Bone Sclerosis in Multiple Myeloma

Abstract

The rarity of roentgenographically demonstrable sclerotic lesions of bone in multiple myeloma is attested by the infrequent mention of this finding in radiologic textbooks and by the small number of reports in the literature. Schinz, Baensch, Friedl, and Uehlinger (13) state that multiple myeloma produces rounded, sharply demarcated bone defects of various sizes without marginal reaction, The most useful point in diagnosis, according to Shanks and Kerley (11) is, local osteoporosis, with no bone of normal density visible in the affected regions. Brailsford (2) states categorically that “the adjacent bone shows no reaction.” The literature contains occasional reports of bony sclerosis in multiple myeloma. Rypins (10) recorded the case of a 21-year-old woman with multiple myeloma proved at autopsy, who had subcutaneous nodules and numerous areas of osteosclerosis and osteolysis in the femurs, pelvis, and hand. “Whiskers” of new bone were laid down perpendicular to the shafts of the bones in some areas. The occurrence of an osteoblastic lesion in the left humerus in a 68-year-old woman was reported by Krainin, D'Angio and Smelin (7). The typical sunburst appearance of a malignant bone tumor was present in this case, as well as zones of osteolysis in the skull, pelvis, clavicles, and right humerus. A biopsy revealed periosteal new bone reaction to myelomatous infiltrations and extensive replacement of marrow by myeloma cells. The peripheral blood contained a significant number of plasma cells and the case was considered one of plasma-cell leukemia. A similar case with plasma cells in the peripheral smear was reported by Sharnoff et al. (12), in a 68-year-old man with multiple myeloma and osteosclerotic lesions in the lumbar spine, pelvis, and ribs similar to “osteoblastic cancer metastases.” Kohler and Laur (6) described a 65-year-old woman with proved multiple myeloma, who presented a dense osteoblastic focus in the left ilium. All other causes for osteosclerosis were excluded. These writers were able to collect from the literature 179 cases of multiple myeloma. Among these, were 4 with bone sclerosis, following irradia-tion of an osteolytic area in 2 instances. One of these 4 cases was that of Bailey (1), in a 65-year-old white male with a solitary myeloma of the right humerus treated by irradiation. Six years later a sclerotic reaction was seen in the shaft of the humerus. Recalcification is seldom noted, however, after radiation therapy of myelomatous foci or after treatment with urethane (3, 9). Odelberg-Johnson reports a case of myelomatosis in which roentgen examination revealed progressive and widespread, circumscribed osteosclerosis resembling metastasis but no evidence of osteolysis (8). The patient had never received roentgen therapy. Microscopic examination showed “many coarse bone-trabecules at the site of these lesions. Between the trabecules were abundant plasma cells.