A Patient presents with renal failure and bone pain. X-rays show evidence of skeletal destruction. Laboratory evaluation reveals hypercalcemia. Serum Electrophoresis shows a prominent M spike. Tissue biopsy shows Plasmacytoma. Bone marrow shows plasmacytosis with 35 percent Plasma cells. The most likely diagnosis is:
Answer is A (Multiple Myeloma): Plasmacytoma on tissue biopsy and Bone marrow plasmacytosis with >30 percent plasma cells are two major criteria for the diagnosis of Multiple Myeloma. Presence of ant' two major criteria is believed to confirm the diagnosis of multiple myeloma. The clinical complex of bone pain and renal failure together with diagnostic observation of skeletal destruction, hypercalcemia, monoclonal 'Al' spike, tissue plasmacytoma and bone marrow plasmacytosis >30 percent confirms a diagnosis of Multiple Myeloma MGUS is typically associated with < 10 % plasma cells on bone marrow biopsy. Solitary Plasmacytoma and Smoldering myeloma are by definition/criteria not associated with any myeloma related symptoms (Anemia, Hypercalcemia, and Renal Failure)
Multiple Myeloma
Plasmacytoma
MGUS
Smoldering Myeloma