijlstra H, Wolterbeek N, Ponds NH, Koene HR, Terpstra WE, Delawi D, Kempen DH. The incidence of vertebral compression fractures and spinal instability in newly diagnosed multiple myeloma patients. J Orthop 2023; 38:62-67. [PMID: 36974337 PMCID: PMC10038922 DOI: 10.1016/j.jor.2023.03.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 02/21/2023] [Accepted: 03/18/2023] [Indexed: 03/29/2023] Open
Abstract
Background Multiple myeloma (MM) is a hematologic malignancy, characterized by clonal proliferation of plasma cells in the bone marrow. These plasma cell proliferations frequently result in scattered osteolytic bone lesions and extensive skeletal destruction. Myeloma bone lesions are frequently located in the spine, and are associated with debilitating bone pain and an increased rate of pathologic fractures and mortality. The aim of this study was to investigate the incidence of vertebral compression fractures (VCFs) and spinal instability in patients with MM. Patients and methods Newly diagnosed patients with MM with computed tomography (CT) scans of the spine within three months of diagnosis were identified through an electronic patient database. Clinical baseline data were manually extracted from the patient charts. Fractured levels were graded on CT scans following the Genant grading system, and spinal instability was assessed through the Spinal Instability Neoplastic Score (SINS). Results A total of 385 patients with 6289 eligible vertebrae were eligible for inclusion. The mean age at diagnosis was 67 years, and 60% were male. At least one VCF was present in 180 patients (47%). A quarter of fractures were classified as severe. The incidence of fractures increased with more advanced disease stages, and men were more likely to have a fracture than women. Conclusions Our data show that 47% of MM patients present with one or more VCFs at the onset of their disease, of which 20% were classified as unstable, meaning a surgical consultation is recommended.
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Affiliation(s)
- Hester Zijlstra
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, the Netherlands
- Department of Orthopedic Surgery, OVLG, Amsterdam, the Netherlands
| | - Nienke Wolterbeek
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, the Netherlands
| | - Noa H.M. Ponds
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, the Netherlands
| | - Harry R. Koene
- Department of Hematology, St. Antonius Hospital, Utrecht, the Netherlands
| | | | - Diyar Delawi
- Department of Orthopedic Surgery, St. Antonius Hospital, Utrecht, the Netherlands
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Iqbal S, Agrawal S, Desai K, Paravathaneni M, Thirumaran R. Incidental diagnosis of a rare pancreatic plasmacytoma with plasmablastic features. Proc AMIA Symp 2022; 36:85-86. [PMID: 36578587 PMCID: PMC9762785 DOI: 10.1080/08998280.2022.2132790] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Multiple myeloma is a plasma cell neoplasm that accounts for 10% of all hematologic malignancies, characterized by malignant proliferation of monoclonal plasma cells in the bone marrow. It predominantly affects men 60 to 70 years of age. Plasmacytoma is a discrete mass of neoplastic monoclonal plasma cells that may be osseous or extramedullary. Though extramedullary plasmacytomas are uncommon, they can involve any tissue or organ. Only a few cases of pancreatic involvement have been reported. We report a case of a 78-year-old woman with a long-standing history of multiple myeloma noted to have pancreatic tail involvement with plasmacytoma with plasmablastic features. Multiple myeloma with plasmablastic transformation has a poor prognosis; hence, a multidisciplinary team approach is crucial to identify and initiate appropriate management in these cases.
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Affiliation(s)
- Sabah Iqbal
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania,Corresponding author: Sabah Iqbal, MD, 14 W Thompson St., Unit C, Philadelphia, PA19125 (e-mail: )
| | - Shubham Agrawal
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Krishna Desai
- Department of Internal Medicine, Mercy Catholic Medical Center, Darby, Pennsylvania
| | - Mahati Paravathaneni
- Department of Hematology and Oncology, USF Morsani College of Medicine, Tampa, Florida
| | - Rajesh Thirumaran
- Department of Hematology and Oncology, Mercy Catholic Medical Center, Darby, Pennsylvania
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Akyol R, Şirin Sarıbal G, Amuk M. Evaluation of mandibular bone changes in multiple myeloma patients on dental panoramic radiographs. Oral Radiol 2022; 38:575-585. [PMID: 35132575 DOI: 10.1007/s11282-022-00590-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Accepted: 01/17/2022] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The aim of this study is to assess the mandibular bone structures of multiple myeloma (MM) patients on panoramic radiographs using fractal analysis (FA) and radio-morphometric indices. METHODS The study group consisted of 67 MM patients, and the control group consisted of 67 individuals without any systemic disease. The mandibular cortical index (MCI) classification, antegonial index (AGI), gonial index (GI), mandibular cortical width (MCW), panoramic mandibular index (PMI) and fractal dimensions (FD) were evaluated on panoramic radiographs. FD measurements were made by identifying 4 related areas. Shapiro-Wilk test was used to determine the normal distribution of the data. Chi-square and independent t tests were used to compare the findings between the two groups. RESULTS The FD values of the study group in ROI1, ROI2, ROI3, ROI4 regions and GI values were found to be statistically significantly lower than the control group (p < 0.001). There was no statistically significant difference between the two groups in terms of AGI, MCW and PMI values (p > 0.05). While C1 was the most common type in the control group, C2 was the most common type in the study group. C2 and C3 were detected more in the study group than in the control group (p < 0.001). CONCLUSION Our study showed a consensus with the studies advocating that fractal analysis and radio-morphometric indices are methods that can be used to determine mandibular bone density. The low bone density of MM patients is a condition that physicians should be aware of for interventional dental procedures.
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Affiliation(s)
- Rıdvan Akyol
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Turkey.
| | - Gamze Şirin Sarıbal
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Turkey
| | - Mehmet Amuk
- Department of Oral and Maxillofacial Radiology, Faculty of Dentistry, Erciyes University, 38039, Kayseri, Turkey
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Invasive Orbital Squamous Cell Carcinoma in a Patient with Multiple Myeloma. Case Rep Ophthalmol Med 2022; 2022:8585692. [PMID: 35815062 PMCID: PMC9259366 DOI: 10.1155/2022/8585692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Revised: 06/03/2022] [Accepted: 06/18/2022] [Indexed: 11/18/2022] Open
Abstract
Background Orbital squamous cell carcinoma (SCC) is a rare entity. It is often a result of local invasion of SCC originating from the skin, nasopharynx, nasal cavity, paranasal sinuses, conjunctiva, lacrimal glands, or sac or less commonly occurs through hematogenous metastasis. Herein, we report a patient with orbital SCC with a history of multiple myeloma (MM). Case presentation. A 45-year-old woman with a history of MM in the past two years presented to our clinic complaining of gradual right eye proptosis for six months. The relative afferent pupillary defect was detected in the right eye on her examination. Ocular movements of the right eye were limited in all directions. Orbital magnetic resonance imaging demonstrated an infiltrative mass in the right orbit extended from the anterior to the orbital apex and the optic canal. The patient underwent debulking, and a histopathology examination revealed SCC results. No other secondary site was found to be the origin of the tumor. Result The patient underwent chemotherapy and subsequent radiotherapy. To our knowledge, this is the first report of concomitant MM and primary orbital SCC.
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He L, Gibbon VE, Xiao X, Wang B, Li H. Metastatic cancer along ancient Silk Road: A possible case from Xinjiang (China). INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2022; 37:23-29. [PMID: 35366493 DOI: 10.1016/j.ijpp.2022.03.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/11/2022] [Accepted: 03/11/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Palaeopathological evidence of cancer, especially metastatic cancer, is rare in China. This paper describes and diagnoses a cranium with multiple lytic lesions recovered from the Sampula cemetery in Xinjiang, attempting to diagnose the type of disease that could have caused the pathological lesions observed. MATERIAL A cranium from an adult male (#00106) was recovered from the Sampula cemetery (dated to 55 BCE to 335 CE) located in the Luopu County, the Hotan River oasis on the southern edge of the Tarim Basin in southern Xinjiang. METHODS The cranium was assessed macroscopically and radiographically (CT). RESULTS Multiple osteolytic lesions with irregular and "moth-eaten" margins were detected in cranium #00106. CT scans revealed the development of the lesions began at the diploe and identified a "button sequestrum". CONCLUSIONS Based on lesion characteristics, metastatic carcinoma was likely the cause of lesions found in cranium #00106. SIGNIFICANCE This case has expanded our knowledge of the malignant neoplasms of ancient populations in northwest China and discusses the possible risk factors in the occurrence of cancer in the Sampula site, as well as the possible impacts of skeletal metastases on the individual. LIMITATIONS The distribution of osteolytic lesions over the complete skeleton cannot be observed because of the unavailability of postcranial bone. SUGGESTIONS FOR FUTURE RESEARCH With the increasing number of reports describing diseases in ancient China, the patterns of diseases occurrence and development can be further explored from spatial and temporal perspectives.
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Affiliation(s)
- Letian He
- School of History and Culture, Department of Archaeology and Museology, Lanzhou University, Lanzhou, Gansu 730000, China.
| | - Victoria E Gibbon
- Division of Clinical Anatomy & Biological Anthropology, Department of Human Biology, University of Cape Town, Observatory 7935, South Africa
| | - Xiaoyong Xiao
- School of Ethnology and Sociology, Minzu University of China, Beijing 100081, China
| | - Bo Wang
- Xinjiang Uygur Autonomous Region Museum, Urumqi 830000, China
| | - Haijun Li
- School of Ethnology and Sociology, Minzu University of China, Beijing 100081, China.
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12
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Eryilmaz K, Bakar HE, Kilbas B. Novel developed HPLC analyses of [
68
Ga]Ga/[
177
Lu]Lu‐EDTMP and [
68
Ga]Ga/[
177
Lu]Lu‐DOTA‐Zoledronate. J Labelled Comp Radiopharm 2022; 65:178-186. [DOI: 10.1002/jlcr.3972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/31/2022] [Accepted: 04/20/2022] [Indexed: 11/10/2022]
Affiliation(s)
| | | | - Benan Kilbas
- Moltek A. S. Gebze Organize Sanayi Kocaeli Turkey
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13
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Jin Z, Wang Y, Wang Y, Mao Y, Zhang F, Yu J. Application of 18F-FDG PET-CT Images Based Radiomics in Identifying Vertebral Multiple Myeloma and Bone Metastases. Front Med (Lausanne) 2022; 9:874847. [PMID: 35510246 PMCID: PMC9058063 DOI: 10.3389/fmed.2022.874847] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2022] [Accepted: 03/17/2022] [Indexed: 12/18/2022] Open
Abstract
Purpose The purpose of this study was to explore the application of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) image radiomics in the identification of spine multiple myeloma (MM) and bone metastasis (BM), and whether this method could improve the classification diagnosis performance compared with traditional methods. Methods This retrospective study collected a total of 184 lesions from 131 patients between January 2017 and January 2021. All images were visually evaluated independently by two physicians with 20 years of experience through the double-blind method, while the maximum standardized uptake value (SUVmax) of each lesion was recorded. A total of 279 radiomics features were extracted from the region of interest (ROI) of CT and PET images of each lesion separately by manual method. After the reliability test, the least absolute shrinkage and selection operator (LASSO) regression and 10-fold cross-validation were used to perform dimensionality reduction and screening of features. Two classification models of CT and PET were derived from CT images and PET images, respectively and constructed using the multivariate logistic regression algorithm. In addition, the ComModel was constructed by combining the PET model and the conventional parameter SUVmax. The performance of the three classification diagnostic models, as well as the human experts and SUVmax, were evaluated and compared, respectively. Results A total of 8 and 10 features were selected from CT and PET images for the construction of radiomics models, respectively. Satisfactory performance of the three radiomics models was achieved in both the training and the validation groups (Training: AUC: CT: 0.909, PET: 0.949, ComModel: 0.973; Validation: AUC: CT: 0.897, PET: 0.929, ComModel: 0.948). Moreover, the PET model and ComModel showed significant improvement in diagnostic performance between the two groups compared to the human expert (Training: P = 0.01 and P = 0.001; Validation: P = 0.018 and P = 0.033), and no statistical difference was observed between the CT model and human experts (P = 0.187 and P = 0.229, respectively). Conclusion The radiomics model constructed based on 18F-FDG PET/CT images achieved satisfactory diagnostic performance for the classification of MM and bone metastases. In addition, the radiomics model showed significant improvement in diagnostic performance compared to human experts and PET conventional parameter SUVmax.
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Affiliation(s)
- Zhicheng Jin
- Department of Nuclear Medicine, Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yongqing Wang
- School of Geophysics and Information Technology, China University of Geosciences, Beijing, China
| | - Yizhen Wang
- Department of Nuclear Medicine, Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Yangting Mao
- Department of Nuclear Medicine, Second Affiliated Hospital, Dalian Medical University, Dalian, China
| | - Fang Zhang
- Department of Nuclear Medicine, Second Affiliated Hospital, Dalian Medical University, Dalian, China
- *Correspondence: Fang Zhang
| | - Jing Yu
- Department of Nuclear Medicine, Second Affiliated Hospital, Dalian Medical University, Dalian, China
- Jing Yu
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Elboga U, Sahin E, Cayirli YB, Okuyan M, Aktas G, Haydaroglu Sahin H, Dogan I, Kus T, Akkurd DM, Cimen U, Mumcu V, Kilbas B, Celen YZ. Comparison of [68Ga]-FAPI PET/CT and [18F]-FDG PET/CT in Multiple Myeloma: Clinical Experience. Tomography 2022; 8:293-302. [PMID: 35202189 PMCID: PMC8875266 DOI: 10.3390/tomography8010024] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2021] [Revised: 01/22/2022] [Accepted: 01/26/2022] [Indexed: 11/16/2022] Open
Abstract
Objective: In this study, we aimed to compare [68Ga]FAPI PET/CT and [18F]FDG PET/CT imaging to detect lesions in multiple myeloma. Methods: A total of 14 patients with multiple myeloma who underwent [68Ga]FAPI PET/CT and [18F]FDG PET/CT imaging were included in this retrospective study. SUVmax values of [68Ga]FAPI and [18F]FDG were compared according to lesion locations. Also, lesion localization ability of both imaging methods was compared on the patient basis. Results: In 4 of 14 patients, [68Ga]FAPI PET/CT and [18F]FDG PET/CT have not detected any bone lesions. In 8 of the remaining 10 patients [18F]FDG PET/CT detected bone lesions but in this group, 6 patients showed more higher SUVmax values than [18F]FDG PET/CT in [68Ga]FAPI PET/CT.In contrast, 2 of 8 patients showed more higher SUVmax values than [68Ga]FAPI PET/CT in [18F]FDG PET/CT. Moreover, [68Ga]FAPI PET/CT detected bone lesions in two patients, which werenot detected by [18F]FDG PET/CT. Also, in five patients, [68Ga]FAPI PET/CT showed more bone lesions in comparison with[18F]FDG PET/CT. Only one patient, [18F]FDG PET/CT showed more bone lesions. Three extramedullary involvements were observed in the following locations: lung, presacral lymph node, and soft tissue mass lateral to the right maxillary sinus. Among these involvements, higher SUVmax values were observed in the lung and presacral lymph node with [68Ga]FAPI compared to [18F]FDG. However, the soft tissue mass showed a higher SUVmax value in [18F]FDG than [68Ga]FAPI. Conclusions: No significant superiority was observed in [68Ga]FAPI PET/CT over [18F]FDG PET/CT in patients with MM. However, [68Ga]FAPI PET/CT can be utilized as a complementary imaging method to [18F]FDG PET/CT in some settings, especially in low-[18F]FDG affinity and inconclusive cases. Considering the favorable aspects of [68Ga]FAPI PET/CT in MM, such as low background activity, absence of non-specific bone marrow, and physiological brain involvement, further studies with a larger sample size should be conducted.
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Affiliation(s)
- Umut Elboga
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
- Correspondence:
| | - Ertan Sahin
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Yusuf Burak Cayirli
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Merve Okuyan
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Gokmen Aktas
- Department of Oncology, Medical Park Private Hospital, Gaziantep 27090, Turkey;
| | | | - Ilkay Dogan
- Department of Biostatistics, Gaziantep University, Gaziantep 27310, Turkey;
| | - Tulay Kus
- Department of Oncology, Gaziantep University, Gaziantep 27310, Turkey;
| | - Dervis Murat Akkurd
- Department of Hematology, Gaziantep University, Gaziantep 27310, Turkey; (H.H.S.); (D.M.A.)
| | - Ufuk Cimen
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Vuslat Mumcu
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
| | - Benan Kilbas
- Department of R&D, Moltek Health Services Production & Marketing Inc., Kocaeli 41400, Turkey;
| | - Yusuf Zeki Celen
- Department of Nuclear Medicine, Gaziantep University, Gaziantep 27310, Turkey; (E.S.); (Y.B.C.); (M.O.); (U.C.); (V.M.); (Y.Z.C.)
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15
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Parthiban J, Udaykumar B, Peddireddy SR, Prakash B, Kumar VK. Multiple Myeloma Involving Left Hemicranium. INDIAN JOURNAL OF NEUROSURGERY 2022. [DOI: 10.1055/s-0041-1726603] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
AbstractMultiple myeloma (MM) is a malignant neoplasm of bone marrow affecting plasma cells. It is commonly seen as multiple punched-out lesions in the skull bone as a characteristic feature. Its presentation as hemicranial involvement with intracranial extension is rare. A 46-year-old male presented with left side scalp swelling, prominent over parietal region. X-ray showed multiple punched out lesions involving left hemicranium. CT and MRI brain showed intracranial extension of lesion without brain parenchyma invasion. He was treated with biopsy of lesion followed by chemotherapy.
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Affiliation(s)
- Jutty Parthiban
- Department of Neurosurgery, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
| | - B. Udaykumar
- Department of Neurosurgery, Kovai Medical Centre and Hospital, Coimbatore, Tamil Nadu, India
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16
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Michels M, Morais-Faria K, Rivera C, Brandão TB, Santos-Silva AR, Oliveira ML. Structural complexity of the craniofacial trabecular bone in multiple myeloma assessed by fractal analysis. Imaging Sci Dent 2022; 52:33-41. [PMID: 35387107 PMCID: PMC8967490 DOI: 10.5624/isd.20210160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 08/30/2021] [Accepted: 09/24/2021] [Indexed: 11/18/2022] Open
Abstract
Purpose This study aimed to evaluate the structural complexity of craniofacial trabecular bone in multiple myeloma by fractal analysis of panoramic and lateral skull radiography, and to compare the fractal dimension values of healthy patients (HPs), pre-treatment patients (PTPs), and patients during bisphosphonate treatment (DTPs). Materials and Methods Pairs of digital panoramic and lateral skull radiographs of 84 PTPs and 72 DTPs were selected. After application of exclusion criteria, 43 panoramic and 84 lateral skull radiographs of PTPs, 56 panoramic and 72 lateral skull radiographs of DTPs, and 99 panoramic radiographs of age- and sex-matched HPs were selected. The fractal dimension values from panoramic radiographs were compared among HPs, PTPs, and DTPs and between anatomical locations within patient groups using analysis of variance with the Tukey test. Fractal dimension values from lateral skull radiographs were compared between PTPs and DTPs using the Student t-test. Pearson correlation coefficients were used to assess the relationship between the mandible from panoramic radiographs and the skull from lateral skull radiographs. Intra-examiner agreement was assessed using intraclass correlation coefficients (α=0.05). Results The fractal dimension values were not significantly different among HPs, PTPs, and DTPs on panoramic radiographs or between PTPs and DTPs on lateral skull radiographs (P>0.05). The mandibular body presented the highest fractal dimension values (P≤0.05). The fractal dimension values of the mandible and skull in PTPs and DTPs were not correlated. Conclusion Fractal analysis was not sensitive for distinguishing craniofacial trabecular bone complexity in multiple myeloma patients using panoramic and lateral skull radiography.
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Affiliation(s)
- Mariane Michels
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Karina Morais-Faria
- Dental Oncology Service, São Paulo State Cancer Institute, São Paulo University Medical School, São Paulo, SP, Brazil
| | - César Rivera
- Oral Medicine and Pathology Research Group, Department of Basic Biomedical Sciences, Faculty of Health Sciences, University of Talca, Talca, Maule, Chile
| | - Thaís Bianca Brandão
- Dental Oncology Service, São Paulo State Cancer Institute, São Paulo University Medical School, São Paulo, SP, Brazil
| | - Alan Roger Santos-Silva
- Division of Oral Medicine, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
| | - Matheus L Oliveira
- Division of Oral Radiology, Department of Oral Diagnosis, Piracicaba Dental School, University of Campinas, Piracicaba, SP, Brazil
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17
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Baksh M, Jiang L, Bhatia U, Alegria V, Sher T, Roy V, Chanan‐Khan A, Ailawadhi S, Parrondo RD. Management of lytic bone disease in lymphoplasmacytic lymphoma: A case report and review of the literature. Clin Case Rep 2021; 9:e05181. [PMID: 34934497 PMCID: PMC8650751 DOI: 10.1002/ccr3.5181] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2021] [Revised: 11/17/2021] [Accepted: 11/21/2021] [Indexed: 12/22/2022] Open
Abstract
Waldenström macroglobulinemia (WM)/lymphoplasmacytic lymphoma (LPL) is often differentiated from myeloma based on the presence of lytic bone lesions (LBL). However, WM/LPL can present with LBL, and management is poorly understood. We describe a case of an 81-year-old woman with LPL who presented with LBL and was successfully treated with chemoimmunotherapy.
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Affiliation(s)
- Mizba Baksh
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Liuyan Jiang
- Department of PathologyMayo ClinicJacksonvilleFloridaUSA
| | - Unnati Bhatia
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Victoria Alegria
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Taimur Sher
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Vivek Roy
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
| | - Asher Chanan‐Khan
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
- Department of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
- Hematology‐OncologySt. Vincent's RiversideJacksonvilleFloridaUSA
| | - Sikander Ailawadhi
- Division of Hematology‐OncologyMayo ClinicJacksonvilleFloridaUSA
- Department of Cancer BiologyMayo ClinicJacksonvilleFloridaUSA
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Creeper K, Augustson B, Kusel K, Fulham MJ, Ho J, Quach H, Mollee P, Weber N, Talaulikar D, Johnston A, Murphy N, Joshua D, Ward C, Ling S, Gibson J, Szer J, Harrison S, Zannettino A, Jaksic W, Lee C, Spencer A, Kalff A, Szabo F, Romeril K, Chan H, Gibbs S, Horvath N, Prince HM. Imaging of patients with multiple myeloma and associated plasma cell disorders: consensus practice statement by the Medical Scientific Advisory Group to Myeloma Australia. Intern Med J 2021; 51:1707-1712. [PMID: 34664367 DOI: 10.1111/imj.15457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 11/30/2022]
Abstract
Imaging modalities for multiple myeloma (MM) have evolved to enable earlier detection of disease. Furthermore, the diagnosis of MM requiring therapy has recently changed to include disease prior to bone destruction, specifically the detection of focal bone lesions. Focal lesions are early, abnormal areas in the bone marrow, which may signal the development of subsequent lytic lesions that typically occur within the next 18-24 months. Cross-sectional imaging modalities are more sensitive for the detection and monitoring of bone and bone marrow disease and are now included in the International Myeloma Working Group current consensus criteria for initial diagnosis and treatment response assessment. The aim of this consensus practice statement is to review the evidence supporting these modalities. A more detailed Position Statement can be found on the Myeloma Australia website.
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Affiliation(s)
- Katherine Creeper
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Bradley Augustson
- Department of Haematology, Sir Charles Gairdner Hospital, Perth, Western Australia, Australia
| | - Kieran Kusel
- Department of Diagnostic and Interventional Radiology, Royal Perth Hospital, Perth, Western Australia, Australia
| | - Michael J Fulham
- Department of Molecular Imaging, Royal Prince Alfred Hospital Camperdown, Sydney, New South Wales, Australia
| | - Joy Ho
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Hang Quach
- Department of Haematology, St Vincent's Hospital and University of Melbourne, Melbourne, Victoria, Australia
| | - Peter Mollee
- Department of Haematology, Princess Alexandra Hospital and University of Queensland, Brisbane, Queensland, Australia
| | - Nicholas Weber
- Department of Haematology, Royal Brisbane Hospital, Brisbane, Queensland, Australia
| | - Dipti Talaulikar
- Department of Haematology, The Canberra Hospital, Canberra, Australian Capital Territory, Australia
| | - Anna Johnston
- Department of Clinical Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Nick Murphy
- Department of Clinical Haematology, Royal Hobart Hospital, Hobart, Tasmania, Australia
| | - Douglas Joshua
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Christopher Ward
- Department of Haematology, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - Silvia Ling
- Department of Haematology, Liverpool Hospital, Sydney, New South Wales, Australia
| | - John Gibson
- Institute of Haematology, Royal Prince Alfred Hospital, University of Sydney, Sydney, New South Wales, Australia
| | - Jeff Szer
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - Simon Harrison
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
| | - Andrew Zannettino
- Department of Experimental Haematology, University of Adelaide, Adelaide, South Australia, Australia
| | - Wilfrid Jaksic
- Department of Haematology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia
| | - Cindy Lee
- Department of Clinical Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - Andrew Spencer
- Department of Clinical Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Anna Kalff
- Department of Clinical Haematology, Alfred Hospital, Melbourne, Victoria, Australia
| | - Ferenc Szabo
- Department of Haematology, Royal Darwin Hospital, Darwin, Northern Territory, Australia
| | - Ken Romeril
- Bowen Icon Cancer Centre, Wellington, New Zealand
| | - Henry Chan
- Department of Haematology, North Shore Hospital, Auckland, New Zealand
| | - Simon Gibbs
- Department of Clinical Haematology, Monash University Eastern Health Clinical School, Melbourne, Victoria, Australia
| | - Noemi Horvath
- Department of Clinical Haematology, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - H Miles Prince
- Department of Clinical Haematology, Peter MacCallum Cancer Centre and University of Melbourne, Melbourne, Victoria, Australia
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Spinnato P, Filonzi G, Conficoni A, Facchini G, Ponti F, Sambri A, De Paolis M, Cavo M, Salizzoni E, Nanni C. Skeletal Survey in Multiple Myeloma: Role of Imaging. Curr Med Imaging 2021; 17:956-965. [PMID: 33573573 DOI: 10.2174/1573405617666210126155129] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2020] [Revised: 11/23/2020] [Accepted: 12/18/2020] [Indexed: 11/22/2022]
Abstract
Bone disease is the hallmark of multiple myeloma. Skeletal lesions are evaluated to establish the diagnosis, to choose the therapies and also to assess the response to treatments. Due to this, imaging procedures play a key role in the management of multiple myeloma. For decades, conventional radiography has been the standard imaging modality. Subsequently, advances in the treatment of multiple myeloma have increased the need for an accurate evaluation of skeletal disease. The introduction of new high performant imaging tools, such as whole-body lowdose computed tomography, different types of magnetic resonance imaging studies, and 18F-fluorodeoxyglucose positron emission tomography, replaced the conventional radiography. In this review, we analyze the diagnostic potentials, indications of use, and applications of the imaging tools nowadays available. Whole-body low-dose CT should be considered as the imaging modality of choice for the initial assessment of multiple myeloma lytic bone lesions. MRI is the gold-standard for the detection of bone marrow involvement, while PET/CT is the preferred technique in the assessment of response to therapy. Both MRI and PET/CT are able to provide prognostic information.
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Affiliation(s)
- Paolo Spinnato
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Alberto Conficoni
- Neuroradiology Unit, Department of Radiology, Azienda Ospedaliero-Universitaria di Ferrara, Ferrara, Italy
| | - Giancarlo Facchini
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Federico Ponti
- Diagnostic and Interventional Radiology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | - Andrea Sambri
- Orthopaedic Oncology, IRCCS Istituto Ortopedico Rizzoli, Bologna, Italy
| | | | - Michele Cavo
- "Seràgnoli" Institute of Hematology, Bologna University School of Medicine, Bologna, Italy
| | - Eugenio Salizzoni
- Imaging Division, Clinical Department of Radiological and Histocytopathological Sciences, University of Bologna, Sant'Orsola-Malpighi Hospital, Bologna, Italy
| | - Cristina Nanni
- Nuclear Medicine, MNM AOU S.Orsola-Malpighi, Bologna, Italy
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Negroni D, Cassarà A, Trisoglio A, Soligo E, Berardo S, Carriero A, Stecco A. Learning curves in radiological reporting of whole-body MRI in plasma cell disease: a retrospective study. Radiol Med 2021; 126:1451-1459. [PMID: 34309766 PMCID: PMC8558285 DOI: 10.1007/s11547-021-01391-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2020] [Accepted: 06/25/2021] [Indexed: 10/25/2022]
Abstract
BACKGROUND The plasma cell disease is been studying by the whole-body MRI technology. However, the time requested to learn this radiological technique is unknown. PURPOSE To esteem, quantitatively and qualitatively, the essential time to learn the whole-body MRI diffusion-weighted imaging with background body signal suppression in patients with plasma cell disease. MATERIALS AND METHODS Between January 2015 and February 2017, three readers in-training with different levels of experience examined the anonymised and randomised whole-body MRI images of 52 patients with a diagnosis of plasma cell disease and analysed their morphological (T1w, T2w with and without fat suppression) and functional sequences. Reports of an expert radiologist were considered the standard of reference. Images were analysed in two sessions, during which each reader was timed. Readers reported the number of segments with lesions and staged the disease using the Durie-Salmon PLUS staging system. Weighted Cohen's ĸ and Z-test were used to compare the trainees' reports with those of the expert radiologist, and learning curves were drawn up to show changes between the two sessions. RESULTS Weighted Cohen's ĸ of number of lesioned segments increased from 0.536 ± 0.123 to 0.831 ± 0.129 (Prob > Z under 0.005), thus approaching the goal of ĸ > 0.8. Trainees reached the level of experienced radiologist in terms of time by the 33rd patient. Agreement concerning the Durie-Salmon PLUS increased from 0.536 ± 0.123 to 0.831 ± 0.129 (Prob > Z under 0.005). CONCLUSIONS The findings of this study demonstrate that whole-body MRI with DWIBS can be learned in about 80 reports and leads to a high level of inter-observer concordance when using the Durie-Salmon PLUS staging system.
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Affiliation(s)
- Davide Negroni
- AOU Maggiore Hospital, Via 2 Giugno 12, Galliate, 28066, Novara, Italy.
| | | | | | | | - Sara Berardo
- AOU Maggiore Hospital, Via 2 Giugno 12, Galliate, 28066, Novara, Italy
| | | | - Alessandro Stecco
- AOU Maggiore Hospital, Via 2 Giugno 12, Galliate, 28066, Novara, Italy
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Sharma JK, Kataria R, Choudhary M, Purohit DK. Differential Diagnosis of Calvarial Tumors: A Series of 8 Cases. INDIAN JOURNAL OF NEUROSURGERY 2021. [DOI: 10.1055/s-0041-1722828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
Abstract
Introduction To present and discuss the clinical presentations, investigations, and treatment options for skull bone tumors.
Materials and Methods This study was conducted from January 2019 to December 2019 at the Department of Neurosurgery. During this period, eight patients presented with skull bone tumor in the outpatient department. All patients were thoroughly investigated. Surgery was conducted on six patients and two patients had disseminated carcinoma; hence, surgery was not done. Patients were regularly followed-up after the surgery.
Results In our study, out of eight cases, five were females and three were males. We had two cases of fibrous dysplasia, two cases of osteomas, and one case each of brown tumor, metastases from lung carcinoma, metastases from follicular carcinoma of thyroid, and Ewing sarcoma/primitive neuroectodermal tumor (PNET). Excision of tumor was performed where indicated and adjuvant chemo- and radiotherapy was suggested wherever required.
Conclusion Bony tumors of the skull are uncommon diseases for the neurosurgeons. These tumors require a careful diagnosis with suitable radiological examinations and proper clinical correlation for proper management.
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Affiliation(s)
| | - Rashim Kataria
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
| | - Madhur Choudhary
- Department of Neurosurgery, SMS Medical College, Jaipur, Rajasthan, India
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Ge X, Jiang W, Jiang Y, Lv X, Liu X, Wang X. Expression and Importance of TMED2 in Multiple Myeloma Cells. Cancer Manag Res 2020; 12:12895-12903. [PMID: 33364837 PMCID: PMC7751311 DOI: 10.2147/cmar.s278570] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2020] [Accepted: 11/20/2020] [Indexed: 11/23/2022] Open
Abstract
Objective TMED2 is a member of the transmembrane emp24 domain (Tmed)/p24 protein family, which is significantly upregulated in breast cancer, ovarian cancer and other tumour tissues. The purpose of this study was to investigate the expression of TMED2 in MM cell lines and its effect on the biological behaviour of MM cell lines. Methods Real-time quantitative PCR (RT-qPCR) was used to detect the expression of TMED2 in MM cell lines, including MM.1S and RPMI 8226 cells, and lentivirus vector-mediated TMED2 gene silencing was used to further study the effect of the downregulation of TMED2 expression on cell viability, the cell cycle, and apoptosis. Results Based on the RT-qPCR results, the expression of the TMED2 mRNA was increased in the MM cell lines MM.1S and RPMI 8226 compared with endogenous control GAPDH. The expression of the TMED2 mRNA was substantially reduced after transfection of the shRNA targeting TMED2 (shTMED2) in both MM cell lines. The CCK-8 assay showed significant decreases in the viability of MM.1S and RPMI 8226 cells, suggesting that the TMED2 gene plays an important role in the proliferation of these two cell lines. The cell cycle of MM.1S and RPMI 8226 cells was substantially altered by shTMED2, as evidenced by the increased number of cells in G1 phase and decreased number of cells in S and G2/M phases. The FACS analysis revealed a significant increase in the apoptosis of MM.1S and RPMI 8226 cells due to the increased activity of Caspase 3/7, suggesting that the TMED2 gene is significantly related to the apoptosis of these two cell lines. Conclusion Based on these results, TMED2 may play an important role in the pathogenesis of MM. This novel study may contribute to further investigations of useful biomarkers and potential therapeutic targets in patients with MM.
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Affiliation(s)
- Xueling Ge
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, People's Republic of China
| | - Wei Jiang
- Information Center, Shandong Mental Health Center, Jinan, Shandong 250014, People's Republic of China
| | - Yujie Jiang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, People's Republic of China
| | - Xiao Lv
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, People's Republic of China
| | - Xin Liu
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, People's Republic of China
| | - Xin Wang
- Department of Hematology, Shandong Provincial Hospital Affiliated to Shandong First Medical University, Jinan, Shandong 250021, People's Republic of China
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Gillani SFUHS, Iqbal Y, Taqi M, Ahmad Blouch T, Iqbal M, Siddiq A. Recurrence Rate of Giant Cell Tumor With the Treatment of Scooping Curettage, Burr Down Technique, Phenolization, and Bone Cement. Cureus 2020; 12:e11953. [PMID: 33425532 PMCID: PMC7788055 DOI: 10.7759/cureus.11953] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objective: To find the recurrence and outcomes of giant cell tumors treated with scooping curettage, burr down technique, phenolization, and bone cement. Method: We conducted a descriptive case series using a non-probability consecutive sampling technique at the Department of Orthopedics, Lahore General Hospital, Lahore, Pakistan, from May 2014 to June 2018. A total of 40 patients aged between 20 to 40 years with Compannacci grade I, II & III giant cell tumors (GCT) were included and patients unfit for the surgery, those with multiple, recurrent, malignant giant cell tumors, tumors involving the axial skeleton, and previously treated cases were excluded. We recorded the side, site of the tumor, post-operative distal neurovascular status, and recurrence of giant cell tumors. The patients were follow-up in the out-patient department (OPD) at the second week, fourth week, 12th week, 24th week, 48th week, 96th week, and 144th week after the surgery. Side, site of the tumor, and post-operative distal neurovascular status were assessed clinically, and recurrence of the tumors was observed clinically and radiologically. Results: The mean age of all patients was 25.75±5.74 years. Males were 45% (18) and females were 55% (22). Most (12, 30%) tumors were present in the upper limb, and 22 (70%) were present in the lower limb. The majority (24, 60%) tumors were present around the knee joint. Companacci grade I was five (12.5%), grade II was 14 (35%), and grade III was 21 (52%). There were six (15%) pathological fractures. There was no case of distal neurovascular (DNV) injury, and three patients had a recurrence in two years of follow-up. Conclusion: Giant cell tumor treated with scooping curettage, burr down technique, phenolization and poly-methyl methacrylate showed 7.5% recurrence. The combined use of local adjuvants in the treatment of giant cell tumors is a safe and effective way to reduce the rate of local recurrence.
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Affiliation(s)
| | - Yasir Iqbal
- Orthopedics, Swat Medical Complex and Teaching Hospital, Swat, PAK
| | - Muhammad Taqi
- Orthopedic Surgery, King Edward Medical University/Mayo Hospital, Lahore, PAK
| | | | - Muhammad Iqbal
- Orthopedics and Traumatology, Swat Medical Complex and Teaching Hospital, Swat, PAK
| | - Abubakar Siddiq
- Orthopedics and Traumatology, Lahore General Hospital, Lahore, PAK
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Dittmar JM, Berger ES, Mao R, Wang H, Yeh HY. A probable case of multiple myeloma from Bronze Age China. INTERNATIONAL JOURNAL OF PALEOPATHOLOGY 2020; 31:64-70. [PMID: 33091820 DOI: 10.1016/j.ijpp.2020.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 10/01/2020] [Accepted: 10/01/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVE Paleopathological evidence of cancer from past populations is rare, especially outside of Europe and North Africa. This study expands upon the current temporal and spatial distribution of cancer by presenting a probable case of multiple myeloma from Bronze Age China. MATERIAL The human skeletal remains of an adult male from the Qijia culture horizon (1750-1400 BCE) of the Bronze Age cemetery of Mogou (), located in Gansu Province, Northwest China. METHODS The human skeletal remains were assessed macroscopically and radiographically using plain x-rays. RESULTS Multiple ovoid-shaped osteolytic lesions with sharply demarcated margins were observed. The axial skeletal had the greatest involvement, specifically the vertebrae, ribs, and sternum. Radiographic imaging revealed more extensive destruction of cancellous than cortical bone, indicating that the marrow was the focal point of the disease. CONCLUSION Based on the nature, distribution, and radiographic appearance of the lesions, the most likely diagnosis is multiple myeloma. SIGNIFICANCE This is one of the only cases of cancer identified in archaeological human skeletal remains from East Asia and is the first published case of a hematopoietic malignancy from mainland China. The analysis and publication of examples of neoplasia from areas that expand upon the current known temporal and spatial distribution is necessary in order to better reconstruct the history and evolution of cancer. LIMITATIONS Poor skeletal preservation prevented the full extent of osteolytic lesions to be observed. SUGGESTIONS FOR FUTURE RESEARCH By placing case studies such as this into a temporal and spatial framework, it is possible for future research to begin to interrogate possible underlying causes of cancer in ancient populations within the context of changing environmental conditions and subsistence strategies.
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Affiliation(s)
- Jenna M Dittmar
- McDonald Institute for Archaeological Research, University of Cambridge, Downing Street, Cambridge, CB2 3ER, UK.
| | - Elizabeth S Berger
- Department of Anthropology, University of California, Riverside, 1334 Watkins Hall, Riverside, CA, 92521, United States
| | - Ruilin Mao
- Gansu Provincial Institute for Cultural Relics and Archaeology, Heping Road No. 165, Lanzhou, 730000, China
| | - Hui Wang
- Gansu Provincial Institute for Cultural Relics and Archaeology, Heping Road No. 165, Lanzhou, 730000, China
| | - Hui-Yuan Yeh
- School of Humanities, Nanyang Technological University, 14 Nanyang Drive, 637332, Singapore
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Zijlstra H, Wolterbeek N, Drost RW, Koene HR, van der Woude HJ, Terpstra WE, Delawi D, Kempen DHR. Identifying predictive factors for vertebral collapse fractures in multiple myeloma patients. Spine J 2020; 20:1832-1839. [PMID: 32673729 DOI: 10.1016/j.spinee.2020.07.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 05/26/2020] [Accepted: 07/08/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Vertebral compression fractures (VCFs) are a common complication for patients with multiple myeloma. These fractures are associated with significant morbidity and mortality due to severe back pain, spinal instability, increased risk of new fractures, neurologic dysfunction, and other physical symptoms. PURPOSE To identify risk factors associated with the development of VCFs which may help to predict them in future patients. STUDY DESIGN A retrospective multicenter cohort study. PATIENT SAMPLE Patients with multiple myeloma diagnosed between 2012 and 2018 and appropriate baseline- and follow-up imaging studies (>6 months after diagnosis) were included. OUTCOME MEASURES Individual odds ratios for each of the fifteen potential risk factors including patient factors and radiographical characteristics. METHODS Relevant clinical baseline data were extracted from the patient charts. Computed tomography (CT) scans were used to score all radiographic variables. VCFs were graded following the Genant grading system. General Linear Mixed Models were used to analyze risk factors associated with vertebral fractures. RESULTS A total of 143 patients with 1,605 eligible vertebrae were included in the study with a mean follow-up time of 25 months. Mean age at diagnosis was 65 years and 39% were female. Among 1,605 vertebrae, there were 192 (12%) VCFs (Genant grade 1 or higher) at the time of diagnosis and 111 (7%) occurred during follow-up. In a General Linear Mixed Model, significant predictors were gender (odds ratio [OR]=1.5), International Staging System stage 2 and 3 (OR=3.6 and OR=4.1 respectively), and back pain (OR=2.7). Furthermore, lower Hounsfield Unit score, lytic lesions and abnormal alignment were risk factors for (the development of) VCFs. CONCLUSIONS This study investigated both patient characteristics and vertebra-specific risk factors for VFCs in multiple myeloma patients. The factors found in this study might be useful for identifying patients at higher risk of VFCs to help clinical management to prevent vertebral collapse and the development of spinal deformities.
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Affiliation(s)
- Hester Zijlstra
- Department of Orthopaedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands; Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Nienke Wolterbeek
- Department of Orthopaedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands.
| | - Rosalin W Drost
- Department of Orthopaedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands; Department of Orthopaedic Surgery, OLVG, Amsterdam, The Netherlands
| | - Harry R Koene
- Department of Hematology, St. Antonius Hospital, Utrecht, The Netherlands
| | | | - Wim E Terpstra
- Department of Hematology, OVLG, Amsterdam, The Netherlands
| | - Diyar Delawi
- Department of Orthopaedic Surgery, St. Antonius Hospital, Utrecht, The Netherlands
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Multiple myeloma with intracranial and spinal intradural metastasis: A case report. Biomedicine (Taipei) 2020; 10:45-49. [PMID: 33854927 PMCID: PMC7721472 DOI: 10.37796/2211-8039.1079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2019] [Accepted: 08/05/2019] [Indexed: 11/24/2022] Open
Abstract
Multiple myeloma is a hematopoietic cancer that is multicentric and most commonly involves the spine. Multiple myeloma with extraosseous and intradural involvement is an extremely rare condition. Here we present a rare case of spinal multiple myeloma with intracranial and spinal intradural metastasis causing lumbar spinal nerve compression. We present a 60-year-old woman with progressive weakness of the lower limbs for several weeks. Spinal magnetic resonance imaging (MRI) showed a leptomeningeal tumor with nodularity spreading within the cauda equina. Examination of the brain using MRI showed a lytic skull bone lesion and leptomeningeal enhancement. The patient underwent L3-5 laminectomy. Immunohistological staining confirmed a diagnosis of multiple myeloma of the IgA kappa subtype. After surgery, the patient underwent chemotherapy and rehabilitation exercises. Multiple myeloma has a median survival of 2.5 years, while 75% of patients with spinal involvement die within 1 year of diagnosis. Unfortunately, our patient died 3 months after the diagnosis of multiple myeloma with spinal and intracranial involvement. Intracranial and spinal intradural multiple myeloma invasions are quitely rare. Spine biopsies and cerebrospinal fluid cytology can aid in the diagnosis. Early surgical decompression is necessary, especially when neurological deficits occur.
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Jo A, Jung JY, Lee SY, Lee SE, Park H, Lee SE, Min CK. Prognosis Prediction in Initially Diagnosed Multiple Myeloma Patients Using Intravoxel Incoherent Motion-Diffusion Weighted Imaging and Multiecho Dixon Imaging. J Magn Reson Imaging 2020; 53:491-501. [PMID: 32812318 DOI: 10.1002/jmri.27321] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2020] [Revised: 07/22/2020] [Accepted: 07/23/2020] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Multiparametric MRI provides complementary information for the diagnosis and management of multiple myeloma (MM). PURPOSE To evaluate the association of prognostic factors of MM and parameters derived from intravoxel-incoherent motion diffusion-weighted imaging (IVIM-DWI) and multiecho (ME) Dixon. STUDY TYPE Retrospective. POPULATION In all, 78 MM patients. FIELD STRENGTH/SEQUENCES T1 -weighted turbo spin-echo sequences (TSE), IVIM-DWI, ME 3D gradient echo sequence with multistep adaptive fitting at 3T. ASSESSMENT The region of interest (ROI) on the vertebral body was independently measured on four parametric maps (Dslow , Dfast and perfusion fraction [f], and proton-density fat-fraction [Ff] maps) by two readers. All patients were categorized into three groups based on the International Staging System (ISS). STATISTICAL TESTS Three groups were compared using analysis of variance (ANOVA) and post-hoc tests with Bonferroni correction. Logistic regression analysis was performed to predict the advancement of disease (early vs. advanced). Principal component analysis (PCA) was used to find the deterministic parameters. RESULTS Dslow and Ff were significantly different among ISS-1 (n = 38), ISS-2 (n = 22), and ISS-3 (n = 18) groups in both readers: 0.36, 0.41, and 0.58 × 10-3 mm2 /s for Dslow (P < 0.05), and 46%, 30%, and 15% for Ff (P < 0.05) in reader 1; 0.34, 0.41, and 0.58 × 10-3 mm2 /s for Dslow (P < 0.05), 43%, 27%, and 13.2% for Ff (P < 0.05) in reader 2, respectively. Dfast between ISS-3 and the other groups was significantly different in one reader only: 2.03, 2.29, and 2.85 × 10-3 mm2 /s (P < 0.05). There was no significant difference in f among the groups in both readers. Logistic regression by stepwise selection indicated Ff as the single most significant factor for differentiating early and advanced stages of MM with an accuracy of 76% and area under the curve (AUC) of 0.83 (P < 0.05). PCA revealed Ff, and Dslow as the deterministic parameters, with a cumulative proportion of 0.84. DATA CONCLUSION D slow and Ff are associated with the prognostic factor of MM. Level of Evidence 3 Technical Efficacy Stage 5. J. MAGN. RESON. IMAGING 2021;53:491-501.
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Affiliation(s)
- Aram Jo
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Joon-Yong Jung
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - So-Yeon Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Seung Eun Lee
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Hyerim Park
- Department of Radiology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Sung-Eun Lee
- Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Chang-Ki Min
- Department of Hematology, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
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Bhadra R, Nikova T, Somasundaram M, Ravakhah K. Advanced myeloma masquerading as chronic shoulder pain in a 48-year-old man: a diagnostic dilemma. BMJ Case Rep 2020; 13:13/5/e231219. [PMID: 32467114 DOI: 10.1136/bcr-2019-231219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Although solitary plasmacytomas may occasionally present as collar bone swellings or fractures, multiple myeloma involving clavicle is extremely rare. Ten to forty per cent of multiple myeloma cases are asymptomatic and are incidental diagnoses. Our case report describes an entirely benign presentation like chronic shoulder pain masquerading advanced myeloma, thereby posing a significant diagnostic dilemma. We present a 48-year-old man who presented with chronic bilateral shoulder pain with no history of trauma and was eventually diagnosed with advanced multiple myeloma and pathologic fracture of the right clavicle. It is, therefore, evident that a low threshold for suspicion can lead to early diagnosis and initiation of treatment and better survival.
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Affiliation(s)
- Rajarshi Bhadra
- Internal Medicine, St Vincent Charity Medical Center, Cleveland, Ohio, USA
| | - Teodora Nikova
- Internal Medicine, Northeast Ohio Medical University, Rootstown, Ohio, USA
| | | | - Keyvan Ravakhah
- Internal Medicine, St Vincent Charity Medical Center, Cleveland, Ohio, USA
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The Spectrum of Rib Neoplasms in Adults: A Practical Approach and Multimodal Imaging Review. AJR Am J Roentgenol 2020; 215:165-177. [PMID: 32374664 DOI: 10.2214/ajr.19.21554] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
OBJECTIVE. Adult neoplasms of the ribs are a heterogeneous group consisting of both benign and aggressive entities. Rib neoplasms have a variety of overlapping imaging features, with much of the imaging data disjointed across the musculoskeletal, thoracic, and oncologic imaging literature. Arrival at accurate diagnosis can therefore be quite challenging. This article consolidates this information and introduces the reader to an algorithmic approach to rib lesion evaluation based on imaging. CONCLUSION. Rib neoplasms are a diverse group of benign and malignant entities, which often makes determining an accurate diagnosis challenging. Evaluation requires a multipronged approach that incorporates radiographic imaging features, nonradiographic imaging findings, lesion location, and clinical data.
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Hong Y, Yu J, Wang G, Qiao W. Association between tumor necrosis factor alpha gene polymorphisms and multiple myeloma risk: an updated meta-analysis. ACTA ACUST UNITED AC 2020; 24:216-224. [PMID: 31793411 DOI: 10.1080/16078454.2018.1552341] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE This study aimed to investigate the relationship between tumor necrosis factor alpha (TNFα) polymorphisms and multiple myeloma (MM) risk. METHODS Eligible studies were retrieved from PubMed, the Cochrane Library, Embase, CNKI and the Wanfang database. Polymorphisms of TNFα-308 G/A, TNFα-857 C/T, and TNFα-238 G/A were analyzed based on the allele, recessive, dominant, and additive-dominant models. The meta-analysis was conducted using R 3.12 software. Odds ratio (OR) and 95% confidence intervals (CI) were used as evaluation indicators. Heterogeneity among studies was detected. Publication bias was evaluated. Sensitivity and power analyses were also conducted. RESULTS Significant associations existed between 'TT vs. CC' (OR = 2.3752, 95% CI = 1.1342-4.9740) and 'TT vs. CC + TC' (OR = 2.0802, 95% CI = 1.0250-4.2218) models of the TNFα-857 C/T gene and MM risk. There were no significant differences in other genetic models of TNFα-857 C/T or any genetic models of TNFα-308 G/A and TNFα-238 G/A. No significant publication bias existed among the studies. In addition, sensitivity analyses showed that meta-analysis results of all genetic models of the TNFα-238 G/A gene did not change after omitting one of these studies, but most models of TNFα-857 C/T and TNFα-308 G/A exhibited significant changes. CONCLUSION Our findings indicate that the 'TT vs. CC' and 'TT vs. CC + TC' of TNFα-857 C/T are correlated with MM risk. TNFα-857 C/T may be a risk factor for MM development. There is no association between TNFα-238/-308 polymorphisms and MM risk.
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Affiliation(s)
- Yingjie Hong
- Department of Traditional Chinese Medicine, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Jing Yu
- The Operating Room, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Gang Wang
- The Operating Room, The First Hospital of Jilin University, Changchun, People's Republic of China
| | - Weisong Qiao
- Department of Orthopedics, The First Hospital of Jilin University, Changchun, People's Republic of China
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Kohsari M, Khadem-Ansari MH, Rasmi Y, Sayyadi H. Serum Levels of Interleukin-8 and Soluble Interleukin-6 Receptor in Patients with Stage-I Multiple Myeloma: A Case-Control Study. Asian Pac J Cancer Prev 2020; 21:127-132. [PMID: 31983174 PMCID: PMC7294003 DOI: 10.31557/apjcp.2020.21.1.127] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2019] [Indexed: 11/25/2022] Open
Abstract
Objective: Multiple myeloma (MM) remains an incurable disease that needs better recognition and further research. Previous studies elucidated the interaction between myeloma cells and showed the necessity of bone marrow stromal cells for the initiation and progression of MM. Many chemokines and their receptors including interleukin-8 (IL-8) and soluble interleukin-6 receptor (sIL-6R) play important roles in this interaction. The main purpose of this study is evaluating the serum level of IL-8 and sIL-6R on stage-I of MM patients and healthy controls. Methods: Serum samples from 30 stage-I MM patients (13 males and 17 females) and 30 healthy subjects as controls (13 males and 17 females) were examined in this study. The protein concentrations of serum IL-8 and sIL-6R were assessed by enzyme-linked immunosorbent assay (ELISA). Results: The mean level of IL-8 and sIL-6R were significantly elevated in stage-I MM. The mean levels of IL-8 were 1246.57±279.22 ng/ml in stage-I MM and 902.53± 294.61 ng/ml in controls (P<0.001). The mean levels of sIL-6R were 5.39±1.38 ng/ml and 4.1±1.14 ng/ml in stage-I MM and controls, respectively (P<0.001). The mean levels of IL-8 were 1342.18±193.4 ng/ml in patient females and 859± 278.2ng/ml in control females (P <0.001). The mean levels of sIL-6R were 5.21±1.55 ng/ml and 3.91±1.22 ng/ml in patient females and control females, respectively (P=0.01). The mean level of sIL-6R in patient males and control males were 5.63±1.43 ng/ml and 4.34±1.04 ng/ml, respectively (P=0.01). A significant correlation (Pearson’s correlation = 0.45, P=0.008) was observed in the population of females (patients and controls). Conclusion: The results of study suggest the possible involvement of IL-8 and the sIL-6R at stage-I MM and can better characterize the role of chemokines and their receptors in the disease process, especially in the early stages.
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Affiliation(s)
- Maryam Kohsari
- Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | | | - Yousef Rasmi
- Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
| | - Hojjat Sayyadi
- Department of Biochemistry, Faculty of Medicine, Urmia University of Medical Sciences, Urmia, Iran
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A rare case of newly diagnosed multiple myeloma presenting to the emergency department with acute paraplegias. JOURNAL OF SURGERY AND MEDICINE 2019. [DOI: 10.28982/josam.652699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Lecouvet FE, Boyadzhiev D, Collette L, Berckmans M, Michoux N, Triqueneaux P, Pasoglou V, Jamar F, Vekemans MC. MRI versus 18F-FDG-PET/CT for detecting bone marrow involvement in multiple myeloma: diagnostic performance and clinical relevance. Eur Radiol 2019; 30:1927-1937. [PMID: 31844960 DOI: 10.1007/s00330-019-06469-1] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2019] [Revised: 08/24/2019] [Accepted: 09/19/2019] [Indexed: 12/12/2022]
Abstract
PURPOSE To compare the diagnostic performance of MRI and 18F-FDG-PET/CT in detecting bone marrow involvement (BMI) in patients with multiple myeloma (MM). MATERIALS AND METHODS This retrospective study was approved by our Institutional Review Board. Two radiologists and two nuclear medicine specialists independently and blindly reviewed 84 pairs of MRI and PET/CT scans obtained in 73 MM patients. Readers assessed the presence and patterns of BMI. The best valuable comparator (BVC) for BMI was established by a panel review of all baseline and follow-up imaging, and biological and pathological information. Intra- and inter-reader agreement and correlation between MRI and PET/CT were assessed using the prevalence-adjusted bias-adjusted kappa (k) coefficient. Diagnostic performance of MRI and PET/CT in detecting BMI was evaluated from ROC characteristics. Association between imaging and biological, pathological, and clinical findings was assessed using Wilcoxon rank-sum and chi-square tests. RESULTS Intra- and inter-reader agreement was very good for MRI (k = 0.90 [0.81; 1.00] and 0.88 [0.78; 0.98]). Intra- and inter-reader agreement was good for PET/CT (k = 0.80 [0.69; 0.91] and 0.71 [0.56; 0.86]). The sensitivity of MRI to detect BMI (97% [90%; 100%]) was significantly superior to that of PET/CT (76% [64%; 85%]) (p < 0.001). The specificity of MRI (86% [57%; 98%]) was lower than that of PET/CT (93% [66%; 100%]), without reaching statistical significance (p = 0.32). There was a strong correlation between decisions regarding patient management and PET/CT findings (p < 0.001). CONCLUSION MRI is significantly more sensitive than PET/CT to detect BMI in MM. Patient management is more strongly correlated with PET/CT findings. KEY POINTS • MRI and PET/CT have very close diagnostic value for the detection of bone marrow involvement in multiple myeloma. • MRI has a significantly higher sensitivity and better reproducibility. • PET/CT findings appear to have a higher impact on clinical decisions.
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Affiliation(s)
- Frédéric E Lecouvet
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium.
| | - Dimitar Boyadzhiev
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium
| | | | - Maude Berckmans
- Department of Nuclear Medicine, IREC, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
| | - Nicolas Michoux
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium
| | - Perrine Triqueneaux
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium
| | - Vassiliki Pasoglou
- Department of Radiology, Institut de Recherche Expérimentale et Clinique (IREC), Cliniques Universitaires Saint Luc, Université Catholique de Louvain (UCLouvain), Avenue Hippocrate, 10/2942, B-1200, Brussels, Belgium
| | - François Jamar
- Department of Nuclear Medicine, IREC, Cliniques Universitaires Saint Luc, UCLouvain, Brussels, Belgium
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Faria KM, Ribeiro ACP, Brandão TB, Silva WG, Lopes MA, Pereira J, Alves MC, Gueiros LA, Shintaku WH, Migliorati CA, Santos-Silva AR. Radiographic patterns of multiple myeloma in the jawbones of patients treated with intravenous bisphosphonates. J Am Dent Assoc 2019; 149:382-391. [PMID: 29703280 DOI: 10.1016/j.adaj.2017.12.028] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Revised: 10/29/2017] [Accepted: 12/15/2017] [Indexed: 12/19/2022]
Abstract
BACKGROUND The purpose of this study was to evaluate whether intravenous (IV) bisphosphonate (BP) therapy can change the radiographic patterns of multiple myeloma (MM) in the jawbones. METHODS The authors evaluated panoramic radiographs obtained from 188 patients with MM for the presence of solitary osteolytic lesions, multiple osteolytic lesions, diffuse osteoporosis, diffuse sclerosis, lamina dura abnormalities, nonhealing alveolar sockets, and bone sequestration. The authors compared results obtained from patients treated with IV BPs with those obtained from patients who had never been exposed to BPs. RESULTS Multiple osteolytic lesions (P = .001), diffuse osteoporosis (P = .001), and diffuse sclerosis (P = .0036) occurred more often in the mandible in both groups. Solitary osteolytic lesions occurred less frequently in the BP group (P = .0078). Lamina dura abnormalities (P = .0006) and nonhealing alveolar sockets (P = .0021) were associated with BP treatment. CONCLUSIONS IV BP therapy changes the radiographic patterns of MM in the jawbones. PRACTICAL IMPLICATIONS The effect of BPs in the maxillofacial area is a matter of concern for health practitioners because this type of medication causes several alterations of the jawbones in patients with cancer.
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Multiple Myeloma Breast Involvement: A Case Report. Case Rep Radiol 2019; 2019:2079439. [PMID: 31687247 PMCID: PMC6803727 DOI: 10.1155/2019/2079439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2019] [Accepted: 08/26/2019] [Indexed: 02/01/2023] Open
Abstract
Multiple Myeloma involving the breast is very rare and the diagnosis is challenging because the clinical and radiological features of breast multiple myeloma are indistinguishable to other forms of breast disease whether primary or metastatic. In this article the authors report a case presented with breast masses, which were found to be extra osseous Multiple Myeloma. The patient was managed for multiple spinal lesions that were primarily thought to be metastasis from primary breast cancer.
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Fujimaki T, Hirata S, Terano N, Wakiya K, Kobayashi M. A Large Mass Mimicking Calcified Hematoma of the Skull Showing Involvement of Myeloma Cells and a Good Response to Irradiation. Surg J (N Y) 2019; 5:e159-e162. [PMID: 31637287 PMCID: PMC6800278 DOI: 10.1055/s-0039-1697636] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Accepted: 08/07/2019] [Indexed: 01/18/2023] Open
Abstract
Patients with multiple myeloma often show skull bone involvement, although in most cases this is manifested as skull erosion and large masses develop only rarely. Here we report a patient who presented with a large cranial mass mimicking a subdural hematoma with calcification. The tumor shrunk with 37.5 Gy of focal irradiation in 15 fractions after biopsy. After irradiation the patient was treated with Bortezomib but died because of adverse events. The differential diagnosis of lenticular lesion of the skull and treatment strategy for large skull mass with myeloma cells are discussed.
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Affiliation(s)
| | - Sachiko Hirata
- Department of Neurosurgery, Saitama Medical University, Moroyama, Japan
| | - Naruhiko Terano
- Department of Neurosurgery, Saitama Medical University, Moroyama, Japan
| | - Kenji Wakiya
- Department of Neurosurgery, Saitama Medical University, Moroyama, Japan
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Barefah G, Almaghrabi NA, Elsini R. Multiple myeloma of young adult presented with paraplegia, rare case report in Saudi Arabia. BJR Case Rep 2019; 5:20190008. [PMID: 31555476 PMCID: PMC6750636 DOI: 10.1259/bjrcr.20190008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Revised: 02/20/2019] [Accepted: 03/25/2019] [Indexed: 11/05/2022] Open
Abstract
Multiple myeloma is the second most common hematologic malignancy. It is characterized by the neoplastic proliferation of plasma cells in the bone marrow, leading to excessive production of monoclonal immunoglobulin. The mean age at diagnosis is 65 years. There are only a few cases of Multiple Myeloma arising in young population reported in the literature. We present a case of 33-years-old male presented with complete bilateral lower limbs paralysis and loss of sensation which were gradual in onset and accompanied by upper and lower back pain for 1 month. MRI of the whole spine show multiple infiltrative bone marrow high signal in T2 and STIR sequences involve C4 and the upper dorsal vertebral bodies and the spinous process of D4 with left para-spinal and large posterior epidural mass compress the spinal cord. CT guidance obtains three samples from the mass and placed in formalin in separate containers. Histopathology examination revealed neoplastic growth composed of Sheet of diffuse atypical plasma cells infiltrating fibro collagenous and adipose tissue. Although Multiple myeloma is a disease of elderly; it still could present in young age group. Histopathology examination is the gold standard for diagnosis.
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Affiliation(s)
- Ghaith Barefah
- Body and musculoskeletal radiology consultant, King Fahad General Hospital, Jeddah, Saudi Arabia
| | | | - Rayan Elsini
- Al-Imam Muhammad Ibn Saud Islamic University, Riyadh, Saudi Arabia
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Muñoz-Bermúdez R, Abella E, Zuccarino F, Masclans JR, Nolla-Salas J. Successfully non-surgical management of flail chest as first manifestation of multiple myeloma: A case report. World J Crit Care Med 2019. [DOI: 10.5492/wjcc.v8.i5.59] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
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Muñoz-Bermúdez R, Abella E, Zuccarino F, Masclans JR, Nolla-Salas J. Successfully non-surgical management of flail chest as first manifestation of multiple myeloma: A case report. World J Crit Care Med 2019; 8:82-86. [PMID: 31559147 PMCID: PMC6753394 DOI: 10.5492/wjccm.v8.i5.82] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2019] [Revised: 07/23/2019] [Accepted: 08/16/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Multiple myeloma is a malignant neoplasm of the bone marrow characterized by neoplastic proliferation of monoclonal plasma cells with a high relationship with destructive bone disease. We present a case of a patient diagnosed with multiple myeloma and sternal fracture in association with multiple bilateral rib fractures and thoracic kyphosis, who developed a severe acute respiratory failure, thus complicating the initial presentation of multiple myeloma. We discuss the therapeutic implications of this uncommon presentation.
CASE SUMMARY A 56-year-old man presented to Hematological Department after he had been experiencing worsening back pain over the last five months, with easy fatigability and progressive weight loss. He had no history of previous trauma. The chemical blood tests were compatible with a diagnosis of multiple myeloma. A radiographic bone survey of all major bones revealed, in addition to multiple bilateral rib fractures, a sternal fracture and compression fracture at T9, T10, T11 and L1 vertebrae. Subcutaneous fat biopsy was positive for amyloid. We started treatment with bortezomib and dexamethasone. After 24 h of treatment, he presented dyspnea secondary to flail chest. He required urgent intubation and ventilatory support being transferred to intensive care unit for further management. The patient remained connected to mechanical ventilation (positive pressure) as treatment which stabilized the thorax. A second cycle of bortezomib plus dexamethasone was started and analgesia was optimized. The condition of the patient improved, as evidenced by callus formation on successive computed tomography scans. The patient was taken off the ventilator one month later, and he was extubated successfully, being able to breathe unaided without paradoxical motion.
CONCLUSION This case highlights the importance of combination between bortezomib and dexamethasone to induce remission of multiple myeloma and the initiation of positive airway pressure with mechanical ventilation to stabilize chest wall to solve the respiratory failure. This combined approach allowed to obtain a quick and complete resolution of the clinical situation.
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Affiliation(s)
| | - Eugenia Abella
- Department of Hematology, Hospital del Mar, Barcelona 08003, Spain
| | - Flavio Zuccarino
- Department of Radiology, Hospital del Mar, Barcelona 08003, Spain
| | | | - Juan Nolla-Salas
- Department of Critical Care, Hospital del Mar, Barcelona 08003, Spain
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Wu D, Zhang W, Chen Y, Ma H, Wang M. Platycodin D inhibits proliferation, migration and induces chemosensitization through inactivation of the NF-κB and JAK2/STAT3 pathways in multiple myeloma cells. Clin Exp Pharmacol Physiol 2019; 46:1194-1200. [PMID: 31347196 DOI: 10.1111/1440-1681.13145] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Revised: 07/17/2019] [Accepted: 07/19/2019] [Indexed: 01/10/2023]
Abstract
Multiple myeloma (MM) is a malignancy characterized by the proliferation of malignant plasma cells. Platycodin D (PLD) is a triterpenoid saponin that exerts anti-tumour activity through multiple mechanisms. However, the role of PLD in MM remains unknown. Here, we investigated the effect of PLD on MM cell lines NCI-H929 and U266B1, and elucidated the underlying molecular mechanism. Cell Counting Kit-8 assay showed that the proliferation of NCI-H929 and U266B1 cells was significantly decreased after PLD treatment. Transwell assay confirmed that PLD treatment suppressed migration of NCI-H929 and U266B1 cells. Flow cytometry results indicated that the apoptotic rates of bortezomib (BTZ)-treated NCI-H929 and U266B1 cells were markedly increased after PLD treatment. Western blot analysis revealed that bcl-2 expression was decreased, while bax expression was increased in PLD-treated NCI-H929 and U266B1 cells compared with that in BTZ-treated cells. Furthermore, PLD treatment blocked the activation of nuclear factor-kappa B (NF-κB) and Janus kinase 2 (JAK2)/signal transducer and activator of transcription 3 (STAT3) signalling pathways in NCI-H929 cells. Taken together, these data showed that PLD inhibited proliferation and migration, and enhanced chemosensitization to BTZ through inactivation of the NF-κB and JAK2/STAT3 pathways in MM cell lines. These findings indicated that PLD might serve as a novel therapeutic agent for the treatment of MM.
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Affiliation(s)
- Di Wu
- Department of Haematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Wei Zhang
- Department of General Surgery, Xi'an NO.4 Hospital, Xi'an, China
| | - Ying Chen
- Department of Haematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Hong Ma
- Department of Haematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Mengchang Wang
- Department of Haematology, The First Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Kang B, Park H, Kim B. Anticancer Activity and Underlying Mechanism of Phytochemicals against Multiple Myeloma. Int J Mol Sci 2019; 20:E2302. [PMID: 31075954 PMCID: PMC6539572 DOI: 10.3390/ijms20092302] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2019] [Revised: 05/03/2019] [Accepted: 05/04/2019] [Indexed: 12/14/2022] Open
Abstract
Multiple myeloma (MM)-a common hematologic malignancy of plasma cells-accounts for substantial mortality and morbidity rates. Due to the advent of novel therapies such as immunomodulatory drugs (IMiDs), proteasome inhibitors (PIs), and monoclonal antibodies (mAbs), response rates were increased and free survival and overall survival have been elevated. However, adverse events including toxicity, neuropathy or continuous relapse are still problems. Thus, development of novel drugs which have less side effects and more effective is needed. This review aims to recapitulate the pharmacologic anti-MM mechanisms of various phytochemicals, elucidating their molecular targets. Keywords related to MM and natural products were searched in PUBMED/MEDLINE. Phytochemicals have been reported to display a variety of anti-MM activities, including apoptosis, cell cycle arrest, antiangiogenesis, and miRNA modulation. Some phytochemicals sensitize the conventional therapies such as dexamethasone. Also, there are clinical trials with phytochemicals such as agaricus, curcumin, and Neovastat regarding MM treatment. Taken together, this review elucidated and categorized the evidences that natural products and their bioactive compounds could be potent drugs in treating MM.
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Affiliation(s)
- Beomku Kang
- College of Korean Medicine, Kyung Hee University, Seoul 02453, Korea.
| | - Hyunmin Park
- Department of Pathology, College of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Korea.
| | - Bonglee Kim
- College of Korean Medicine, Kyung Hee University, Seoul 02453, Korea.
- Department of Pathology, College of Korean Medicine, Graduate School, Kyung Hee University, Seoul 02453, Korea.
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Simeone FJ, Harvey JP, Yee AJ, O'Donnell EK, Raje NS, Torriani M, Bredella MA. Value of low-dose whole-body CT in the management of patients with multiple myeloma and precursor states. Skeletal Radiol 2019; 48:773-779. [PMID: 30218303 PMCID: PMC6447458 DOI: 10.1007/s00256-018-3066-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 08/28/2018] [Accepted: 09/04/2018] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To determine the value of low-dose whole-body CT (WBCT) in the management of patients with multiple myeloma (MM) and precursor states. MATERIALS AND METHODS The study group comprised 116 patients (mean age: 68 ± 11 years, 48% women) who underwent WBCT for the work-up or surveillance of MM or MM precursor disease. WBCTs were reviewed for the presence of MM-related bone disease and incidental findings requiring therapy. The medical records, results from bone marrow aspirations and biopsies and follow-up imaging studies were reviewed to assess the influence of WBCT on patient management. RESULTS Whole-body CT led to a change in management in 32 patients (28%). Of those, 17 patients with MM precursor disease were found to have MM-related bone disease, 13 patients had progression of MM, requiring a change in treatment, in one patient hepatocellular carcinoma was diagnosed, requiring a change in therapy, and one patient had a rib lesion requiring intervention. In 65 patients (56%), WBCT was performed for surveillance of MM precursor disease or stable treated MM, and did not detect new lesions, thereby providing reassurance to the hematologist on disease status and management. In 15 patients (13%) WBCT was performed as a new baseline before a change or new therapy. In 4 patients (3%), WBCT was performed for a change in symptoms, but did not detect lesions that would lead to a change in management. CONCLUSION Whole-body CT provides important information for disease monitoring and detection of incidental findings, thereby improving the management of patients with MM.
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Affiliation(s)
- F Joseph Simeone
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Joel P Harvey
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Andrew J Yee
- Division of Hematology-Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Elizabeth K O'Donnell
- Division of Hematology-Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Noopur S Raje
- Division of Hematology-Oncology, Massachusetts General Hospital and Harvard Medical School, 55 Fruit Street, Boston, MA, 02114, USA
| | - Martin Torriani
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Yawkey 6E, 55 Fruit Street, Boston, MA, 02114, USA.
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43
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Morris EV, Edwards CM. Bone marrow adiposity and multiple myeloma. Bone 2019; 118:42-46. [PMID: 29548987 DOI: 10.1016/j.bone.2018.03.011] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Revised: 03/12/2018] [Accepted: 03/12/2018] [Indexed: 11/30/2022]
Abstract
Multiple Myeloma (MM) is an incurable haematological malignancy and is the second most common blood cancer in adults; it is caused by the clonal expansion of abnormal plasma cells within the bone marrow and characterized by osteolytic bone lesions, bone pain, renal disease, and immunodeficiency. MM cells infiltrate the bone marrow where they hijack the microenvironment to sustain growth and survival. The contribution to this process by resident bone cells is well defined. However, the role of bone marrow adipocytes is less clear. As one of the most abundant cell types in the bone marrow these cells are surprisingly understudied. However, in the last few decades they have been recognised as having endocrine function. Adipocytes are metabolically active cells that secrete adipokines, growth factors, and inflammatory mediators, they influence the behaviour and function of neighbouring cells; and have the potential to dysregulate normal bone homeostasis. This review discusses how adipocytes contribute to the metastatic niche in multiple myeloma and cancers that metastasise to the bone and how these new discoveries may contribute to further understanding the mechanisms driving the devastating bone disease associated with MM.
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Affiliation(s)
- Emma V Morris
- Nuffield Dept. of Surgical Sciences, University of Oxford, Oxford, UK
| | - Claire M Edwards
- Nuffield Dept. of Surgical Sciences, University of Oxford, Oxford, UK; Nuffield Dept. of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK.
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45
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Patel MS, Ghasem A, Greif DN, Huntley SR, Conway SA, Al Maaieh M. Evaluating Treatment Strategies for Spinal Lesions in Multiple Myeloma: A Review of the Literature. Int J Spine Surg 2018; 12:571-581. [PMID: 30364863 DOI: 10.14444/5070] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023] Open
Abstract
Background Vertebral disease is a major cause of morbidity in 70% of patients diagnosed with multiple myeloma (MM). Associated osteolytic lesions and vertebral fractures are well documented in causing debilitating pain, functional restrictions, spinal deformity, and cord compression. Currently, treatment modalities for refractory MM spinal pain include systemic therapy, radiotherapy, cementoplasty (vertebroplasty/kyphoplasty), and radio frequency ablation. Our objectives were to report on the efficacy of existing treatments for MM patients with refractory spinal pain, to determine if a standardized treatment algorithm has been described, and to set the foundation upon which future prospective studies can be designed. Methods A systematic search of the PubMed database was performed for studies relevant to the treatment of vertebral disease in MM patients. A multitude of search terms in various combinations were used, including but not limited to: "vertebroplasty," "kyphoplasty," "radiation," "multiple myeloma," "radiotherapy," and "radiosurgery." Results Our preliminary search resulted in 219 articles, which subsequently resulted in 19 papers following abstract, title, full-text, and bibliography review. These papers were then grouped by treatment modality: radiotherapy, cementoplasty, or combination therapy. Significant pain and functional score improvement across all treatment modalities was found in the majority of the literature. While complications of treatment occurred, few were noted to be clinically significant. Conclusions Treatment options-radiotherapy and/or cementoplasty-for vertebral lesions and pathologic fractures in MM patients demonstrate significant radiographic and clinical improvement. However, there is no consensus in the literature as to the optimal treatment modality as a result of a limited number of studies reporting head-to-head comparisons. One study did find significantly improved pain and functional scores with preserved vertebral height in favor of kyphoplasty over radiotherapy. When not contraindicated, we advocate for some form of cementoplasty. Further prospective studies are required before implementation of a standardized treatment protocol. Level of Evidence 5.
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Affiliation(s)
| | - Alexander Ghasem
- University of Miami, Department of Orthopedic Surgery, Miami, Florida
| | - Dylan N Greif
- University of Miami Miller School of Medicine, Miami, Florida
| | | | - Sheila A Conway
- University of Miami, Department of Orthopedic Surgery, Miami, Florida
| | - Motasem Al Maaieh
- University of Miami, Department of Orthopedic Surgery, Miami, Florida
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Gomez CK, Schiffman SR, Bhatt AA. Radiological review of skull lesions. Insights Imaging 2018; 9:857-882. [PMID: 30232767 PMCID: PMC6206383 DOI: 10.1007/s13244-018-0643-0] [Citation(s) in RCA: 52] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2018] [Revised: 06/17/2018] [Accepted: 06/28/2018] [Indexed: 11/29/2022] Open
Abstract
Abstract Calvarial lesions are often asymptomatic and are usually discovered incidentally during computed tomography or magnetic resonance imaging of the brain. Calvarial lesions can be benign or malignant. Although the majority of skull lesions are benign, it is important to be familiar with their imaging characteristics and to recognise those with malignant features where more aggressive management is needed. Clinical information such as the age of the patient, as well as the patient’s history is fundamental in making the correct diagnosis. In this article, we will review the imaging features of both common and uncommon calvarial lesions, as well as mimics of these lesions found in clinical practice. Teaching Points • Skull lesions are usually discovered incidentally; they can be benign or malignant. • Metastases are the most frequent cause of skull lesions. • Metastatic lesions are most commonly due to breast cancer in adults and neuroblastoma in children. • Multiple myeloma presents as the classic “punched out” lytic lesions on radiographs. • Eosinophilic granuloma is an osteolytic lesion with bevelled edges.
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Affiliation(s)
- Carrie K Gomez
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14602, USA.
| | - Scott R Schiffman
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14602, USA
| | - Alok A Bhatt
- Department of Imaging Sciences, University of Rochester, 601 Elmwood Avenue, Rochester, NY, 14602, USA
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Pharmacologic inhibition of AKT leads to cell death in relapsed multiple myeloma. Cancer Lett 2018; 432:205-215. [DOI: 10.1016/j.canlet.2018.06.020] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 06/14/2018] [Accepted: 06/14/2018] [Indexed: 11/18/2022]
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Whole-Body MR Imaging: The Novel, "Intrinsically Hybrid," Approach to Metastases, Myeloma, Lymphoma, in Bones and Beyond. PET Clin 2018; 13:505-522. [PMID: 30219185 DOI: 10.1016/j.cpet.2018.05.006] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Whole-body MR imaging (WB-MR imaging) has become a modality of choice for detecting bone metastases in multiple cancers, and bone marrow involvement by multiple myeloma or lymphoma. Combination of anatomic and functional sequences imparts an inherently hybrid dimension to this nonirradiating tool and extends the screening of malignancies outside the skeleton. WB-MR imaging outperforms bone scintigraphy and CT and offers an alternative to PET in many tumors by time of lesion detection and assessment of treatment response. Much work has been done to standardize procedures, optimize sequences, validate indications, confirm preliminary research into new applications, rendering clinical application more user-friendly.
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Progression of Multiple Myeloma Detected on Cardiac Scintigraphy with 99mTc Sestamibi. Clin Nucl Med 2018; 43:497-498. [DOI: 10.1097/rlu.0000000000002110] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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50
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Morris RW, Kumar V, Saad AG. Anaplastic plasmacytoma: a rare tumor presenting as a pathological fracture in a younger adult. Skeletal Radiol 2018; 47:995-1001. [PMID: 29388036 DOI: 10.1007/s00256-018-2884-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 02/02/2023]
Abstract
Solitary plasmacytoma is the rarest type of plasma cell neoplasm, and the anaplastic form is even more uncommon. Plasmacytoma most commonly originates in bone and predominantly affects older patients. We describe the case of a 35-year-old woman with solitary osseous anaplastic plasmacytoma that presented initially with a pathological fracture following minor trauma. The patient was immunocompetent and had no predisposing conditions for a plasma cell tumor. Left lower extremity radiographs revealed an oblique fracture of the distal femur, and CT imaging indicated a primary osseous lesion at the fracture site. MRI confirmed the diagnosis of pathological fracture. Initial surgical pathology of the lesion was concerning because it could have been an osteosarcoma. Further immunostaining demonstrated CD138 positivity and kappa light chain restriction, confirming the diagnosis of plasmacytoma. In addition, the presence of marked anaplastic cellular changes confirmed the anaplastic variant. Further workup showed no evidence of multiple myeloma. This case is unusual given the age and gender of the patient. Awareness of the anaplastic variant of plasmacytoma is important to avoid erroneous diagnoses.
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Affiliation(s)
- Robert W Morris
- Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA.
| | - Varsha Kumar
- Department of Radiology, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
| | - Ali G Saad
- Department of Pathology and Laboratory Medicine, University of Mississippi Medical Center, 2500 North State Street, Jackson, MS, 39216, USA
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