8 Hematological Diseases
Plasmocytoma
Definition
Malignant tumor with both multiple and solitary skeletal involvement, characterized by round plasma cell-related cells of different degrees of immaturity, including atypical shapes.
Generalized Plasmocytoma (Multiple Myeloma, Kahler Disease)
Pathology
Diffuse osseous involvement leads to destruction of the spongiosa, producing osteolytic lesion through confluence of initially small defects; later also cortical destruction.
Clinical Findings
Anemia
Weight loss
Bone pain
Diagnostic Evaluation
(→ Primary method of choice)
Recommended views
Humerus in two projections
Low KV technique for high-contrast visualization
Findings
Generalized osteoporosis
Osteolytic lesions, usually well-defined and about of equal size
Punched-out cortical defects without periosteal reaction (Fig. 8.1)
(→ Supplementary method)
Recommended protocol
Axial
Section thickness: 2 mm
High-resolution technique
Findings
Coarse bone structure
Visualization of small osteolytic lesions that are not yet detectable radiographically
(→ Supplementary method)
Recommended section
Coronal
Recommended sequences
T1-weighted spin-echo (SE)
Findings
Patchy hypointensity
Goals of Imaging
Determination of decreased bone-mineral density
Visualization of osteolytic lesions or bone destruction
Visualization of extraosseous tumor component
Fig. 8.1 
Generalized plasmocytoma
A | Well-defined osteolytic lesions, ranging in size from a few millimeters to several centimeters but all about the same size in the individual patient. |
B | Punched-out cortical defects without periosteal reaction or accompanying soft-tissue changes. |
Disseminated, Nonosteolytic Myelomatosis (Diffusely Demineralizing Myelomatosis)
Pathology
Generalized bone-marrow involvement
Thinned and rarefied spongiosa
Clinical Findings
Anemia
Diffuse bone pain
Diagnostic Evaluation
(→ Method of choice)
Recommended views
Shoulder in two planes
Findings
Diffuse osteoporosis
Indistinguishable from osteoporosis of other causes
Therapeutic Principles
Solitary: Radiation
Diffuse: Plasmocytoma-directed chemotherapy, possible osteoclastic inhibitor, such as bisphosphonate and calcitonin
Solitary Plasmocytoma (Solitary Myeloma)
Pathology
Plasmocytoma confined to a single lesion
Large osteolytic lesion caused by stimulated osteoclasts
Clinical Findings
Pain
Swelling
Possibly spontaneous fracture
Diagnostic Evaluation
(→ Primary method of choice)
Recommended views
Anteroposterior (AP) view of the shoulder and proximal humerus
Axial view of the shoulder and proximal humerus
Findings (Fig. 8.2)
Sharply demarcated osteolytic defect
Cortical destruction
Expansion of the bone due to neocortex
No calcifications within the tumor
(→ Supplementary method)
Recommended protocol
Standard axial sections
Possibly coronal reconstruction
Findings
Osteolytic tumor
Neocortex
Tumor breakthrough with paraosseous component
(→ Supplementary method)
Recommended sections
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