Solitary Myeloma of Bone

The purpose of this communication is to review a series of cases of solitary myeloma of bone as recorded in the literature, with particular reference to the roentgenologic features, and to report four additional new cases. Solitary myelomatous tumors of bone are generally conceded to be of rare occurrence and the majority of those published have been in the form of single case reports. Geschickter and Copeland (18) found only five recorded in the literature in 1931. Cutler, Buschke, and Cantril (12), in 1936, reviewed 12 cases from the literature together with five others from the Registry of Bone Sarcoma of the American College of Surgeons not previously reported, and added another, a total of 18. Since their article, other cases have been described and we wish to add four more, also not previously recorded. In this connection it should be mentioned that there is a distinct group of plasma-cell tumors which seems to have a predilection for the mucous membrane of the nose and nasopharynx. These tumors have received special attention in the rhinologic and pathologic literature. Blumenfeld (4) brought the subject up to date (1935) on this particular phase of myeloma. A total of 21 cases were reviewed by him including one of his own. Histologically these tumors are identical with plasma-cell myeloma of bone but show less tendency to metastasize. The etiologic factors have not been definitely established. Most writers on the subject believe them to be true neoplasms related to malignant lymphoma and to be only a variant of multiple myeloma of the plasma-cell type. In reviewing these cases it is difficult to segregate them from myeloma originating in bone. Destruction of the bony structures adjacent to the tumor is sometimes present, and the possibility that the lesion originated in bone must be given consideration. The case of Cappell and Mathers (8) illustrates the difficulties encountered. The tumor in this patient involved the petrous pyramid and base of the skull: at postmortem examination it was the only focus found. The patient had had a chronic otorrhea for many years, and the authors were not certain whether the lesion should be classed as a myeloma of bone or as one originating from the mucous membrane of the mastoid cells. A case reported by Gross and Vaughan (19) also illustrates the same difficulty. The original lesion which occurred in the maxillary antrum and was treated surgically, recurred and a swelling developed in the region of the middle of the right tibia. Some time later this became enlarged and painful and roentgen examination showed an expansile, multilocular, cystic lesion involving the tibial shaft, very similar in appearance to others recorded in the literature. The authors cite this case as a plasma-cell myeloma and do not mention the possibility that the lesion in the antrum may have originated in the mucous membrane.