January 11, 2013

Extraosseous Myeloma

Axial PET/CT images show a large homogeneous soft tissue mass in the lett buttock involving the gluteal muscles, which demonstrates significant FDG avidity. 

Extraosseous Myeloma

  • 10-16% of patients with multiple myeloma
  • Rising incidence possibly due to better imaging techniques and increased survival of patients with myeloma
  • More common in younger myeloma patients and more aggressive subtypes
  • Shorter survival and shorter progression-free survival (than patients without extraosseous involvement)
  • Has been integrated into an updated version of Durie-Salmon staging system

How to Image Patients with Myeloma

  • Skeletal survey (current minimum standard)
  • Whole-body PET/CT vs. whole-body MRI for newly diagnosed myeloma and with no findings or limited findings on skeletal survey (two different methods have been suggested by different authorities) to assess for occult involvement
Imaging Appearances
  • Soft tissue: nodules in subcutaneous tissues and muscles (like in our case)
  • Reticuloendothelial system: lymph node enlargement in multiple stations
  • Liver: hepatomegaly, low-attenuation liver lesions without enhancement
  • CNS: leptomengineal process 
  • Lungs: lung nodules, masses, interstitial infiltration
  • Kidneys: masses, diffuse enlargement
  • Peritoneum: masses
Hall MN, Jagannathan JP, Ramaiya NH, et al. Imaging of extraosseous myeloma: CT, PET/CT and MRI features. AJR 2010; 195:1057-1065. 

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