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Answer 3
  1. Neither myeloma nor MGUS. Although the patient has a lytic lesion showing plasma cells and a monoclonal serum spike, there is no evidence of multiple lesions and the bone marrow is normal. As a result, this patient does not meet the criteria for myeloma. The lytic lesion with a pathologic fracture is incompatible with MGUS. The diagnosis for the case patient is solitary plasmacytoma of bone. Unfortunately, even when the work-up for myeloma is negative, approximately 70% of patients with “solitary plasmacytoma of bone” eventually prove to have multiple myeloma when followed over time. In contrast, the majority of patients with solitary soft tissue plasmacytoma (eg, involving the nasopharynx) do not progress to myeloma and may be cured by local radiation therapy.

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