As defined in Cecil's text,1 multiple myeloma is a malignant plasmacytoma arising in the bone marrow which tends to occur in persons after the fifth decade. It is usually characterized by pain in the back and weakness, destructive osseous lesions involving especially the bones of the trunk, pathologic fractures, a normocytic anemia of moderate degree, and the presence, in many cases, of a peculiar type of protein (Bence Jones) in the urine. The condition is observed twice as commonly in men as in women. Almost all cases occur after the age of 40 years. Pain of a vague intermittent shifting type, often referable to the spine, is commonly the earliest evidence of the disease.
Anemia is moderate in degree, as a rule, and normocytic, but sometimes it is severe and macrocytic. The leucocyte count may be normal, slightly increased, or low. Myeloma (plasma) cells like those
WITKOV HR. Multiple Myeloma with Granuloma of the Leg. AMA Arch Derm. 1956;74(5):484–486. doi:10.1001/archderm.1956.01550110028008
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