Extraskeletal spread in multiple plasma cell myeloma:A review of 57 autopsied cases

Abstract

This study analyzes the extraskeletal spread in 57 consecutively autopsied cases of multiple myeloma. Three stages of spread were recognized: stage I in which myeloma nodules were grossly confined to the skeleton; stage II with extraskeletal spread grossly confined to adjoining paraskeletal tissues; stage III with gross spread to distant sites. Extraskeletal gross or microscopic myeloma infiltrates were present in 65% of cases in this series. In stage I, microscopic infiltrates were found in 34% of cases. In addition to the gross lesions seen in stage III, all stage II and III cases showed distant microscopic tumor infiltrates. The commonest sites of these were the spleen, liver, lymph nodes and kidneys. Patients with the longest duration of illness tended to have the most widespread extramedullary involvement. Patients dying with stage III lesions tended to have a higher proportion of poorly differentiated tumor as compared to patients with stage I and II. Because of evidence of intravascular and “linear” spread in paravertebral connective tissues and because of involvement of sites other than lymphoreticular organs, it is difficult to escape the conclusion that extraskeletal sites in myeloma represent true metastases rather than autochthonous multifocal growths.

Clinical and pathologic findings in 52 consecutively autopsied cases with multiple myeloma

“…Primary extramedullary plasmacytomas are also rare, and they commonly originate in head and neck, especially in the upper aerodigestive tract [4,5]. Extraosseous spread was found in approximately two-thirds of the myeloma patients at autopsy [2,6]. The common lesions were reticuloendothelial organs such as the liver and the spleen, but the myeloma cells were also present in other organs and tissues.…”

Testicular Plasmacytoma as Initial Presentation of Multiple Myeloma

“…Overall, 65 and 71% of myeloma patients have some form of extramedullary plasmacytoma [3], [4], [5] . Generally the prognosis of EMP without evidence of multiple myeloma is good with 5-year survival rates as high as 70% and median survival time around 8 years [6], [7] .…”

Breast involvement in immunolymphoproliferative disorders: Report of a case of multiple myeloma of the breast

“…Clinically apparent extraosseous manifestation are present in less than 5% of patients with multiple myeloma and are usually associated with more aggressive behaviour, resistance to treatment and shorter survival. Clinicopathologic studies, however, show extraosseous involvement in about two third of the patients, liver, spleen and lymph nodes being the most frequent sites [4,5]. Central nervous system, kidney, skin, pleura, lung, testes, pancreas, thyroid, adrenal glands and omental involvement have also been described.…”