A 55-year-old woman presents with pathological fracture through a lytic lesion in the proximal femur. Biopsy shows sheets of plasma cells. Serum protein electrophoresis shows an M-spike. Skeletal survey reveals multiple 'punched-out' lesions. This bone tumour is classified as:
- A Multiple myeloma — a haematological malignancy, not a primary bone tumour; managed with systemic therapy plus orthopaedic stabilisation of pathological fractures ✓
- B Primary bone tumour — treated with limb-salvage surgery alone
- C Metastatic bone disease from breast carcinoma
- D Ewing's sarcoma
Correct answer: A. Multiple myeloma — a haematological malignancy, not a primary bone tumour; managed with systemic therapy plus orthopaedic stabilisation of pathological fractures
Explanation
Multiple myeloma is the most common primary malignancy of bone in adults (>40 years), but is technically a haematological malignancy (plasma cell dyscrasia) rather than a primary bone tumour. Skeletal lesions are lytic ('punched-out') due to osteoclast activation by RANK-L and other cytokines. Pathological fractures through weight-bearing long bones require orthopaedic stabilisation (intramedullary nail for femoral shaft lesions) followed by systemic therapy (bortezomib-based regimens, autologous stem cell transplant). Biphosphonates reduce skeletal-related events.
Reference: Maheshwari Essential Orthopaedics, 6th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.