Résumé
The purpose of this study was to evaluate the frequency of osteolytic lesions and their pathogenesis in plasma cell myeloma [PCN]. The study was conducted in Ghurki Trust Teaching Hospital [GTTH], Combined Military Hospital, Jinnah Hospital and a Private Clinic at Lahore from January 2002 to November 2007. A total of 26 indoor male and female patients from Orthopaedic, ICU and Medical wards were included in the study. Among these patients, 18 cases reported to GTTH, 2 each from CMH Lahore and JHL respectively and 4 cases reported to a Private Clinic. Clinical parameters were further differentiated into Male n=15; 57.6%, Female; n = 11; 42.3% and mean age was 63 year. Lymphadenopathy was seen in 5 patients [n=5, 19.2%], hepatomegaly in 8 patients [n=8, 30.7%], splenomegaly in 7 [n=7, 26.9%] and bone pain in 20 patients [n=20; 76.9%]. Osteolytic bone lesions as revealed by conventional X-ray skeleton was seen in majority of patients [n=17; 65.3%]. After fulfilling the criteria for the diagnosis of Plasma cell myeloma, frequency/ prevalence of osteolytic lesions were assessed and compared with clinical and laboratory parameters. Multiple osteolytic lesions revealed, by conventional radiography, were most commonly seen in the skull, verterbrae, ribs, pelvis and proximal long bones. However, use of MRI indicates that skeletal abnormalities exist in nearly all patients with myeloma. These osteolytic lesions evolve from imbalance between osteoblasts and asteoclasts interplay with primary derangement originating in bone marrow microenvironment. The basic stimulus is interaction of malignant plasma cells with bone marrow stromal cells and the production of different cytokines and growth factors. These inflammatory factors produce proliferation and differentiation of osteoclasts, inhibition of osteoblasts and formation of osteolytic lesions. The resultant demineralisation is manifested as raised serum calcium level