usmle2004
Forum Newbie
Topics: 4
Posts: 23
|
A 67-year-old man presents to the emergency department because he awoke with severe lower back pain radiating down his legs. X-rays of the spine demonstrate a compression fracture of the L4 vertebrae, and the radiologist thinks that this may have occurred in a lucent area of the vertebrae, which is now so distorted by the fracture that he cannot be completely sure. Bone marrow biopsy of the iliac bone demonstrates a dense infiltrate of plasma cells, some of which appear morphologically normal, but others of which have larger-than-normal nuclei with irregular nuclear shapes. Which of the following is the most likely diagnosis?
(A) Acute lymphoblastic leukemia
(B) Chronic lymphocytic leukemia
(C) Chronic myelogenous leukemia
(D) Multiple myeloma
(E) Waldenstrom macroglobulinemia
___________________
best,
ed
|
| asmi
Forum Hero
Topics: 1043
Posts: 4,609
|
D ..
|
| dxtxpx
Forum Guru
Topics: 259
Posts: 1,233
|
MM
|
| alice8
Forum Guru
Topics: 37
Posts: 643
|
(D) Multiple myeloma
___________________
Dream on 'til your dream comes true.
|
| Colombia
Forum Guru
Topics: 85
Posts: 438
|
MM
|
| usmle2004
Forum Newbie
Topics: 4
Posts: 23
|
yes, it is a multiple myeloma case presentation. I just wanted to share this Kaplan Q with you. Here is the detail answer:
Multiple myeloma is a malignant proliferation of plasma cells that may be considered a variant of B-lineage lymphomas. It is practically the only leukemia/lymphoma with a strong predilection for causing lytic lesions of bone. These lytic lesions are classically described as "punched out," but the shape may not be apparent if a pathologic fracture through the weak bone has distorted the morphology. The other distinctive feature of multiple myeloma is the production of a clonal proliferation of immunoglobulins or immunoglobulin precursors, leading to "monoclonal spikes" on an electrophoresis of urine or serum.
Acute lymphoblastic leukemia (choice A) is characterized by large numbers of blast cells in marrow, and often in peripheral blood.
Chronic lymphocytic leukemia (choice B) is characterized by large numbers of small lymphocytes (not plasma cells) in peripheral blood, and hypercellular marrow infiltrated by lymphocytes.
Chronic myelogenous leukemia (choice C) is characterized by large numbers of mature neutrophils, eosinophils, and basophils in peripheral blood, and hypercellular marrows dominated by granulocytic precursors.
Waldenstrom macroglobulinemia (choice E) is the disease most closely related to multiple myeloma among those listed. It can also produce a monoclonal electrophoretic spike, but the cellular morphology is typically more lymphoplasmacytic (e.g., smaller cells with less cytoplasm) than truly plasmacytoid, and lytic bone lesions are uncommon.
___________________
best,
ed
|
| md2besoon
Forum Elite
Topics: 33
Posts: 228
|
D, MM
___________________
Service to others is the rent that you pay for your room here on earth.
|
|
| |
| | | | | | | |
Similar forum topics