Plasma Cell Myeloma: A Clinical, Pathologic and Roentgenologic Review of 90 Cases

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Abstract
The study is based on 90 cases including primary extramedullary plasma cell tumors, apparent solitary lesions of bone and diffuse plasma cell myeloma. There is no absolute categorical separation of these various groups. Solitary bone and extramedullary lesions are erratic in their course but may after many years, eventuate into diffuse myeloma. Clinically diffuse myeloma is a disease predominantly of men in the 5th and 6th decades of life. Bone pain is the outstanding symptom and is often associated with a progressively severe anemia, hyperglobulinemia, Bence Jones proteinuria and hypercalcemia. Renal damage is not infrequent and due to mechanical block of the nephron by protein-aceous precipitate and an associated toxic effect on the renal tubule cells. Roentgen diagnosis of myeloma is unreliable as it may be confused with other conditions producing discrete osteolytic lesions. Myeloma therapy is often beneficial but not necessarily curative. Roentgen therapy may control or eradicate localized lesions. Urethan either alone or with ACTH or cortisone is the choice of the drugs. Even this gives objective evidence of relief in only a small number of patients. Toxic effects may be severe. Brief summaries of some of the more interesting cases are given including 1 case still living after 22 years and 1 case in which death was attributed to toxic effect of urethan on liver.