- Recognise myeloma as a multisystem disease, with a heavy musculoskeletal burden - Highlight the need for review of unusual locations including the CNS - Understand that, whilst uncommon, myeloma deposits can occur anywhere in the body as solid tumours - Consolidate knowledge of the imaging findings of marrow infiltration and plasmacytoma with a view to recognising myeloma in the presence of dual pathology.

Myeloma is a disease that commonly requires input from musculoskeletal radiologists. We are usually familiar with the vertebral findings in myeloma, but confusion can arise when myeloma presents as solid tumours, plasmacytoma, outside of the skeleton – or when there is a coexistent malignancy. Plasmacytoma can arise in any compartment and the mass effect and impact on local tissues can frequently be the presenting complaint. We review several cases of atypical presentations of plasmacytoma, including intradural and epidural deposits, intramuscular and subcutaneous tumours (including bilateral...

General considerations Musculoskeletal findings in multiple myeloma (MM) typically occur in one of several patterns. The disease can be disseminated, with lesions usually affecting the axial skeleton, or focal, with a mass of plasma cells forming a plasmacytoma. The disseminated form classically has multiple lytic lesions, described as 'punched out'. It is also recognised thatdisseminated disease can alter the appearance of the bone marrow without identifiable lesions; the relative reduction of fat content within the marrow is identifiable on MRI but not specific for disease....

Myeloma is a common, heterogeneous disease that musculoskeletal radiologists will frequently encounter. Given the non-specific nature of atypical presentations and patients with comorbidities, we have presented several cases where the diagnosis could be unclear and have given tips to improve the chances of successful and prompt patient management. The fundamental lesson is to always suspect distant disease in a patient with myeloma, and to tailor a comprehensive imaging strategy to assess this.

Wallington M, Mendis S, Premawardhana U, Sanders P, Shahsavar-Haghighi K. Local control and survival in spinal cord compression from lymphoma and myeloma. Radiother Oncol. 1997;42:43–47. Gedam BS, Soni N, Sadriwala QS, Kale VB, Bansod PY (2017) A rare case of male breast plasmacytoma. JSM Gen Surg Cases Images. 2(4): 1039 Dores GM, Landgren O, McGlynn KA, Curtis RE, Linet MS, Devesa SS. Plasmacytoma of bone, extramedullary plasmacytoma, and multiple myeloma: Incidence and survival in the United States, 1992−2004.Br J Haematol. 2009;144(1):86-94. Wu X-N, Zhao X-Y,...

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