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Solitary Myeloma: Review of Sixty-one Cases

1945; Radiological Society of North America; Volume: 45; Issue: 4 Linguagem: Inglês

10.1148/45.4.385

1527-1315

Lester T. Gootnick,

Cancer Treatment and Pharmacology

The Treatment and prognosis of multiple myeloma are usually regarded as extremely discouraging. In recent years, however, numerous reports have appeared of solitary myeloma and in many of these cases x-ray therapy, judiciously carried out, delayed the progress of the disease, produced relief of symptoms, and prolonged life. Among 24 cases of myeloma seen in the University of Chicago Clinics, 2 examples of solitary lesions have been observed, both of which responded excellently to x-ray therapy. Case Reports Case I: T. O., a machinist aged 48 years, was seen on May 14, 1941, complaining of persistent pain in the right hip, following an injury six months previously. The pain was dull, aching in nature, more severe on exercise, and accompanied by a slight limp. The history was otherwise irrelevant. The patient was well nourished and robust, with tenderness in the right hip on all extremes of motion but no other abnormal physical findings. The red blood cell count was 4,700,000; hemoglobin 13.0 gm.; white cell count 8,000. The specific gravity of the urine was 1.028; it contained no albumin or sugar, no casts or red blood cells. No test was made initially for Bence-Jones protein. The Wassermann reaction was negative. X-ray examination of the right hip disclosed a large multiloculated expansile lesion of reduced density involving the greater portion of the ilium adjacent to the acetabulum and of the ischium (Fig. 1). The margins of the lesion were sharply defined and the overlying cortex was irregularly thinned. On May 21, 1941, a biopsy was performed. In the region about the spine of the ischium along the posterior wall, the bone was eroded by a soft, grayish-red tissue. This was curetted out. Microscopic examination showed densely packed round cells with dark, round, eccentrically placed nuclei at the periphery of which chromatin was distributed in cart-wheel pattern. A diagnosis of plasma-cell myeloma was made. The urine was then tested for the presence of Bence-Jones protein and none was found. Plasma proteins were 7.04 gm. per cent with A/G = 3.85/3.19 = 1.20. On June 7, 1941, x-ray therapy was begun. The patient received treatments of 300 r in air to each of three portals at 200 kv., 20 ma. A total of 2,500 r to each of three portals was given in three weeks. Following these treatments the patient experienced marked relief of pain and subsequently returned to work. On Sept. 12, 1941, the patient was again seen, complaining of occasional pain in the right hip. The x-ray appearance of the lesion was unchanged. A second series of roentgen treatments was then given, for a total dose of 2,500 r to each of three portals. From that time until Jan. 30, 1945, four years and three months after the onset of symptoms, there had been no progression of the disease as seen by x-ray examination. The only noteworthy change was progressive collapse and flattening of the head of the right femur due to necrosis produced by the radiation.