Do all lytic lesions start as a focal lesion?

[Music] do all the delusions start as a focal lesion the way to think about it is when myeloma cells are active they they they don't like to leave the bone marrow they tend to like that environment and so they start sort of dividing and taking over the bone marrow and occasionally they start making your basically nests of cells that in other cancers we call tumor here we called legions and they're inside the bone marrow and so as they grow they kind of start to distort some of the bone some of the bone around them the other thing that myeloma cells do is that they activate these things called osteoclasts in Austria a cells that resorb your bones so our bones are constantly remodeling we're making new bone and we're resorbing bone but myeloma favors the resource unit bone so as the bone gets resorbed the bones start to be weakened and so as that happens you will start actually eating into the bone and will start to appear as they punch that hole in your bone and we call those little collisions but they have to start from inside the bone marrow and then move their way out now that's different from when we have what we call extramedullary disease where myeloma cells do learn how to escape the bone marrow and they actually concede in any other tissue and they're not they're not coming out of the bone marrow or the bone per se [Music]