Southern Medical College Journal
Case Report
Volume 3 Number 1 July 2017; 14-14
X-ray Skull with Multiple Punched Out Lesions Rajat Sanker Roy Biswas1*
Abstract X-ray skull with the numerous punched out/lytic lesions, multiple myeloma with or without plasmacytoma formation is the most likely diagnosis. Male patients with increased age might give the differential diagnosis of metastatic cancer also. Introduction Multiple myeloma is condition where malignant proliferation of plasma cells occurs1. There are two types of plasma cells which are derived from B cells and produce monoclonal immunoglobulins and contain heavy and light chains. In myeloma, plasma cells produce immunoglobulin of a single heavy and light chain which is a monoclonal protein and called a paraprotein2. It causes involvement of marrow and produce osteolytic lesions which give the differential diagnosis of metastatic cancer also3. Case Report These are two X-rays of a 56 years old male admitted in our hospital for cough and fever for 15 days and progressive weakness and lethargy for one month and body ache for same duration. During his evaluation he was found to have anemia (Hb 7.5gm/dl) with high ESR (106 mm in first hour). On consideration with above clues he was evaluated with plasma protein electrophoresis where M protein was found, but his urine for Bence-Jones protein was found negative and radiological evaluation was done with sketetal survey (Photograph 1 and Photograph 2). Bone marrow study was done where malignant plasma cell was found more than 40%4.
Photograph 1 : X-ray skull AP view.
Acknowledgement To Dr. Mary Chowdhury for her inspiration and support. Conclusion A diagnosis of multiple myeloma was done. X-rays provided a valuable clue for punched out lesion which is an important diagnostic criteria of this disease. Photograph 2 : X-ray skull lateral view.
Disclosure The author declared no competing interest.
Description Photograph showing multiple punched out lytic lesion in both AP and Lateral view of x-ray skull.
References 1. George ED, Sadovsky R: Multiple myeloma: recognition and management. Am Fam Physician. 1999; 59(7):1885-1894.
1. Assistant Professor of Medicine Chattagram Maa-O-Shishu Hospital Medical College, Chittagong.
2. Fonseca R, Barlogie B, Bataille R, et al. Genetics and cytogenetics of multiple myeloma: a workshop report. Cancer Res. 2004;64:1546-1558.
*Correspondence: Dr. Rajat Sanker Roy Biswas Cell: 01819 808433 Email :
[email protected] Received on Accepted on
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3. Nofsinger YC, Mirza N, Rowan PT, Lanza D, Weinstein G: Head and neck manifestations of plasma cell neoplasms. Laryngoscope. 1997;107(6):741-746.
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4. Bataille R, Harousseau JL: Multiple myeloma.N Engl J Med. 1997;336(23):1657-1664.
