Multiple myeloma Case Study No. 8 (Pathology)

Now we try to understand the Multiple myeloma in this Harsh Mohan Pathology based case study. This case is taken from harsh Mohan Pathology. Multiple myeloma is cancer that forms in a type of white blood cell called a plasma cell. Healthy plasma cells help you fight infection by making antibodies that recognize and attack germs.

In multiple myeloma, cancerous plasma cells accumulate in the bone marrow and displace healthy blood cells. Instead of making helpful antibodies, the cancer cells produce abnormal proteins that can cause complications.


Multiple myeloma Case:

A 70-year-old man has been complaining of lower back pain, fatigue, and increasing pallor  for a month. When examined, he has tenderness in the lower vertebrae. An x-ray shows multiple lytic lesions in the pelvis and sacrum.


1. You are required to Discuss the clinical correlation with the pathogenesis of the features.

2. What is the probable diagnosis?

3. Investigate and confirm the diagnosis?


Clinical Correlation

This elderly patient has lower back pain and tenderness, which shows a lytic lesion in the pelvis and sacrum on an X-ray. One of the main characteristics of multiple myeloma is the presence of multiple osteolytic lesions due to bone resorption due to infiltration by the malignant plasma cells in the bone marrow.

It is more commonly seen in the central skeleton and occurs with advanced age. Its systemic features of fatigue and anaemia also fit the profile of multiple myeloma more than metastases from prostate cancer, another central skeletal lesion in this age group where osteoblastic lesions are present in the bone.


Probable Diagnosis

Multiple myeloma



Here is how you can investigate Multiple myeloma through Clinical pathology

  1. CBC (haemoglobin, counts, indices), ESR, PCV, blood smear for the type of anaemia, paraproteins and rouleaux formation. i
  2. Also do Urine examination (albumin, glucose, microscopy and for Bence-Jones proteins).
  3. Perform Biochemical estimation: Renal function tests (urea, creatinine, BUN), liver function tests (bilirubin, ALT, AST, alkaline phosphatase, total proteins and AG ratio), blood glucose, lipid profile, calcium, phosphate. i
  4. Skeletal X-ray.
  5. Ultrasound examination of the abdomen

Additional tests

You can perform the additional tests in order to diagnose Acute lymphoblastic leukaemia case no. 7

  1. Bone marrow examination.
  2. Serum electrophoresis.
  3. Urine electrophoresis.
  4. CT scan of the pelvis and abdomen.
  5. Bone scan.

Reference: Harsh Mohan Pathology


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