Myeloma

Myeloma (synonym: the disease of Rusticola, myeloma, myeloma, retikulozitos) is a systemic disease, similar to leukemia, belonging to the group of retikuleze. Myeloma is rare, occurs in 50-60 years of age, most men. The etiology is unclear.
The main symptom of the disease is spread to bone, blood, and urinary systems and the violation of protein metabolism. First, pain in the bones of the chest, spine, hip , and other Then the deformation and spontaneous fractures. When x-rays of the affected bone finds defects rounded, mainly in the skull, ribs and hip bones. In the blood - hypochromic anemia, leukopenia, thrombocytopenia. In clause the bone marrow - a large number of plasma and reticular cells. Violation of protein metabolism is manifested by hyperglobulinemia. The result of violation of protein metabolism is the kidney nephrotic nature with the presence of large amounts of protein and cylinders in the urine, and in the future may develop failure of the kidneys, up to uremia. Sometimes in the urine detect the Bence-Jones protein (see). The prognosis is unfavorable.
Treatment in a hospital. Apply sarkolizin, cyclophosphamide , etc. in combination with corticosteroids, vitamin therapy.

Myeloma (from the Greek. myelos - brain; synonym: the disease of Rusticola, myeloma, myeloma, retikulozitos - the system defeat mainly bones, characterized by the proliferation of tumor type radiculopathies bone marrow cells and destructive changes in the bones with a tendency to spontaneous fractures. Myeloma is a systemic disease, similar to leukemia, belonging to the group of retikuleze.
Ill M. B. usually in 50-60 years of age. Rather uncommon. Due to improved diagnostic techniques (bone marrow biopsy, x-ray of the bones, electrophoresis of proteins of plasma and urine) M. B. was diagnosed more often.
There are the following forms M. b.: solitary myeloma (bone and uncostly localization), multiple nodular myeloma and diffuse multiple myeloma. Diffuse multiple myeloma (diffuse form of myeloma) developed by tumor hyperplasia reticular plasma elements of the bone marrow. System, the generalized nature of the disease is revealed most clearly in the forms, flowing through the leukemia type (so-called plasmocracy leukemia). When multiple nodular myeloma (nodular form M. B.) along with individual tumor growths noted in a more or less diffuse radikulopatia metaplasia of the bone marrow. In addition to the classic form of bone marrow M. b., there is a "visceral" form, in which, along with damage to bone marrow has extensive lymphocytic infiltration of the internal organs and lymph nodes.
Pathological substrate myeloma are reticular plasma cells in the bone marrow, lymph nodes, spleen, liver, etc. On histological sections myeloma nodes, as in the preparations of bone marrow obtained by puncture or trepanobiopsy bones, discovered characteristic "myeloma cells" - a kind, usually large plasma and reticular cells. The morphological diversity of paintings characteristic of M. b., due to the different stages of development and the degree of malignancy (malignant transformation) reticular plasma cells (Fig. 1-6).


Fig. 1. Sternal punctat in multiple myeloma: plasmogamy metaplasia

Fig. 2. Myeloma skull (histological section): plasmodiidae cells.

Fig. 3. Myeloma: single - and dual-core myeloma cells.

Fig. 4. Solitary myeloma (punctat tumors).

Fig. 5. Plasmodiidae cells in the peripheral blood.

Fig. 6. Dual-core plasmogamy cell in the blood.

Studies by means of an electronic microscope detect structural commonality myeloma and typical plasma cells, characterized by cellular ("frothy", Fig. 3) structure of the cytoplasm (elastoplast). Structural features of myeloma cells reflect the inherent secretory function. Product secretion malignant transformed plasma, resp. myeloma cells are abnormal protein molecules related to globulin fraction,the so - called paraproteins.
Pathological anatomy. M. B. characterized system proliferate in the bone marrow radiculopathies (myeloma cells and destructive changes in the bones. Are mainly affected the bones of the skull, pelvis, vertebrae, sternum, ribs, less long tubular bones. Bones become soft, brittle; may experience spontaneous fractures, deformity of the chest, flattening of the vertebral bodies with sdavlennoy spinal cord.

myeloma
Fig. 6 and 7. Myeloma; sawing on the spine (Fig. 6) and hips (Fig. 7) see the proliferation of tumor tissue pinkish-yellow or pinkish-white color.

When multiple nodular myeloma (the nodular form of myeloma) the growth of myeloma tissue proceeds with the formation of multiple nodes rounded shapes of various sizes (from 0.5 to 5 hedgehog in diameter), white, grey-red colour, a mild consistence (printing. Fig. 6 and 7); sometimes the nodes contain hemorrhage, pockets of neurosis. In the field of knotted enlargement marks the destruction of bone tissue. In some cases there is a growing into surrounding soft tissue.
Less common diffuse myeloma when diffuse the growth of myeloma cells not accompanied by the development of nodes. In this form the fabric of bone marrow on the cut has a mottled appearance, contains pinkish-white, grey-red field, observed diffuse osteoporosis; in rare cases, the bone resorption is insignificant. Histological examination of the bone marrow discover expansion reticular cells of various sizes and shapes, often plasma type with basophilic cytoplasm, rich RNA; meet giant multinucleated cells. In the field growths always shows tender network argyrophilic fibers (Fig. 7).


Fig. 7. Myeloma site in the bone marrow with a strong network argyrophilic fibers (silver impregnation method on Foot).

Fig. 8. Knotty infiltration of plasma and reticular cells in the liver, with multiple myeloma.


According to different maturity proliferating cells secrete differentiated and undifferentiated myeloma (reticulosarcoma). The first consists of atypical plasma cells homogeneous structure. The latter are characterized by proliferation of immature elements and, according to A. I. Strukova, are of several types: small cell (lymphocytopenia), and both polimervolokno. G. A. Alekseev allocates retikulozitos, plasmablastic and cancer (piroplasmosis). In connection with the interpretation of Genesis myeloma cells division of myeloma at myeloblasts, malietoa, erythroblastes, limfozitami taken earlier in the literature, is now almost completely abandoned. It is now established that the development of paraproteins related to myeloma cells.
In most cases, multiple myeloma, there are marked axillary (Century A. Rusakov) and smooth resorption of bone tissue, sometimes it lacunar resorption of bone. The destruction of the bones in a number of tissues and organs (kidneys, lungs, blood vessels and so on) are laid phosphate-lime mass-type metastatic calcification. In some cases, multiple myeloma, along with resorption occurs focal formation of bone substance is a primitive structure, mainly in the field of microfractures and hemorrhages. Deposits of osteoid and focal osteosclerosa also noted in sections myeloma growths in the treatment of M. B. the sarcolysin (I. A. Avdeev).
Along with damage to bone marrow and focal or diffuse infiltrates often detected in the lymph nodes, spleen, liver (Fig. 8), less often in the tonsils, kidneys, endocrine glands, the skin. In some cases, occurring usually with leukemia blood picture, there is a massive infiltration of internal organs with the increase of their volume; possible development of knotted growths. The presence in myeloma generalized system process rather makes them similar to leukemia, and among them the nature of cellular growths with retikulez.
The main manifestation of tissue paraproteins is the deposition of amyloid and paramilita encountered in some cases, M.B. Parmelee has coloring properties of amyloid, but does not metachromatic with methyl violet. The peculiarity of amyloidosis (paramilita) in multiple myeloma is a higher prevalence. Due to deposits of the protein mass in myeloma nodes in the bones may experience a kind of amyloid-like formation. The accumulation of the protein mass in the kidneys cause the obturation gleams tubules, atrophy, infiltrative-sclerotic changes in the stroma and leads to the development of neprocitana. In rare cases in myeloma cells and extracellular in myeloma growths, as well as kidney, vessels, the cornea contains crystalline deposits, which origin is connected with protein Bence-Jones.
Solitary myeloma is very rare, is characterized by the development in any single bone tumor node consisting of plasma cells. Violation of protein metabolism is usually absent. In some cases, long observed as solitary myeloma, at the end of the disease occurred in the generalization process.
Also described isolated uncustomizable, a cancer of various localizations: in the upper respiratory tract, lungs, pleura, stomach, skin, etc., In most cases, a long time they remain localized and have a benign course. However, the known observations, when after surgical removal of the tumor had a relapse with growth into the surrounding tissue, or in a few years developed myeloma. Occasionally uncustomary plasmacytoma proceeds with dysproteinemias phenomena.