scholarly journals Treatment of a patient with multiple myeloma of the femur

2021 ◽  
Vol 27 (2) ◽  
pp. 265-269
Author(s):  
K.V. Shevyrev ◽  
◽  
V.P. Voloshin ◽  
D.A. Shavyrin ◽  
T.A. Mitina ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Destruction ◽  
Pathologic Fracture ◽  
Lower Limbs ◽  
Left Femur ◽  
Multiple Myeloma Patient ◽  
Early Weight Bearing ◽  
Pathologic Fractures ◽  
The Right ◽  
Im Nailing

Introduction Multiple myeloma (MM) is a malignant tumor that causes widespread bone damage. The bone is involved in 90 % of MM patients, and 60% of patients develop pathologic fractures. Material and methods We report a case of combined surgical treatment and chemotherapy of a multiple myeloma patient who sustained a pathological diaphyseal fracture of the left femur and later presented with a lytic myeloma lesion in the right femur. Closed reduction and interlocking intramedullary (IM) nailing of the left femur was performed for the patient who was diagnosed with bone destruction in the shaft of the right femur a few months later. The right femur was fixed with interlocking IM nail for prophylaxis. Results The left femur consolidated at 6 months. The patient had no pain in the right femur, and enlargement in the bone destruction was not seen in the femur. The patient could ambulate with a cane with signs of deforming arthritis in the adjacent joints of the lower limbs. Discussion Three common surgical approaches used for bone tumors being complicated or not complicated by a pathologic fracture include nailing/plating, bone replacement and joint arthroplasty. Bone tumor replacement with oncological endoprostheses can be produced in specialized oncological orthopaedic units and is not available with regular trauma and orthopaedic services for different reasons. The operating orthopedic surgeon is to choose the appropriate implant to address the tumor involvement. Conclusion Interlocking IM nailing can be the method of choice for a pathologic fracture or for prophylactic bone fixation with appropriate indications identified with the Mirels's scoring system. Intramedullary nailing offers the advantage of minimally invasive stability for the operated limb and early weight-bearing in contrast to plate fixation treatment for fractures and prophylactic plating.

scholarly journals Percutaneous sacroplasty for the management of painful pathologic fracture in a multiple myeloma patient: Case report and review of the literature

2016 ◽  
Vol 30 (1) ◽  
pp. 80-83 ◽  
Author(s):  
AA Dmytriw ◽  
K Talla ◽  
R Smith
Keyword(s):  
Multiple Myeloma ◽  
Pathologic Fracture ◽  
Multiple Myeloma Patient ◽  
Pmma Bone Cement ◽  
Pathologic Fractures ◽  
Patient Reported ◽  
Procedural Complications ◽  
History Of ◽  
The Impact ◽  
Oblique Approach

Percutaneous kyphoplasty has a well-established role in the treatment of pathologic fractures in patients with multiple myeloma. Despite this, there is a scarcity of literature surrounding its use and efficacy in the sacrum. We present a case of successful symptom resolution in a patient with painful sacral fracture following sacroplasty, and review the existing literature. An 81-year-man with multiple myeloma presented to the hematology/oncology clinic with a history of excruciating pain while seated. The impact of this pain on his quality of life subjectively was rated to be particularly high. Computed tomography of the sacrum confirmed the presence of pathologic fracture within the S1 and S2 vertebrae. Under fluoroscopic guidance, polymethyl methacrylate (PMMA) bone cement was injected via 11-gauge needles using an anterior-oblique approach. No immediate post-procedural complications occurred, such as foraminal extravasation or venous injection. The patient reported himself to be pain-free 1 day following the procedure, and this remains the case to date at 2 years of follow-up. Sacroplasty is technically feasible and can provide durable relief of symptoms in patients with painful pathologic fractures of the sacrum. It is likely underused and can offer tremendous benefit to myeloma patients.

Posttraumatic intercostal pulmonary herniation – case report

2021 ◽  
Vol 100 (5) ◽  
Keyword(s):  
Case Report ◽  
Chest Wall ◽  
Surgical Repair ◽  
Lung Parenchyma ◽  
Trauma Centre ◽  
Lower Limbs ◽  
Left Femur ◽  
Wall Defect ◽  
The Right ◽  
Car Accident

Introduction: Pulmonary hernias are rare conditions, most are the results of an injury or previous thoracic surgery. Case report: We present a case of a 48-year-old woman injured in a car accident. The examination in the trauma centre revealed a chest injury with herniation of the lung parenchyma into the chest wall and fractures of long bones of lower limbs. Initially, an osteosynthesis of the left femur and the right tibia fracture were performed. The patient underwent a subsequent surgery to repair the pulmonary hernia. Conclusion: A pulmonary hernia is diagnosed either directly during a clinical examination or by imaging. A sovereign diagnostic method is a computed tomography. The method of treatment is a surgical repair with primary suture of the chest wall defect or implantation of a mesh to repair the pulmonary hernia.

scholarly journals Salmonella Osteomyelitis in a Rhesus Monkey

1986 ◽  
Vol 23 (2) ◽  
pp. 190-197 ◽  
Author(s):  
S. A. Klumpp ◽  
D. S. Weaver ◽  
C. P. Jerome ◽  
M. P. Jokinen
Keyword(s):  
Rhesus Monkey ◽  
Polychlorinated Biphenyl ◽  
Clinical Signs ◽  
Pathologic Fracture ◽  
Left Femur ◽  
Macaca Mulatto ◽  
Severity Of The Disease ◽  
The Right ◽  
Male Rhesus ◽  
Salmonella Osteomyelitis

An adult male rhesus monkey ( Macaca mulatto) developed clinical signs of severe osteomyelitis of the left femur 42 days after onset of enteritis. Salmonella sp. were cultured from feces, blood, and femoral lesions. Response to antibiotic therapy was poor, and the animal was euthanized. The left femur, with pathologic fracture and involucrum, and the right femur, tibia and fibula were most severely affected. Additionally hepatic microgranulomas, mild tubulointcrstitial nephritis, medullary histiocytosis and erythrophagocytosisin the lymph nodes, and a mild colitis were diagnosed microscopically. The severity of the disease and serum electrophoresis findings were suggestive of lowered resistance to the organism, possibly due to anemia or polychlorinated biphenyl toxicosis.

scholarly journals Intramedullary Nailing for Pathological Fractures of the Proximal Humerus Caused by Multiple Myeloma: A Case Report and Literature Review

2021 ◽  
Author(s):  
guoqiang xu ◽  
gang wang ◽  
xiaodong bai ◽  
zhenyu liu ◽  
xinjia wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Proximal Humeral Fracture ◽  
Pathological Fracture ◽  
Proximal Humerus ◽  
Combined Treatment ◽  
Bone Destruction ◽  
Humeral Fracture ◽  
Whole Body ◽  
Left Shoulder ◽  
Im Nailing

Abstract Background: Multiple myeloma bone disease(MMBD) is indicative of multiple myeloma (MM), and it will reduce patient life quality. In addition to oncological, antineoplastic systemic therapy, surgical therapy in patients with MM represents an essential treatment pillar within the framework of supportive therapy measures and is the task of orthopedic tumor surgery. Nevertheless, there are few reports about applying intramedullary (IM) nailing in treating MM-induced proximal humeral fracture to prevent fixation loss. This paper aims to describe a case of pathological fracture of the proximal humerus caused by multiple myeloma effectively treated with IM nailing without removal of tumors and review the current literature.Case presentation: This study reported a 64-year-old male patient complaining of serious left shoulder pain and limited movement. X-ray films showed left proximal humeral fracture accompanying with osteoporosis and bone destruction. During the preoperative examinations, tumor markers, whole-body bone imaging and bone marrow biopsy were performed. The patient was finally diagnosed with multiple myeloma (IgAλ, IIIA/II). After the treatment of pathological fracture with IM nailing, the patient's function recovered and the pain was relieved rapidly. The visual analogue scale (VAS) reduced by 7 points to 2 points postoperatively compared with that preoperatively. Histopathological examination results presented plasma cell myeloma. Next, the patient received chemotherapy in the hematology department. Humeral fracture displayed good union in the 40-month follow-up, with complete healing of fracture, and the clinical outcome was still satisfactory.Conclusion: The pathological fracture of proximal humerus caused by multiple myeloma should be treated by surgery early. IM nail can be used for this kind of fracture without removal of tumors, bone cement augmentation for bone defect or local adjuvant therapy was also employed. Under the combined treatment, the proximal humerus fracture can eventually heal.

scholarly journals Multiple Myeloma in a Dog

2016 ◽  
Vol 44 (1) ◽  
pp. 5
Author(s):  
Claudine Botelho De Abreu ◽  
Rodrigo Bernardes Nogueira ◽  
Luiz Eduardo Duarte De Oliveira ◽  
Flávia Dada Paiva ◽  
Antônio Carlos Cunha Lacreta Junior ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Plasma Cells ◽  
Final Diagnosis ◽  
Initial Assessment ◽  
Radiographic Examination ◽  
Cardiac Murmur ◽  
Left Femur ◽  
The Right ◽  
Bence Jones Proteinuria

Background: The multiple myeloma is a neoplasia characterized by the uncontrolled proliferation of plasma cells (plasmacytes) in the bone marrow and in other tissues. The infiltration of the neoplasia cells associated to the high level of anomalous immunoglobulin production (M protein) results in a variety of clinic-pathologic anomalies. It is a rare disease in dogs, corresponding to 0.3% of all malignant neoplasia and 2% of the hematopoietic, with few literature descriptions. So, the present paper aims at properly report a multiple myeloma in a dog of non-defined breed, emphasizing the clinic, laboratorial, radiographic and pathologic aspects.Case: In a Veterinary Teaching Hospital, an 11-year-old dog of non-defined breed was admitted, weighing 10.8 kg of body mass. The clinic history was claudication of the right thoracic member, hyporexia and lethargy in the past 20 days. The main abnormalities in the physical examination were holosystolic cardiac murmur III/VI on mitral focus, and high sensibility to touch in the right humerus. Laboratory tests showed pancytopenia, serum hypercalcemia and Bence-Jones proteinuria. Radiographic examination confirmed polyostotic punctate osteolysis on the right humerus; pelvic, femurs and vertebrae bones from L2 to L7, on generalized condition. Cytology by aspiration puncture from the left femur marrow bone did not confirm neoplasia cells. The clinic condition of the referred animal was progressively getting worse and euthanasia was performed. At the dog’s necropsy it was spotted tumor infiltrations on the femur, the humerus and the vertebrae canal. Histopathological exam of the bone marrow revealed diffuse occupation by distinguished plasmacytes, in some áreas reaching around 100% of cell population. Metastases on the primary tumor were found on the liver, kidney and spleen.Discussion: The diagnosis of multiple myeloma in this dog was confirmed by bone marrow histopathological exam. It is confirmed when there is more than 20% of plasmacytes in the examined structure. In this report, certain areas were spotted with 100% occupation of neoplasia cells. On the other hand, the first cytological assess did not reveal any abnormalities, suggesting that the place which received the puncture (aspiration) was not infiltrated by tumor cells. It is described that in the bone marrow may occur grouping of plasmacytes, as it was observed the animal’s necropsy of this report. This aspect point out that the diagnosis cannot be discarded only with a negative cytological exam from the bone marrow; especially if there are clinic, laboratorial and radiographic signs compatible to the illness. The spotted clinic signs by this patient are frequent in dogs with multiple myeloma, as well as the laboratory results, except to the monoclonal gammopathy. Due to a no realization of electrophoresis, this abnormality cannot be confirmed. At the initial assessment of the disease, the radiographic exam is considered golden standard as it was observed in this dog. The radiographic abnormalities were determinant, once they conducted the diagnosis towards the suspected neoplasia. According to current diagnosis criteria, on this present case, the pancytopenia, serum hypercalcemia and Bence-Jones proteinuria also helped towards the suspicion of multiple myeloma. However, the evaluation of the bone marrow was decisive to the final diagnosis; and a special attention was given to puncture more than one place in the bone marrow, which improved/enhanced the diagnosis possibility in this patient.Keywords: plasma cells, bone marrow, pancytopenia, osteolysis, radiography.

scholarly journals Intramedullary Nailing for Pathological Fractures of the Proximal Humerus caused by Multiple Myeloma: A Case Report and Literature Review

2021 ◽  
Author(s):  
guoqiang xu ◽  
gang wang ◽  
xiaodong bai ◽  
zhenyu liu ◽  
xinjia wang ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Proximal Humeral Fracture ◽  
Pathological Fracture ◽  
Proximal Humerus ◽  
Combined Treatment ◽  
Bone Destruction ◽  
Humeral Fracture ◽  
Whole Body ◽  
Left Shoulder ◽  
Im Nailing

Abstract BackgroundMultiple myeloma bone disease(MMBD) is indicative of multiple myeloma (MM), and it will reduce patient life quality. In addition to oncological, antineoplastic systemic therapy, surgical therapy in patients with MM represents an essential treatment pillar within the framework of supportive therapy measures and is the task of orthopedic tumor surgery. Nevertheless, there are few reports about applying intramedullary (IM) nailing in treating MM-induced proximal humeral fracture to prevent fixation loss. This paper aims to describe a case of pathological fracture of the proximal humerus caused by multiple myeloma effectively treated with IM nailing without removal of tumors and review the current literature.Case presentationThis study reported a 64-year-old male patient complaining of serious left shoulder pain and limited movement. X-ray films showed left proximal humeral fracture accompanying with osteoporosis and bone destruction. During the preoperative examinations, tumor markers, whole-body bone imaging and bone marrow biopsy were performed. The patient was finally diagnosed with multiple myeloma (IgAλ, IIIA/II). After the treatment of pathological fracture with IM nailing, the patient's function recovered and the pain was relieved rapidly. The visual analogue scale (VAS) reduced by 7 points to 2 points postoperatively compared with that preoperatively. Histopathological examination results presented plasma cell myeloma. Next, the patient received chemotherapy in the hematology department. Humeral fracture displayed good union in the 40-month follow-up, with complete healing of fracture, and the clinical outcome was still satisfactory.ConclusionThe pathological fracture of proximal humerus caused by multiple myeloma should be treated by surgery early. IM nail can be used for this kind of fracture without removal of tumors, bone cement augmentation for bone defect or local adjuvant therapy was also employed. Under the combined treatment, the proximal humerus fracture can eventually heal.

Advanced myeloma masquerading as chronic shoulder pain in a 48-year-old man: a diagnostic dilemma

2020 ◽  
Vol 13 (5) ◽  
pp. e231219
Author(s):  
Rajarshi Bhadra ◽  
Teodora Nikova ◽  
Meyappan Somasundaram ◽  
Keyvan Ravakhah
Keyword(s):  
Multiple Myeloma ◽  
Case Report ◽  
Early Diagnosis ◽  
Shoulder Pain ◽  
Pathologic Fracture ◽  
Diagnostic Dilemma ◽  
History Of ◽  
Low Threshold ◽  
The Right ◽  
Chronic Shoulder Pain

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.

The massive nodular cutaneous and soft tissues lesions of the right shoulder and the arm as the extramedullary manifestation of the advanced stage of multiple myeloma

Oncoreview ◽  
2017 ◽  
Vol 7 (4) ◽  
pp. 180-183
Author(s):  
Arkadiusz Drobiecki ◽  
Marcin Pasiarski ◽  
Agnieszka Stelmach-Gołdyś ◽  
Bartosz Garus
Keyword(s):  
Multiple Myeloma ◽  
Soft Tissues ◽  
Advanced Stage ◽  
The Right

Bone disease as the first manifestation of systemic AL-amyloidosis

2020 ◽  
Vol 92 (7) ◽  
pp. 85-89
Author(s):  
L. P. Mendeleeva ◽  
I. G. Rekhtina ◽  
A. M. Kovrigina ◽  
I. E. Kostina ◽  
V. A. Khyshova ◽  
...  
Keyword(s):  
Multiple Myeloma ◽  
Bone Marrow ◽  
Bone Disease ◽  
Plasma Cells ◽  
Interventricular Septum ◽  
Bone Destruction ◽  
Amyloid Deposition ◽  
Bone Lesions ◽  
Al Amyloidosis ◽  
Linear Type

Our case demonstrates severe bone disease in primary AL-amyloidosis without concomitant multiple myeloma. A 30-year-old man had spontaneous vertebral fracture Th8. A computed tomography scan suggested multiple foci of lesions in all the bones. In bone marrow and resected rib werent detected any tumor cells. After 15 years from the beginning of the disease, nephrotic syndrome developed. Based on the kidney biopsy, AL-amyloidosis was confirmed. Amyloid was also detected in the bowel and bone marrow. On the indirect signs (thickening of the interventricular septum 16 mm and increased NT-proBNP 2200 pg/ml), a cardial involvement was confirmed. In the bone marrow (from three sites) was found 2.85% clonal plasma cells with immunophenotype СD138+, СD38dim, СD19-, СD117+, СD81-, СD27-, СD56-. FISH method revealed polysomy 5,9,15 in 3% of the nuclei. Serum free light chain Kappa 575 mg/l (/44.9) was detected. Multiple foci of destruction with increased metabolic activity (SUVmax 3.6) were visualized on PET-CT, and an surgical intervention biopsy was performed from two foci. The number of plasma cells from the destruction foci was 2.5%, and massive amyloid deposition was detected. On CT scan foci of lesions differed from bone lesions at multiple myeloma. Bone fragments of point and linear type (button sequestration) were visualized in most of the destruction foci. The content of the lesion was low density. There was no extraossal spread from large zones of destruction. There was also spontaneous scarring of the some lesions (without therapy). Thus, the diagnosis of multiple myeloma was excluded on the basis based on x-ray signs, of the duration of osteodestructive syndrome (15 years), the absence of plasma infiltration in the bone marrow, including from foci of bone destruction by open biopsy. This observation proves the possibility of damage to the skeleton due to amyloid deposition and justifies the need to include AL-amyloidosis in the spectrum of differential diagnosis of diseases that occur with osteodestructive syndrome.

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