Skip to main content
SpringerLink
Log in

Multiple myeloma: a review of atypical imaging features and other distinct plasma cell disorders that demonstrate similar imaging features

Skeletal Radiology volume 51, pages 135–144 (2022)Cite this article

Abstract

Multiple osteolytic lesions are a well-recognized and typical imaging feature of multiple myeloma as well as several other plasma cell disorders. Given the high volume of imaging studies obtained of multiple myeloma patients, radiologists will likely encounter a subset of multiple myeloma patients with less common or “atypical” findings during their practice. These atypical findings include osteosclerotic lesions, extramedullary lesions, and amyloid deposition. Similar imaging findings that are considered atypical for multiple myeloma can also be detected in other plasma cell disorders that are distinct from multiple myeloma. For instance, POEMS syndrome is a distinct plasma cell disorder from multiple myeloma, but also can present with osteosclerotic lesions. This article reviews the atypical findings associated with multiple myeloma and also reviews other plasma cell disorders that can have a similar spectrum of imaging findings. Special attention is paid to the musculoskeletal imaging findings.

This is a preview of subscription content, access via your institution.

Access options

Buy single article

Instant access to the full article PDF.

USD 39.95

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8
Fig. 9
Fig. 10

References

  1. Kazandjian D. Multiple myeloma epidemiology and survival: a unique malignancy. Semin Oncol. 2016;43(6):676–81.

    Article  Google Scholar 

  2. NIH: National Cancer Institute. Cancer Stat Facts: Myeloma url: https://seer.cancer.gov/statfacts/html/mulmy.html.

  3. Lacy MQ, Gertz MA, Hanson CA, Inwards DJ, Kyle RA. Multiple myeloma associated with diffuse osteosclerotic bone lesions: a clinical entity distinct from osteosclerotic myeloma. (POEMS syndrome). Am J Hematol. 1997;56(4):288–93.

    Article  CAS  Google Scholar 

  4. Glazebrook K, Guerra Bonilla FL, Johnson A, Leng S, Dispenzieri A, et al. Eur Radiol. 2015;25(2):497–504.

    Article  CAS  Google Scholar 

  5. Wang F, Huang X, Zhang Y, Li J, Zhou D, Jin Z. Bone lesions in Chinese POEMS syndrome patients: imaging characteristics and clinical implications. PeerJ. 2016;4:e2294.

    Article  Google Scholar 

  6. Mulleman D, Gaxatte C, Guillerm G, Leroy X, Cotten A, Duquesnoy B, et al. Multiple myeloma presenting with widespread osteosclerotic lesions. Joint Bone Spine. 2004;71(1):79.

    Article  Google Scholar 

  7. Rajkumar SV, Dimopoulos MA, Palumbo A, Blade J, Merlini G, Mateos M-V, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538–48.

    Article  Google Scholar 

  8. Kremer M, Ott G, Nathrath M, Specht K, Stecker K, Alexiou C, et al. Primary extramedullary plasmacytoma and multiple myeloma: phenotypic differences revealed by immunohistochemical analysis. J Pathol. 2005;205(1):92–101.

    Article  CAS  Google Scholar 

  9. Martinez-Lopez J, Blade J, Mateos M-V, Grande C, Alegre A, García-Laraña J, et al. Long-term prognostic significance of response in multiple myeloma after stem cell transplantation. Blood. 2011;118(3):529–34.

    Article  CAS  Google Scholar 

  10. Ooi GC, Chim JC, Au WY, Khong PL. Radiologic manifestations of primary solitary extramedullary and multiple solitary plasmacytomas. AJR Am J Roentgenol. 2006 Mar;186(3):821–7.

    Article  Google Scholar 

  11. Gautam A, Sahu KK, Alamgir A, Siddiqi I, Ailawadhi S. Extramedullary solitary plasmacytoma: demonstrating the role of 18F-FDG PET imaging. J Clin Diagn Res. 2017 Apr;11(4):XD01–3.

    PubMed  PubMed Central  Google Scholar 

  12. Khoo HW, Ding CSL, Tandon AA. Radiologic findings in polyarticular amyloid arthropathy and myopathy in multiple myeloma: a case report. Am J Case Rep. 2018;. 19(1941–5923. (Electronic)):1398–1404.

  13. Desikan KR, Dhodapkar MV, Hough A, Waldron T, Jagannath S, Siegel D, et al. Incidence and impact of light chain associated (AL) amyloidosis on the prognosis of patients with multiple myeloma treated with autologous transplantation. Leuk Lymphoma. 1997;27(3-4):315–9.

    Article  CAS  Google Scholar 

  14. Merlini G, Stone MJ. Dangerous small B-cell clones. Blood. 2006;108(8):2520–30.

    Article  CAS  Google Scholar 

  15. Prokaeva T, Spencer B, Kaut M, Ozonoff A, Doros G, Connors LH, et al. Soft tissue joint, and bone manifestations of AL amyloidosis: clinical presentation, molecular features, and survival. Arthritis Rheum. 2007;56(11):3858–68.

    Article  Google Scholar 

  16. Gavriatopoulou M, Musto P, Caers J, Merlini G, Kastritis E, van de Donk N, et al. European myeloma network recommendations on diagnosis and management of patients with rare plasma cell dyscrasias. Leukemia. 2018;32(9):1883–98.

    Article  Google Scholar 

  17. Dispenzieri A. Monoclonal gammopathies of clinical significance. Hematology Am Soc Hematol Educ Program. 2020;2020(1):380–8.

    Article  Google Scholar 

  18. Bardwick PA, Zvaifler NJ, Gill GN, Newman D, Greenway GD, Resnick DL. Plasma cell dyscrasia with polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes: the POEMS syndrome. Report on two cases and a review of the literature. Medicine (Baltimore). 1980;59(4):311–22.

    Article  CAS  Google Scholar 

  19. Dispenzieri A, Kyle RA, Lacy MQ, Rajkumar SV, Therneau TM, Larson DR, et al. POEMS syndrome: definitions and long-term outcome. Blood. 2003;101(7):2496–506.

    Article  CAS  Google Scholar 

  20. Kumar SK, Dispenzieri A, Lacy MQ, Gertz MA, Buadi FK, Pandey S, et al. Continued improvement in survival in multiple myeloma: changes in early mortality and outcomes in older patients. Leukemia. 2014;28(5):1122–1128.21.

    Article  CAS  Google Scholar 

  21. Keddie S, Foldes D, Caimari F, Baldeweg SE, Bomsztyk J, Ziff OJ, et al. Clinical characteristics, risk factors, and outcomes of POEMS syndrome: a longitudinal cohort study. Neurology. 2020;95(3):e268–79.

    Article  Google Scholar 

  22. Chong ST, Beasley HS, Daffner RH. POEMS syndrome: radiographic appearance with MRI correlation. Skelet Radiol. 2006;35(9):690–5.

    Article  Google Scholar 

  23. Soubrier MJ, Dubost JJ, Sauvezie BJ. POEMS syndrome: a study of 25 cases and a review of the literature. French Study Group on POEMS Syndrome. Am J Med. 1994;97(6):543–53.

    Article  CAS  Google Scholar 

  24. Takao Nakanishi IS, Toyokura Y, Nishitani H, Kuroiwa Y, Satoyoshi E, Tsubaki T, et al. The Crow- Fukase syndrome. A study of cases in Japan. Neurology. 1984;34(6):712. https://doi.org/10.1212/WNL.34.6.712.

    Article  Google Scholar 

  25. Albertí MA, Martinez-Yélamos S, Fernandez A, Vidaller A, Narváez JA, Cano LM, et al. 18F-FDG PET/CT in the evaluation of POEMS syndrome. Eur J Radiol. 2010;76(2):180–2.

    Article  Google Scholar 

  26. Stefanelli A, Treglia G, Leccisotti L, Laurenti L, Luigetti M, Sabatelli M, et al. Usefulness of F-18 FDG PET/CT in the follow-up of POEMS syndrome after autologous peripheral blood stem cell transplantation. Clin Nucl Med. 2012;37(2):181–3.

    Article  Google Scholar 

  27. Madan R, Chen J-H, Trotman-Dickenson B, Jacobson F, Hunsaker A. The spectrum of Castleman’s disease: mimics, radiologic pathologic correlation and role of imaging in patient management. Eur J Radiol. 2012;81(1):123–31.

    Article  Google Scholar 

  28. Ziff OJ, Hoskote C, Keddie S, D'Sa S, Davangnanam I, Lunn MPT. Frequent central nervous system, pachymeningeal and plexus MRI changes in POEMS syndrome. J Neurol. 2019;266(5):1067–72.

    Article  Google Scholar 

  29. Fernández de Larrea C, Kyle RA, Durie BG, Ludwig H, Usmani S, Vesole DH, et al. Plasma cell leukemia: consensus statement on diagnostic requirements, response criteria and treatment recommendations by the international myeloma working group. Leukemia. 2013 Apr;27(4):780–91.

    Article  Google Scholar 

  30. Tiedemann RE, Gonzalez-Paz N, Kyle RA, Santana-Davila R, Price-Troska T, Van Wier SA, et al. Genetic aberrations and survival in plasma cell leukemia. Leukemia. 2008;22(5):1044.

    Article  CAS  Google Scholar 

  31. Ali A, Paul Y, Nwabudike SM, Ogbonna O, Grantham M, Taddesse-Heath L. Plasma cell leukemia presenting as a Chest Wall mass: a case report. Case Rep Oncol. 2016 May-Aug;9(2):338–43.

    Article  CAS  Google Scholar 

  32. Wong P, Kashtwari D, Nair MK. Radiographic features of plasma cell leukemia in the maxilla: a case report. Imaging Sci Dent. 2016;46(4):273–8.

    Article  Google Scholar 

  33. Rothschild BM, Ruhli F, Rothschild C. Skeletal clues apparently distinguishing Waldenstrom’s macroglobulinemia from multiple myeloma and leukemia. Am J Hum Biol. 2002;14(4):532–7.

    Article  CAS  Google Scholar 

  34. Epperla N, McKiernan FE, Kenney CV. Radiographic findings in Waldenström’s macroglobulinemia resembling fibrogenesis imperfecta ossium (FIO): a case report. Skelet Radiol. 2014 Mar;43(3):381–5.

    Article  Google Scholar 

  35. Soutar R, Lucraft H, Jackson G, Reece A, Bird J, Low E, et al. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Br J Haematol. 2004 Mar;124(6):717–26.

    Article  Google Scholar 

  36. Nahi H, Genell A, Wålinder G, Uttervall K, Juliusson G, Karin F, et al. Incidence, characteristics, and outcome of solitary plasmacytoma and plasma cell leukemia. Population-based data from the Swedish myeloma register. Eur J Haematol. 2017 Sep;99(3):216–22.

    Article  Google Scholar 

  37. Weihrauch MR, Diehl V. Retrobulbar, intracranial, and cutaneous secondary plasmacytomas in a patient with atypical multiple myeloma. N Engl J Med. 2001;345(26):1917.

    Article  CAS  Google Scholar 

  38. Köse M, Buraniqi E, Akpinar TS, Kayacan SM, Tükek T. Relapse of multiple myeloma presenting as extramedullary plasmacytomas in multiple organs. Case Rep Hematol. 2015

  39. Ames J, Al-Samaraee A, Takahashi T. Extraosseous multiple myeloma: case report of presentation in the lower extremity soft tissues with literature review. Case Rep Radiol. 2017;2017:9159035.

    PubMed  PubMed Central  Google Scholar 

  40. Moore RD, Nelson SM, Cecava ND. Diffuse skeletal muscle extramedullary plasmacytomas: a rare case and review of the literature. Skelet Radiol. 2020;49(12):2087.

    Article  Google Scholar 

  41. Strojan P, Soba E, Lamovec J, Munda A. Extramedullary plasmacytoma: clinical and histopathologic study. Int J Radiat Oncol Biol Phys. 2002;53(3):692–701.

    Article  Google Scholar 

  42. Menke DM, Horny HP, Griesser H, Tiemann M, Katzmann JA, Kaiserling E, et al. Primary lymph node plasmacytomas (plasmacytic lymphomas). Am J Clin Pathol. 2001;115(1):119–26.

    Article  CAS  Google Scholar 

  43. Tathineni P, Cancarevic I, Malik BH. Uncommon presentations of multiple myeloma. Cureus. 2020 Jun 1;12(6):e8400.

    PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA

    Rupert O. Stanborough & Hillary W. Garner

Authors
  1. Rupert O. Stanborough
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Hillary W. Garner
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Hillary W. Garner.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and Permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Stanborough, R.O., Garner, H.W. Multiple myeloma: a review of atypical imaging features and other distinct plasma cell disorders that demonstrate similar imaging features. Skeletal Radiol 51, 135–144 (2022). https://doi.org/10.1007/s00256-021-03792-x

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00256-021-03792-x

Keywords

search

Navigation