An Apparently Solitary Myeloma of Bone with Subsequent Generalization

Abstract

According to the latest reports (Paul A and Pohle; Bichel and Kirketerp; King; Tilden; Esposito), 48 cases of so-called solitary myeloma have been recorded in the literature. Only about one-fourth of these, however, are known to have remained solitary after four years' observation. In approximately 30 per cent the typical picture of multiple myeloma developed after varying intervals and 40 to 50 per cent were observed too short a time to permit a definite conclusion. Bichel and Kirketerp, emphasizing the importance of sternal puncture as a diagnostic aid, accepted as unquestionable solitary myeloma only 5 of a series of 27 cases which they reviewed, mainly on the basis of their long clinical course. They believe that a roentgenographic investigation of the entire skeleton does not wholly exclude the possibility of a generalized myelomatosis in the presence of a single roentgenologically demonstrable lesion, inasmuch as sternal puncture in their two cases showed evidence of systemic disease when roentgenologically no other lesion could be found. It is a matter of speculation whether these tumors, i.e., the ones which remained solitary after four years' observation, and those which ultimately became typical multiple myelomas, are really representative of two different entities. The important point is that all of these lesions apparently have a better prognosis and respond more favorably to treatment than the classical multiple myeloma. Paul and Pohle incline to the belief that myeloma may occur in varying degrees of malignancy, with rapid progress in the classical cases and a relatively benign course in the so-called “solitary” lesions. Between the two extremes—i.e., the typical multiple myeloma and the probably permanently solitary tumors—many grades of malignancy may be found. This assumption naturally would favor the outlook in cases with early institution of proper treatment. From the roentgen diagnostic point of view, two main types of lesion have been described. The first is the purely osteolytic lesion with sharp demarcation and little, if any, expansion. This type is most frequently located in a single vertebra or the shaft of a long bone and is easily mistaken for an osteolytic cancer metastasis. The second, or so-called giant-cell, type is a multicystic, osteolytic, destructive lesion, with rather sharp demarcation and occasional expansion.