Rothschild B M, Hershkovitz I, Dutour O
Arthritis Center of Northeast Ohio and Northeastern Ohio Universities College of Medicine, Youngstown 44512, USA.
Am J Phys Anthropol. 1998 Feb;105(2):241-50. doi: 10.1002/(SICI)1096-8644(199802)105:2<241::AID-AJPA10>3.0.CO;2-0.
This study was conducted to determine whether individual bony lesions are specific for recognizing multiple myeloma and thereby distinguish it from metastatic cancer and leukemia. The lytic skeletal lesions of multiple myeloma are characterized by sharply defined, spheroid lesions. They have smooth borders and effaced/erased trabeculae. Unique spheroid myeloma lesions appear to be responsible for the "punched out" appearance of affected bone. The total absence of remodeling in myeloma forms a contrast to irregular preservation of trabeculae and buttressing, isolated "fronts of" cortical bone "resorption" coalescing to confluence, and the "golf-ball surface" phenomenon observed in metastatic cancer. The uniform effacement of both cortical and trabecular bone in multiple myeloma also contrasts with some cortical preservation in metastatic cancer. Leukemic lesions are more numerous than those of myeloma, but they lack the latter's "space-occupied" appearance. The relatively small holes and "fronts of resorption" of leukemia are quite different from the "space-occupied" lesions of multiple myeloma. Uniform size is a characteristic traditionally attributed to the bone lesions of multiple myeloma. The occurrence of isolated examples of uniform size lesions in metastatic cancer and of variable size lesions in some individuals with multiple myeloma precludes unequivocal use of size in differential diagnosis. Fortunately, the newly recognized macroscopic characteristics appear to separate multiple myeloma from metastatic cancer, and also distinguish myeloma from leukemia.
本研究旨在确定单个骨病变是否对识别多发性骨髓瘤具有特异性，从而将其与转移性癌症和白血病区分开来。多发性骨髓瘤的溶骨性骨病变的特征是边界清晰的球形病变。它们具有光滑的边界且小梁消失/被侵蚀。独特的球形骨髓瘤病变似乎是受累骨骼出现“穿凿样”外观的原因。骨髓瘤中完全没有骨重塑，这与转移性癌症中观察到的小梁不规则保留和支撑、孤立的皮质骨“吸收前沿”融合成汇合以及“高尔夫球表面”现象形成对比。多发性骨髓瘤中皮质骨和小梁骨的均匀消失也与转移性癌症中部分皮质骨保留形成对比。白血病病变比骨髓瘤病变更多，但它们缺乏骨髓瘤的“占位”外观。白血病相对较小的孔洞和“吸收前沿”与多发性骨髓瘤的“占位”病变有很大不同。大小均匀是传统上归因于多发性骨髓瘤骨病变的一个特征。转移性癌症中出现大小均匀病变的孤立例子以及一些多发性骨髓瘤患者中出现大小不一的病变，使得在鉴别诊断中明确使用大小标准变得不可能。幸运的是，新认识到的宏观特征似乎能将多发性骨髓瘤与转移性癌症区分开来，也能将骨髓瘤与白血病区分开来。
