Dysphagia as an Unusual Presentation of Myeloma

Table 2

Possible mechanism of extramedullary spread, adapted from [9].

Mechanism	Factors involved
Decreased expression of adhesion molecules	VLA-4, CD44, P-selectin
Downregulation of chemokine receptors	CCR1, CCR2, CXCR4
Downregulation of tetraspanins expression	CD81, CD82
Increased heparanase-1 expression	Angiogenic and metastasic potential
Angiogenesis	VEGF, MMP-9, angiopoetin-1, CD31, endoglin
Activation pathway	Mutations in alternative or classical NF-kB

MMP-9: matrix metalloproteinase-9; NF-kB: nuclear factor kB; VEGF: vascular endothelial growth factor.