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Multiple Myeloma

  • Most common malignant primary bone tumor can present as a part of syndrome: POEMS Polyneuropathy, Organomegaly, Endocrinopathy, Myeloma, Skin lesions)
  • Hypercalcaemia is seen
  • X Ray: punched out lesion is seen in skull
    MRI: mini brain appearance is pathognomonic
    Bone scan is not indicated (no increased uptake)


Differential diagnosis


Multiple myeloma


Less common

More common (1% population >50yr&10% in>75years)


>30 g/L

<10% bone marrow plasma cells

<30g/L(3g/dL) of M component


a. Urinary Bence Jones protein

b. Anemia

c. Renal failure

d. Hypercalcemia

e. Lytic bone lesions



<1% labelling inded

Much shorter

2 year shorter survival than normal.

1% per year develop myeloma

Malignant Fibrous Histocytoma

  1. Malignant histocytic less than also called waste basket tumor
  2. Secondary to bone infarct, Paget’s tumor, Radiation
  3. Seen in metaphysis

Synovial Sarcoma

  1. Malignant soft tissue near joint rarely within join
  2. Cellular origin unknown (not from synovial)
  3. Most common malignant tumor of foot
  4. Genetic chromosome trans location T(X : 18)
  5. Metastasis to lung most common
  6. Metastasis to lymph node (other soft tissue sarcoma which metastasis to lymph node are : Mnenomic CLEAR-MS)
    Clear cell sarcoma
    Epithelial sarcoma
    Malignant fibrous histiocytomas
    Synovial cell sarcoma

Extra Edge:

Tumor metastasis beyond Elbow or Knee - Bronchus , Bladder, Colon ------- BBC


Bone to Bone, Osteosarcoma, Neuroblastoma, Ewings Sarcoma ……… BONE

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