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mansouri H, elouaouch S, el youssi Z, guerrouaz MA, moukhlissi M, berhili S, mezouar L. Solitary plasmacytoma of the skull base: A case report and literature review. Radiol Case Rep 2023; 18:3894-3898. [PMID: 37670923 PMCID: PMC10475402 DOI: 10.1016/j.radcr.2023.08.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2023] [Revised: 06/18/2023] [Accepted: 08/04/2023] [Indexed: 09/07/2023] Open
Abstract
Plasmacytoma of the skull base is a rare entity. We present a case of sphenoid plasmacytoma in a 51-year-old woman who had nasal obstruction, intermittent epistaxis, headaches, decreasing visual acuity, and diplopia. Computed Tomography (CT) scan and magnetic resonance imaging (MRI) showed a large heterogeneous, expansile lesion measuring 75 mm × 54 mm, centered on the sphenoidal bone and the clivus. Biopsy confirmed the diagnosis of solitary plasmacytoma after ruling out systemic spread by the initial assessment. The patient was successfully managed by external beam radiotherapy and a complete response was obtained after 12 months of follow-up.
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Affiliation(s)
- Hanane mansouri
- Faculty of Medicine, Mohammed First University, Oujda, 60000, Morocco
- Department of Radiotherapy, Hassan II Oncology Center, Mohammed VI University Hospital Center, Oujda, 60000, Morocco
| | - Sofia elouaouch
- Faculty of Medicine, Mohammed First University, Oujda, 60000, Morocco
- Department of Radiotherapy, Hassan II Oncology Center, Mohammed VI University Hospital Center, Oujda, 60000, Morocco
| | - Zahira el youssi
- Faculty of Medicine, Mohammed First University, Oujda, 60000, Morocco
- Department of Radiotherapy, Hassan II Oncology Center, Mohammed VI University Hospital Center, Oujda, 60000, Morocco
| | - Mohammed Amine guerrouaz
- Faculty of Medicine, Mohammed First University, Oujda, 60000, Morocco
- Department of Radiotherapy, Hassan II Oncology Center, Mohammed VI University Hospital Center, Oujda, 60000, Morocco
| | - Mohamed moukhlissi
- Faculty of Medicine, Mohammed First University, Oujda, 60000, Morocco
- Department of Radiotherapy, Hassan II Oncology Center, Mohammed VI University Hospital Center, Oujda, 60000, Morocco
| | - Soufiane berhili
- Faculty of Medicine, Mohammed First University, Oujda, 60000, Morocco
- Department of Radiotherapy, Hassan II Oncology Center, Mohammed VI University Hospital Center, Oujda, 60000, Morocco
| | - Loubna mezouar
- Faculty of Medicine, Mohammed First University, Oujda, 60000, Morocco
- Department of Radiotherapy, Hassan II Oncology Center, Mohammed VI University Hospital Center, Oujda, 60000, Morocco
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Aloui A, Kacem MS, Bahroun S, Jhimi A, Bouaziz A, Daghfous MS. Solitary plasmocytoma of the thoracic spine: A case report. Int J Surg Case Rep 2023; 111:108799. [PMID: 37738828 PMCID: PMC10518447 DOI: 10.1016/j.ijscr.2023.108799] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/05/2023] [Accepted: 09/05/2023] [Indexed: 09/24/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Solitary spinal plasmacytoma (SSP) is an uncommon neoplasm originating from bone marrow plasma cells. Although infrequent in the thoracic region, it has the potential to induce substantial damage. In this study, we present the case of a patient with thoracic spine SSP treated through surgical intervention. CASE PRESENTATION We report the case of a 38-year-old female who presented with progressive mid-back pain, numbness, weakness in both lower limbs and gait disturbance. Imaging showed an osteolytic lesion with vertebral collapse of T11. MRI was strongly suggestive of solitary plasmocytoma. Hematologic tests were normal. Surgery was carried out. At the first stage, a posterior approach with laminectomy and fixation were performed. Biopsy of tumor cells confirmed the diagnosis of SSP. At the second stage, a trans-thoracic approach was performed, the tumor was resected in a single block and anterior interbody fusion was done. After the surgery the patient fully recovered from the paraparesis and at two years follow up no recurrence of tumor cells was detected. CLINICAL DISCUSSION Spinal malignant bone tumors are rare, with solitary plasmacytoma being the most common. Diagnosis of SSP is based on bone biopsy findings. MRI and CT scans assess tumor extent and spinal stability. Prognosis relates to the likelihood of progressing into multiple myeloma. Though radiotherapy is common, surgery offers local control, especially for instability and neurological issues. CONCLUSION SSP in the thoracic spine is a rare condition that requires a multidisciplinary approach and a prompt treatment.
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Affiliation(s)
- Ala Aloui
- Mohamed Kassab national Institute of orthopaedics, Workers Street, Ksar Saïd, Manouba 2010, Tunisia.
| | - Mohamed Samih Kacem
- Mohamed Kassab national Institute of orthopaedics, Workers Street, Ksar Saïd, Manouba 2010, Tunisia
| | - Sami Bahroun
- Mohamed Kassab national Institute of orthopaedics, Workers Street, Ksar Saïd, Manouba 2010, Tunisia
| | - Ali Jhimi
- Mohamed Kassab national Institute of orthopaedics, Workers Street, Ksar Saïd, Manouba 2010, Tunisia
| | - Anis Bouaziz
- Mohamed Kassab national Institute of orthopaedics, Workers Street, Ksar Saïd, Manouba 2010, Tunisia
| | - Mohamed Samir Daghfous
- Mohamed Kassab national Institute of orthopaedics, Workers Street, Ksar Saïd, Manouba 2010, Tunisia
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Albano D, Tomasini D, Bonù M, Giubbini R, Bertagna F. 18F-FDG PET or PET/CT role in plasmacytoma: A systemicatic review. Rev Esp Med Nucl Imagen Mol 2020. [DOI: 10.1016/j.remnie.2019.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Albano D, Tomasini D, Bonù M, Giubbini R, Bertagna F. 18F-FDG PET or PET/CT role in plasmacytoma: A systematic review. Rev Esp Med Nucl Imagen Mol 2020; 39:220-224. [PMID: 32522411 DOI: 10.1016/j.remn.2019.12.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Revised: 12/04/2019] [Accepted: 12/12/2019] [Indexed: 01/03/2023]
Abstract
BACKGROUND The metabolic behavior of plasmacytoma at 18F-FDG PET/CT is not yet clear. OBJECTIVE The aim of this systematic review was to analyze published data about the role of 18F-FDG PET or PET/CT in patients affected by plasmacytoma. METHODS Acomprehensive computer literature search of the Scopus, PubMed/MEDLINE, Embase and Cochrane Library databases was conducted including articles up to July 2019 to find relevant published papers about the performance of 18F-FDG PET and PET/CT in plasmacytoma. RESULTS The comprehensive computer literature search revealed 371 articles. On reviewing the titles and abstracts, 363 articles were excluded because the reported data were not within the field of interest of this review. Eight articles were selected and retrieved in full-text version. From the analyses of the selected studies, the following main findings have been founded: 1) plasmacytoma generally is a 18F-FDG-avid tumor and PET/CT had good diagnostic performance with high sensitivity; 2) 18F-FDG PET/CT influenced patient management in most cases avoiding useless therapies and choosing the best therapeutic approach; 3) prognostic value of PET/CT qualitative and semiquantitative parameters is only suggested with controversial reports. CONCLUSION Despite several limitations affect this analysis, especially related to the low number of articles and patients studied, plasmacytoma looks to be an 18F-FDG-avid tumor in most of the cases; 18F-FDG PET or PET/CT had good diagnostic performance and had a significant clinical impact in change of therapeutic approach. Moreover, a possible prognostic role of PET/CT features is described.
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Affiliation(s)
- D Albano
- Nuclear Medicine, University of Brescia and Spedali Civili, Brescia, Italia.
| | - D Tomasini
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italia
| | - M Bonù
- Department of Radiation Oncology, University of Brescia and Spedali Civili, Brescia, Italia
| | - R Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili, Brescia, Italia
| | - F Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili, Brescia, Italia
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Plasmocytome solitaire osseux : expérience du service de radiothérapie de l’hôpital militaire d’instruction Mohammed-V de Rabat (Maroc). Cancer Radiother 2019; 23:867-873. [DOI: 10.1016/j.canrad.2019.06.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/15/2019] [Accepted: 06/18/2019] [Indexed: 11/22/2022]
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Stojanović N, Kostić A, Mitić R, Radisavljević M, Berilažić L. TOTAL SURGICAL RESECTION OF SOLITARY BONE PLASMACYTOMA OF THE SPINAL COLUMN. ACTA MEDICA MEDIANAE 2019. [DOI: 10.5633/amm.2019.0321] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Dagrosa AT, Cowdrey MCE, LeBlanc RE, Lansigan F, Kaur P, Carter JB. Adenopathy and extensive skin patch overlying a plasmacytoma with unusual histologic findings in a patient with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes syndrome and Castleman disease. J Cutan Pathol 2019; 46:784-789. [DOI: 10.1111/cup.13514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Alicia T. Dagrosa
- Department of Surgery, Section of DermatologyDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Molly C. E. Cowdrey
- Department of DermatologyLahey Hospital & Medical Center Burlington Massachusetts
| | - Robert E. LeBlanc
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Frederick Lansigan
- Section of Hematology/OncologyDartmouth‐Hitchcock Norris Cotton Cancer Center Lebanon New Hampshire
| | - Prabhjot Kaur
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Joi B. Carter
- Department of Surgery, Section of DermatologyDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
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Rahim Y, Tareen FZ, Ahmed R, Khan JA. Primary pulmonary plasmacytoma presenting with rare IgG lambda monoclonal gammopathy. BMJ Case Rep 2019; 12:12/3/e227514. [PMID: 30846451 PMCID: PMC6424279 DOI: 10.1136/bcr-2018-227514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Extramedullaryplasmacytoma (EMP) represents a peculiar and typically progressive malignancy that can originate outside the bone marrow. Primary pulmonary plasmacytoma (PPP) is a rare subset of EMP, confined to the lung. A 55-year-old man, diabetic, non-smoker presented to our clinic with a right chest wall swelling. A routine chest radiograph showed a well-circumscribed opacity in the right upper lung zone. A CT of the chest revealed a large right upper lobe mass with extensive local infiltration. Biopsy and immunohistochemical evaluation led to a diagnosis of PPP. Screening for multiple myeloma was negative. Serum immunofixation showed an IgG lambda monoclonal gammopathy, found in a minority of PPP patients. In view of disease extent, treatment with chemotherapy and radiotherapy was initiated. The patient is currently in out patient follow-up and has shown a favourable response to the treatment with a considerable decrease in serum IgG levels.
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Affiliation(s)
- Yasmin Rahim
- Department of Pulmonology and Critical Care, Aga Khan University, Karachi, Pakistan
| | - Farrukh Zia Tareen
- Department of Hematology and Oncology, Aga Khan University, Karachi, Pakistan
| | - Rashida Ahmed
- Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan
| | - Javaid Ahmed Khan
- Department of Pulmonary Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Abstract
Primary malignant tumors of the spine are rare and mainly include chordoma, chondrosarcoma, Ewing sarcoma or primitive neuroectodermal tumor, and osteosarcoma. The final diagnosis is based on the combination of patient age, topographic and histologic features of the tumor, and lesion pattern on computed tomography (CT) and magnetic resonance (MR) imaging. Imaging evaluation includes radiography, CT, bone scintigraphy, and MR imaging. CT is more useful than radiography for evaluating location of the lesion and analyzing bone destruction and matrix, whereas MR has unmatched ability to assess soft tissue extension. This pictorial review provides an overview of the most prevalent primitive malignant tumors of spine.
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Wang SSY, Lee MB, George A, Wang SB, Blackwell J, Moran S, Francis IC. Five cases of orbital extramedullary plasmacytoma: diagnosis and management of an aggressive malignancy. Orbit 2018; 38:218-225. [PMID: 29985709 DOI: 10.1080/01676830.2018.1490437] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Purpose: Multiple myeloma is an insidious haematological malignancy characterised by monoclonal proliferation of plasma cells in the bone marrow. Extramedullary plasmacytoma is a rare manifestation of multiple myeloma and usually occurs in the upper respiratory tract. Orbital involvement is particularly uncommon, but may be associated with devastating visual impairment and poor clinical outcomes. Therefore, this article aims to highlight the need for multidisciplinary management of orbital extramedullary plasmacytoma. Methods: This is a retrospective observational case series of five patients. All presented to the authors for management of orbital extramedullary plasmacytomas from 2004 to 2015 at Prince of Wales and Mater Hospitals in Sydney, Australia. Medical records were reviewed for pertinent information including demographics, disease features, management strategy, and clinical progress. The study met Medical Ethics Board standards and is in accordance with the Helsinki Agreements. Results: This case series of five patients underscores the poor prognosis of orbital extramedullary plasmacytoma. Despite aggressive multidisciplinary management, four of these five patients succumbed to their illness during the study period. However, multidisciplinary management did manage to minimise symptoms and preserve quality of life. Conclusions: On a case-by-case basis, patients may derive palliative benefit from orbital surgery in conjunction with radiotherapy and chemotherapy. Orbital surgeons are encouraged to work within a multidisciplinary framework of medical specialists, including haematologists and radiation oncologists, when determining the optimal management plan in cases of orbital extramedullary plasmacytoma.
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Affiliation(s)
- Samuel S Y Wang
- a Faculty of Medicine , University of New South Wales , Sydney, Australia
| | - Mitchell B Lee
- b Sydney Medical School , University of Sydney , Sydney, Australia
| | - Adarsh George
- a Faculty of Medicine , University of New South Wales , Sydney, Australia
| | - Sarah B Wang
- b Sydney Medical School , University of Sydney , Sydney, Australia
| | | | - Steve Moran
- c Department of Haematology , Mater Hospital , Sydney , Australia
| | - Ian C Francis
- a Faculty of Medicine , University of New South Wales , Sydney, Australia.,d Department of Ophthalmology , Prince of Wales Hospital , Sydney , Australia
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Lombardi C, Calvi A, Bonera E, Savio A, Savio E. Bilateral Breast Involvement in A 71-Year-Old White Man with Lambda Light Chain Disease. Regression after A new Chemotherapy Combination. A Case Report. TUMORI JOURNAL 2018; 78:35-6. [PMID: 1609457 DOI: 10.1177/030089169207800108] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
A rare case of lambda light chain disease with bilateral breast involvement is described. A complete regression after a new chemotherapy combination (peptichemio + teniposide + dexa-methasone) was obtained. A previous treatment with prednisone + melphalan was ineffective.
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Affiliation(s)
- C Lombardi
- Dept. of Internal Medicine, S. Orsola Hospital, Brescia, Italy
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Guida M, Casamassima A, Abbate I, Paradiso A, Zito A, Marzullo F, Lorusso V, Timurian A, Cramarossa A, De Lena M. Solitary Plasmacytoma of Bone and Extramedullary Plasmacytoma: Two Different Nosological Entities? TUMORI JOURNAL 2018; 80:370-7. [PMID: 7839469 DOI: 10.1177/030089169408000512] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background The relationship between solitary plasmacytoma and multiple myeloma is still unclear, but they can be distinguished by their different clinical course. Indicators of disease activity and extension, and of a possible evolution to multiple myeloma, have not been identified as yet. Methods Two cases of solitary plasmacytoma are described: one of the mandible and one extramedullary plasmacytoma (EMP) of the rhinopharynx. Pathologic data included immunohistochemical staining for heavy and light Ig chains, and for the proliferating cell nuclear antigen (PCNA). Analysis of the peripheral immunological status and serum parameters ( β2 microglobulin, thymidine kinase, IL-2, IL-6 and soluble IL-2 receptor) was performed and correlation was made with the clinical status. Flow cytometry analysis of nuclear DNA content and S-phase cell fraction were also studied in both neoplasms. Results Solitary plasmacytoma of bone (SPB) showed important basal immunologic alterations and a marked increase in all serum parameters considered with respect to EMP. Ploidy analysis demonstrated an almost complete aneuploidy cell population for the SPB patient (80%), whereas in the EMP patient only 2% of the cells were aneuploid. The S-phase ceils were 16% and 4%, respectively. PCNA index was 60% in SPB and 10% in EMP. Conclusions Solitary plasmacytoma of the bone appeared to be a more aggressive form of plasmacellular neoplasia, distinct from EMP and similar to multiple myeloma. The study of serum parameters, together with analysis of PCNA, ploidy and S-phase fraction, can aid in better understanding disease activity, and in the choice of more adequate treatment. Moreover, serial analysis of some serum factors might be useful markers for monitoring the disease.
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Affiliation(s)
- M Guida
- Medical Oncology Division, Oncology Institute, Bari, Italy
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Bacci G, Savini R, Calderoni P, Gnudi S, Minutillo A, Picci P. Solitary Plasmacytoma of the Vertebral Column. A Report of 15 Cases. TUMORI JOURNAL 2018; 68:271-5. [PMID: 7135492 DOI: 10.1177/030089168206800313] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The clinical features and the treatment results of 15 patients with solitary plasmacytoma of the spine observed in a 28-year period (1950–1977) are reported. The signs at presentation were back pain in 4 cases and spinal cord compression in 11 cases. Three of these patients had paraplegia. Radiologically, the alteration encountered was an osteolytic lesion in all cases. The local treatment was radiotherapy in 11 cases and surgery plus radiotherapy in 4 cases. In 3 patients systemic chemotherapy was also employed. Seven patients are alive without signs of disease 3 to 9 years (mean 6 years) after diagnosis. Eight patients developed multiple myeloma in a period ranging from 1 to 8 years (mean 3.5 years). The relationship between multiple myeloma and solitary plasmacytoma of the spine, as well as the best treatment for the latter, are discussed.
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Albano D, Bosio G, Treglia G, Giubbini R, Bertagna F. 18F-FDG PET/CT in solitary plasmacytoma: metabolic behavior and progression to multiple myeloma. Eur J Nucl Med Mol Imaging 2017; 45:77-84. [PMID: 28822997 DOI: 10.1007/s00259-017-3810-5] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2017] [Accepted: 08/10/2017] [Indexed: 01/04/2023]
Abstract
PURPOSE Solitary plasmacytoma (SP) is a rare plasma-cell neoplasm, which can develop both in skeletal and/or soft tissue and frequently progresses to multiple myeloma (MM). Our aim was to study the metabolic behavior of SP and the role of 18F-FDG-PET/CT in predicting progression to MM. MATERIALS AND METHODS Sixty-two patients with SP who underwent 18F-FDG-PET/CT before any treatment were included. PET images were qualitatively and semiquantitatively analyzed by measuring the maximum standardized uptake value body weight (SUVbw), lean body mass (SUVlbm), body surface area (SUVbsa), metabolic tumor volume (MTV), total lesion glycolysis (TLG) and compared with age, sex, site of primary disease, and tumor size. RESULTS Fifty-one patients had positive 18F-FDG-PET/CT (average SUVbw was 8.3 ± 4.7; SUVlbm 5.8 ± 2.6; SUVbsa 2 ± 1; MTV 45.4 ± 37; TLG 227 ± 114); the remaining 11 were not 18F-FDG-avid. Tumor size was significantly higher in patients avid lesions compared to FDG not avid; no other features are associated with FDG-avidity. Progression to MM occurred in 29 patients with an average of 18.3 months; MM was more likely to develop in patients with bone plasmacytoma and in patients with 18F-FDG avid lesion. Time to transformation in MM (TTMM) was significantly shorter in patients with osseous SP, in 18F-FDG avid lesion, for SUVlbm > 5.2 and SUVbsa > 1.7. CONCLUSIONS 18F-FDG pathological uptake in SP occurred in most cases, being independently associated with tumor size. PET/CT seemed to be correlated to a higher risk of transformation in MM, in particular for 18F-FDG avid plasmacytoma and SBP. Among semiquantitative features, SUVlbm > 5.2 and SUVbsa > 1.7 were significantly correlated with TTMM.
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Affiliation(s)
- Domenico Albano
- Nuclear Medicine, Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy.
| | - Giovanni Bosio
- Nuclear Medicine, Spedali Civili di Brescia, P.le Spedali Civili 1, 25123, Brescia, Italy
| | - Giorgio Treglia
- Department of Nuclear Medicine and PET/CT Center, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland
| | - Raffaele Giubbini
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
| | - Francesco Bertagna
- Nuclear Medicine, University of Brescia and Spedali Civili Brescia, Brescia, Italy
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McCoy JM, Oreadi D. Diagnosis and Management of Pathological Conditions. J Oral Maxillofac Surg 2017; 75:e224-e263. [DOI: 10.1016/j.joms.2017.04.024] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
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Thumallapally N, Meshref A, Mousa M, Terjanian T. Solitary plasmacytoma: population-based analysis of survival trends and effect of various treatment modalities in the USA. BMC Cancer 2017; 17:13. [PMID: 28056880 PMCID: PMC5216567 DOI: 10.1186/s12885-016-3015-5] [Citation(s) in RCA: 65] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 12/16/2016] [Indexed: 01/11/2023] Open
Abstract
Background Solitary plasmacytoma (SP) is a localized neoplastic plasma cell disorder with an annual incidence of less than 450 cases. Given the rarity of this disorder, it is difficult to conduct large-scale population studies. Consequently, very limited information on the disorder is available, making it difficult to estimate the incidence and survival rates. Furthermore, limited information is available on the efficacy of various treatment modalities in relation to primary tumor sites. Methods The data for this retrospective study were drawn from the Surveillance, Epidemiology and End Results (SEER) database, which comprises 18 registries; patient demographics, treatment modalities and survival rates were obtained for those diagnosed with SP from 1998 to 2007. Various prognostic factors were analyzed via Kaplan-Meier analysis and log-rank test, with 5-year relative survival rate defined as the primary outcome of interest. Cox regression analysis was employed in the multivariate analysis. Results The SEER search from 1998 to 2007 yielded records for 1691 SP patients. The median age at diagnosis was 63 years. The patient cohort was 62.4% male, 37.6% female, 80% Caucasian, 14.6% African American and 5.4% other races. Additionally, 57.8% had osseous plasmacytoma, and 31.9% had extraosseous involvement. Unspecified plasmacytoma was noted in 10.2% of patients. The most common treatment modalities were radiotherapy (RT) (48.8%), followed by combination surgery with RT (21.2%) and surgery alone (11.6%). Univariate analysis of prognostic factors revealed that the survival outcomes were better for younger male patients who received RT with surgery (p < 0.05). Additionally, patients who received neoadjuvant RT had increased survival rates compared to those receiving adjuvant RT (86% vs 73%, p < 0.05). Furthermore, the analyses revealed that 5-year survival rates for patients with axial plasmacytoma were superior when RT was combined with surgery (p < 0.05). In the multivariate analysis, age <60 years and treatment with either RT or surgery showed superior survival rates. Progression to multiple myeloma (MM) was noted in 551 patients. Age >60 years was associated with a lower 5-year survival in patients who progressed to MM compared to those who were diagnosed initially with MM (15.1 vs 16.6%). Finally, those who received RT and progressed to MM still had a higher chance of survival than those who were diagnosed with MM initially and treated with RT/surgery (21.8% vs 15.9%, p < 0.05). Conclusions A review of the pertinent literature indicates that we provided the most comprehensive population-based analysis of SP to date. Moreover, our study contributes to the establishment of the optimal SP treatment modality, as RT is the favored option in frontline settings. Consensus is currently lacking regarding the benefits of combined treatment including surgery. Thus, the findings reported here elucidate the role of primary treatment modalities while also demonstrating the quantifiable benefits of combining RT with surgery in relation to different primary tumor sites. While our results are promising, they should be confirmed through further large-scale randomized studies. Electronic supplementary material The online version of this article (doi:10.1186/s12885-016-3015-5) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nishitha Thumallapally
- Department of Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, NY, 10305, USA.
| | - Ahmed Meshref
- Department of Medicine, Suez Canal University, Ismailia, Egypt
| | - Mohammed Mousa
- Department of Medicine, Suez Canal University, Ismailia, Egypt
| | - Terenig Terjanian
- Department of Hematology/oncology, Staten Island University Hospital, Staten Island, NY, USA
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C2 Solitary Bone Plasmacytoma Curettage and Vertebral Augmentation in an 83-Year-Old Female: Case Report and Review of Surgical Treatment Approaches in the Spine. Case Rep Orthop 2017; 2017:5692402. [PMID: 29391960 PMCID: PMC5748137 DOI: 10.1155/2017/5692402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2017] [Accepted: 11/01/2017] [Indexed: 11/25/2022] Open
Abstract
Surgically, solitary bone plasmacytoma (SBP) of the craniocervical junction (CCJ) is typically treated with cement augmentation and occipital-cervical stabilization (OCS). In the orthopedic spine literature, various surgical treatment options have been described for SBP, but only a few studies exist describing SBP of the CCJ with treatment involving cement augmentation alone. We report the case of an 83-year-old female found to have C2 SBP that was successfully treated with curettage and cement augmentation alone.
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Has Şimşek D, Kuyumcu S, Bilgiç B, Işık EG, Türkmen C, Adalet I. An Incidental Solitary Plasmacytoma of Bone Mimicking Neuroendocrine Tumor Metastasis on 68Ga-DOTATATE Positron Emission Tomography/Computed Tomography. Mol Imaging Radionucl Ther 2016; 25:147-149. [PMID: 27751979 PMCID: PMC5100088 DOI: 10.4274/mirt.93064] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
A 54-year-old woman with suspicion of neuroendocrine tumor (NET) was referred for 68Ga-DOTATATE positron emission tomography/computed tomography (CT) imaging due to clinical findings. A well-defined osteolytic lesion on the corpus of the third lumbar vertebra was evident on CT images with mild uptake of 68Ga-DOTATATE, which led to suspicion of NET metastasis. Histopathologic examination revealed solitary plasmacytoma of the bone. The patient received local external radiotherapy for plasmacytoma. This case indicatesthat other diseases expressing somatostatin receptors may be inaccurately reported as tumor recurrence and highlights the importance of meticulous evaluation of positive findings.
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Affiliation(s)
- Duygu Has Şimşek
- Tokat State Hospital, Clinic of Nuclear Medicine, Tokat, Turkey, Phone: +90 356 214 54 00 E-mail:
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19
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Sariya DR, Jambhekar NA, Srinivas V, Advani SH, Dinshaw KA. A Clinicopathologic Study of Solitary Myeloma. Int J Surg Pathol 2016. [DOI: 10.1177/106689699900700407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A retrospective clinicopathologic review of 17 solitary myelomas (SMs) including 13 osseous (solitary plasmacytomas of bone [SPB]) and four extraosseous (extramedullary plasmacytomas [EMP]) tumors in 14 male and three female patients was undertaken. The average age of patients with SPB and EMP was 47.2 years and 48.75 years, respectively, and the most common site was the spine and the head and neck, respectively. The possible utility of histologic and cytologic characteristics of the tumor cells to predict evolution to multiple myeloma (MM) was studied. Follow-up was 63 months (SPB) and 107 months (EMP). No consistent cytohistologic features emerged in patients ultimately evolving either into MM (three patients) or developing recurrences (two patients). Thus, although the correct recognition of SM, as distinct from MM, has clinical relevance, morphology does not help further prognostication.
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Affiliation(s)
| | | | - V. Srinivas
- Department of Pathology, Tata Memorial Hospital, Parel, Mumbai
| | - S. H. Advani
- Departments of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai
| | - K. A. Dinshaw
- Departments of Radiation Oncology, Tata Memorial Hospital, Parel, Mumbai
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20
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Amini B, Yellapragada S, Shah S, Rohren E, Vikram R. State-of-the-Art Imaging and Staging of Plasma Cell Dyscrasias. Radiol Clin North Am 2016; 54:581-96. [PMID: 27153790 DOI: 10.1016/j.rcl.2015.12.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Monoclonal gammopathy of unknown significance (MGUS) is a clinically asymptomatic premalignant clonal plasma cell or lymphoplasmacytic proliferative disorder. Smoldering multiple myeloma, also called asymptomatic multiple myeloma, is an intermediate stage between MGUS and symptomatic multiple myeloma. As the name implies, extraosseous or extramedullary myeloma refers to the presence of myeloma deposits outside the skeletal system. Waldenström macroglobulinemia is a distinct subtype of plasma cell dyscrasia characterized by lymphoplasmacytic lymphoma in the bone marrow with an associated IgM monoclonal gammopathy. Amyloidosis is a condition characterized by extracellular deposition of fibrils composed of a variety of normal serum proteins.
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Affiliation(s)
- Behrang Amini
- Musculoskeletal Imaging, Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Sarvari Yellapragada
- Hematology & Oncology, Medicine, Michael E DeBakey VA Medical Center, Baylor College of Medicine, 2002 Holcombe Boulevard, Houston, TX 77030, USA
| | - Shetal Shah
- Diagnostic Radiology, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Eric Rohren
- Nuclear Medicine, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA
| | - Raghunandan Vikram
- Abdominal Imaging, Diagnostic Radiology, The University of Texas MD Anderson Cancer Center, 1515 Holcombe Boulevard, Houston, TX 77030, USA.
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21
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Li QW, Niu SQ, Wang HY, Wen G, Li YY, Xia YF, Zhang YJ. Radiotherapy Alone is Associated with Improved Outcomes Over Surgery in the Management of Solitary Plasmacytoma. Asian Pac J Cancer Prev 2016; 16:3741-5. [PMID: 25987031 DOI: 10.7314/apjcp.2015.16.9.3741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A moderate dose of radiation is the recommended treatment for solitary plasmacytoma (SP), but there is controversy over the role of surgery. Our study aimed at comparing different treatment modalities in the management of SP. MATERIALS AND METHODS Data from 38 consecutive patients with solitary plasmacytoma, including 16 with bone plasmacytoma and 22 with extramedullary plasmacytoma, were retrospectively reviewed. 15 patients received radiotherapy alone; 11 received surgery alone, and 12 received both. The median radiation dose was 50Gy. All operations were performed as radical resections. Local progression-free survival (LPFS), multiple myeloma-free survival (MMFS), progression-free survival (PFS) and overall survival (OS) were calculated and outcomes of different therapies were compared. RESULTS The median follow-up time was 55 months. 5-year LPFS, MMFS, PFS and OS were 87.0%, 80.9%, 69.8% and 87.4%, respectively. Univariate analysis revealed, compared with surgery alone, radiotherapy alone was associated with significantly higher 5-year LPFS (100% vs 69.3%, p=0.016), MMFS (100% vs 51.4%, p=0.006), PFS (100% vs 33.7%, p=0.0004) and OS (100% vs 70%, p=0.041). CONCLUSIONS Radiotherapy alone can be considered as a more effective treatment for SP over surgery. Whether a combination of radiotherapy and surgery improves outcomes requires further study.
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Affiliation(s)
- Qi-Wen Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China E-mail :
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22
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De la Garza-Ramos R, Benvenutti-Regato M, Caro-Osorio E. The 100 most-cited articles in spinal oncology. J Neurosurg Spine 2016; 24:810-23. [PMID: 26771372 DOI: 10.3171/2015.8.spine15674] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
OBJECTIVE The authors' objective was to identify the 100 most-cited research articles in the field of spinal oncology. METHODS The Thomson Reuters Web of Science service was queried for the years 1864-2015 without language restrictions. Articles were sorted in descending order of the number of times they were cited by other studies, and all titles and abstracts were screened to identify the research areas of the top 100 articles. Levels of evidence were assigned on the basis of the North American Spine Society criteria. RESULTS The authors identified the 100 most-cited articles in spinal oncology, which collectively had been cited 20,771 times at the time of this writing. The oldest article on this top 100 list had been published in 1931, and the most recent in 2008; the most prolific decade was the 1990s, with 34 articles on this list having been published during that period. There were 4 studies with Level I evidence, 3 with Level II evidence, 9 with Level III evidence, 70 with Level IV evidence, and 2 with Level V evidence; levels of evidence were not assigned to 12 studies because they were not on therapeutic, prognostic, or diagnostic topics. Thirty-one unique journals contributed to the 100 articles, with the Journal of Neurosurgery contributing most of the articles (n = 25). The specialties covered included neurosurgery, orthopedic surgery, neurology, radiation oncology, and pathology. Sixty-seven articles reported clinical outcomes. The most common country of article origin was the United States (n = 62), followed by Canada (n = 8) and France (n = 7). The most common topics were spinal metastases (n = 35), intramedullary tumors (n = 18), chordoma (n = 17), intradural tumors (n = 7), vertebroplasty/kyphoplasty (n = 7), primary bone tumors (n = 6), and others (n = 10). One researcher had authored 6 studies on the top 100 list, and 7 authors had 3 studies each on this list. CONCLUSIONS This study identified the 100 most-cited research articles in the area of spinal oncology. The studies highlighted the multidisciplinary and multimodal nature of spinal tumor management. Recognition of historical articles may guide future spinal oncology research.
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Affiliation(s)
- Rafael De la Garza-Ramos
- Tecnológico de Monterrey, School of Medicine and Health Sciences; and.,Neurology and Neurosurgery Institute, Centro Médico Zambrano Hellion, TecSalud, Monterrey, Mexico
| | - Mario Benvenutti-Regato
- Tecnológico de Monterrey, School of Medicine and Health Sciences; and.,Neurology and Neurosurgery Institute, Centro Médico Zambrano Hellion, TecSalud, Monterrey, Mexico
| | - Enrique Caro-Osorio
- Tecnológico de Monterrey, School of Medicine and Health Sciences; and.,Neurology and Neurosurgery Institute, Centro Médico Zambrano Hellion, TecSalud, Monterrey, Mexico
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23
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Jia R, Xue L, Liang H, Gao K, Li J, Zhang Z. Surgery combined with radiotherapy for the treatment of solitary plasmacytoma of the rib: a case report and review of the literature. J Cardiothorac Surg 2015; 10:125. [PMID: 26464186 PMCID: PMC4605096 DOI: 10.1186/s13019-015-0335-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 10/05/2015] [Indexed: 12/31/2022] Open
Abstract
Solitary plasmacytoma of the bone, especially of a single rib, is a rare disease. We present the case of a 44-year-old Han Chinese man who was diagnosed with a solitary plasmacytoma of the bone located in the right sixth rib. The patient presented with a 4-year history of continuous pain in the right chest area and moderate fever lasting 7 days. A chest roentgenogram showed a solitary expanding lesion in the right thorax, and chest computed tomography revealed an osteolytic tumor in the chest wall. The patient underwent complete en-bloc resection of the chest wall, including the ribs, muscle, and parietal pleura. Histologically, the resected mass was composed of abundant neoplastic plasma cells, and the diagnosis was confirmed to be a plasmacytoma of rib. The examination of marrow cells showed 9 % normal plasma cells among karyocytes without clonal disease. On postoperative day 14, the patient underwent thoracic radiotherapy with a total dose of 50 Gy. The patient remained asymptomatic during the 6-month follow-up period. Herein, we also review previous reports on solitary plasmacytomas of the rib. In summary, this report provides further insights for the diagnosis and effective treatment of this rare disease.
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Affiliation(s)
- Rui Jia
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, 258 Wenhua Road, Qinhuangdao, Hebei, 066000, China.
| | - Lei Xue
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, 258 Wenhua Road, Qinhuangdao, Hebei, 066000, China.
| | - Huagang Liang
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, 258 Wenhua Road, Qinhuangdao, Hebei, 066000, China.
| | - Kun Gao
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, 258 Wenhua Road, Qinhuangdao, Hebei, 066000, China.
| | - Jian Li
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, 258 Wenhua Road, Qinhuangdao, Hebei, 066000, China.
| | - Zhefeng Zhang
- Department of Thoracic Surgery, The First Hospital of Qinhuangdao, 258 Wenhua Road, Qinhuangdao, Hebei, 066000, China.
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24
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Curreri R, Bonacina R, Mariani U, Caprioli C, Stefanoni P, Rambaldi A. Progressione del plasmocitoma solitario dell’osso a livello mandibolare in mieloma multiplo. DENTAL CADMOS 2015. [DOI: 10.1016/s0011-8524(15)30083-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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25
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Heo D, Boo KY, Jwa H, Lee HY, Kim J, Kim ST, Seo HM, Han SH, Maeng YH, Lee JH. A Case of Posterior Mediastinal Plasmacytoma Confounded by Community-Acquired Pneumonia. Tuberc Respir Dis (Seoul) 2015; 78:262-6. [PMID: 26175782 PMCID: PMC4499596 DOI: 10.4046/trd.2015.78.3.262] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2014] [Revised: 12/05/2014] [Accepted: 01/01/2015] [Indexed: 12/31/2022] Open
Abstract
Plasmacytomas are extramedullary accumulations of plasma cells originating from soft tissue. Mediastinal plasmacytoma is a rare presentation. A 67-year-old man recovered after antibiotic treatment for community-acquired pneumonia. However, on convalescent chest radiography after 3 months, mass like lesion at the right lower lung field was newly detected. Follow-up chest computed tomography (CT) revealed an increase in the extent of the right posterior mediastinal mass that we had considered to be pneumonic consolidations on previous CT scans. Through percutaneous needle biopsy, we diagnosed IgG kappa type extramedullary plasmacytoma of the posterior mediastinum.
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Affiliation(s)
- Dahee Heo
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Ki Yung Boo
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Hyeyoung Jwa
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Hwa Young Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jihyun Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Seong Taeg Kim
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Hye Mi Seo
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Sang Hoon Han
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Young-Hee Maeng
- Department of Pathology, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
| | - Jong Hoo Lee
- Department of Internal Medicine, Jeju National University Hospital, Jeju National University School of Medicine, Jeju, Korea
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26
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Zadnik PL, Goodwin CR, Karami KJ, Mehta AI, Amin AG, Groves ML, Wolinsky JP, Witham TF, Bydon A, Gokaslan ZL, Sciubba DM. Outcomes following surgical intervention for impending and gross instability caused by multiple myeloma in the spinal column. J Neurosurg Spine 2015; 22:301-9. [DOI: 10.3171/2014.9.spine14554] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
OBJECT
Multiple myeloma is the most common primary tumor of the spine and is the most common primary malignant tumor of bone. Although spinal myeloma is classically a radiosensitive lesion, clinical or radiographic signs of instability merit surgical intervention. The authors present the epidemiology, surgical indications, and outcome data of a series of consecutive cases involving 31 surgically treated patients with diagnoses of multiple myeloma and plasmacytoma of the spine (the largest such series reported to date).
METHODS
Surgical instability was the criterion for operative intervention in this patient cohort. The Spinal Instability Neoplastic Score (SINS) was used to make this assessment of instability. The cases were analyzed using location of the lesion, spinal levels involved, Frankel score, adjuvant therapy, functional outcome, and patient survival.
RESULTS
All patients undergoing surgical intervention were determined to have indeterminate or gross spinal column instability according to SINS criteria. The median survival was 78.9 months. No significant difference in survival was seen for patients with higher SINS scores or for older patients (> 55 years). There was a statistically significant difference in survival benefit observed for patients receiving chemotherapy and radiation versus radiation alone as an adjuvant to surgery (p = 0.02).
CONCLUSIONS
In this 10-year analysis, the authors report outcomes of surgical intervention for patients with indeterminate or gross spinal instability due to multiple myeloma and plasmacytoma of the spine with improved neurological function following surgery and low rates of instrumentation failure.
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27
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Nair SK, Faizuddin M, D J, Malleshi SN, Venkatesh R. Extramedullary plasmacytoma of gingiva and soft tissue in neck. J Clin Diagn Res 2015; 8:ZD16-8. [PMID: 25584334 DOI: 10.7860/jcdr/2014/9305.5176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2014] [Accepted: 09/17/2014] [Indexed: 11/24/2022]
Abstract
Plasmacytoma is a malignant disease that present either in bone marrow (medullary plasmacytoma), within the bone (solitary plasmacytoma of bone), or outside of bone, as the extramedullary plasmacytoma. Extramedullary plasmacytoma accounts for 3% of all plasma cell tumours and approximately 90% of extramedullary plasmacytomas affect the head and neck region commonly affecting the nasal cavity, paranasal sinuses, tonsillar fossa and oral cavity. Multiple extramedullary plasmacytoma is defined when there is more than one extramedullary tumour of clonal plasma cells and such presentations are extremely rare. We report such a rare case of multiple extramedullary plasmacytoma involving gingiva and neck. Here is a case report of a 65-year-old female patient presenting with extramedullary plasmacytoma of the gingiva and soft tissue in neck.
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Affiliation(s)
- Soumya K Nair
- Private Practioineer, OM Dental Clinic , Mysore, Karnataka, India
| | - Mohamed Faizuddin
- Head of Department, Department of Periodontics, M.R. Ambedkar Dental College & Hospital , Bangalore, India
| | - Jayanthi D
- Professor, Department of Periodontics, M.R. Ambedkar Dental College & Hospital , Bangalore, India
| | - Suchetha N Malleshi
- Reader, Department of Oral Medicine & Radiology, J.S.S Dental College & Hospital, jss University , Mysore, India
| | - Rashmi Venkatesh
- Reader, Department of Oral Medicine & Radiology, K M Shah Dental College and Hospital , Gujarat, India
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28
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Saksena A, Mahajan N, Agarwal S, Jain S. Solitary bone plasmacytoma: An interesting case report with unusual clinico-cytological features. J Cytol 2014; 31:158-60. [PMID: 25538386 PMCID: PMC4274528 DOI: 10.4103/0970-9371.145650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Solitary bone plasmacytoma (SBP) is a rare entity characterized by localized proliferation of monoclonal plasma cells primarily occurring in the axial skeleton without systemic involvement. Involvement of the distal extremity is unusual. In the absence of typical clinical presentation, diagnosis may not be suspected clinico-radiologically; hence, fine-needle aspiration cytology may help in early and definitive diagnosis, hastening meticulous diagnostic workup and appropriate management of these patients. Intracytoplasmic crystalline inclusions (CI) have been reported in multiple myeloma and lymphoproliferative disorders. The present case highlights unusual clinico-cytological features of SBP with primary involvement of humerus, progression to tibia, and presence of extracellular and intracytoplasmic CI in plasma cells, a morphologic finding not reported in SBP earlier.
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Affiliation(s)
- Annapurna Saksena
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Nidhi Mahajan
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shipra Agarwal
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
| | - Shyama Jain
- Department of Pathology, Maulana Azad Medical College, New Delhi, India
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29
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Zhao J, Li Y, Wu W, Zhang Z, Ding Y. Solitary plasmacytoma of the sternum with a spiculated periosteal reaction: A case report. Oncol Lett 2014; 9:191-194. [PMID: 25435957 PMCID: PMC4246607 DOI: 10.3892/ol.2014.2636] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2014] [Accepted: 09/30/2014] [Indexed: 12/25/2022] Open
Abstract
Solitary plasmacytomas (SPs) represent ≤5% of all plasma cell neoplasms and mostly occur in the spine, pelvis, ribs and pectoral girdle, while rarely occurring in the sternum. The tumors typically appear as osteolytic lesions. In rare cases, SPs can manifest as bony spicules on the surface of the bone. The present study reports the case of a 74 year-old female with an osteolytic tumor localized in the sternum. The tumor displayed extensive bony destruction, with a large quantity of thick straight spicules on the surface of the bone, resembling a sunray in appearance. The imaging, laboratory and pathological examinations of the patient met the diagnostic criteria of SP. The patient was initially treated with radiotherapy at a dose of 45 Gy. Six months later, chemotherapy consisting of vindesine, Adriamycin and dexamethasone was administered. Vindesine and Adriamycin were administered at a dose of 2 and 15 mg/day, respectively on days 1-4 in a 20-day cycle. Dexamethasone was administered at a dose of 20 mg/day on days 1-4, 9-12 and 17-20 in the 20-day cycle. In total, the patient underwent 6 cycles of chemotherapy, with a total duration of 7 months. The patient was followed-up for two years after beginning therapy. At present, the patient is well, without any evidence of progressive disease or multiple myeloma. To the best of our knowledge, this is the first case in the English literature of SP in the sternum, with an unusual sunray periosteal reaction on radiological imaging. The sites of bony spiculation in the lesions that have previously been described in the literature are the mandible, orbit, vertebral body and skull vault. To the best of our knowledge, the current study presents the first case of a SP of the sternum with a unusual spiculated periosteal reaction on radiological imaging to be reported in the English literature.
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Affiliation(s)
- Jingpin Zhao
- Department of Radiology, Third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laboratory of Orthopedics, Shijiazhuang, Hebei 050051, P.R. China
| | - Yuqing Li
- Department of Radiology, Third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laboratory of Orthopedics, Shijiazhuang, Hebei 050051, P.R. China
| | - Wenjuan Wu
- Department of Radiology, Third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laboratory of Orthopedics, Shijiazhuang, Hebei 050051, P.R. China
| | - Zekun Zhang
- Department of Radiology, Third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laboratory of Orthopedics, Shijiazhuang, Hebei 050051, P.R. China
| | - Yang Ding
- Department of Radiology, Third Hospital of Hebei Medical University, Hebei Province Biomechanical Key Laboratory of Orthopedics, Shijiazhuang, Hebei 050051, P.R. China
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30
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Tikku G, Jain M, Mridha A, Grover R. Solitary bone plasmacytoma progressing into retroperitoneal plasma cell myeloma with no related end organ or tissue impairment: a case report and review of the literature. Turk J Haematol 2014; 31:286-9. [PMID: 25330522 PMCID: PMC4287030 DOI: 10.4274/tjh.2012.0167] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Solitary bone plasmacytomas and plasma cell myeloma are clonal proliferations of plasma cells. Many patients with solitary bone plasmacytomas develop plasma cell myeloma on follow-up. We present a case of a 70-year-old man who presented with fracture and a lytic lesion in the subtrochanteric region of the left femur and was assigned a diagnosis of solitary bone plasmacytoma. He received local curative radiotherapy. However, 4 months later his serum M protein and β2-microglobulin levels increased to 2.31 g/dL and 5.965 mg/L, respectively. He complained of abdominal fullness and constipation. Ultrasound and non-contrast CT imaging revealed multiple retroperitoneal masses. Colonoscopic examination was normal. Biopsy of the a retroperitoneal mass confirmed it to be a plasmacytoma. Repeat hemogram, blood urea, serum creatinine, skeletal survey, and bone marrow examination revealed no abnormalities. This is an unusual presentation of plasma cell myeloma, which manifested as multiple huge extramedullary retroperitoneal masses and arose from a solitary bone plasmacytoma, without related end organ or tissue impairment and bone marrow plasmacytosis. The patient succumbed to his disease 8 months after the appearance of the retroperitoneal masses. This case highlights the importance of close monitoring of patients diagnosed with solitary bone plasmacytoma with increased serum M protein and serum β2-microglobulin levels, so that early therapy can be instituted to prevent conversion to plasma cell myeloma.
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Affiliation(s)
- Gargi Tikku
- Delhi State Cancer Institute, Department of Oncopathology, Delhi, India. E-ma-il:
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31
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Ashraf MJ, Azarpira N, Khademi B. Anaplastic Solitary plasmacytoma of mandible, masquerading as sarcoma. Pak J Med Sci 2013; 29:872-3. [PMID: 24353648 PMCID: PMC3809276 DOI: 10.12669/pjms.293.3406] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2013] [Accepted: 04/18/2013] [Indexed: 11/25/2022] Open
Abstract
Plasma cell neoplasm is characterized by a monoclonal neoplastic proliferation of plasma cells and solitary plasmocytoma of bone (SPB) is a localized form. It usually occurs in vertebrae and secondarily in long bones. Its presence in mandible is extremely rare event. A 48-year-old man consulted to our clinic with a chief complaint of pain in his mandible. Radiography revealed a destructive lesion in body and ramus. The initial pathologic evaluation revealed a high grade pleomorphic neoplasm. The diagnosis was confirmed by immunohistochemical markers. Overall, plasmacytoma with anaplastic features can be confused with high grade sarcoma clinically and histologically.
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Affiliation(s)
- Mohamad Javad Ashraf
- Mohamad Javad Ashraf, MD, Department of Pathology, Shiraz University of Medical Science, Shiraz, Iran
| | - Negar Azarpira
- Negar Azarpira, MD, Transplant Research Center, Shiraz University of Medical Science, Shiraz, Iran
| | - Bijan Khademi
- Bijan Khademi, MD, Department of Otolaryngology, Shiraz University of Medical Science, Shiraz, Iran
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32
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Tajima K, Uchida N, Azuma Y, Okada T, Sasamoto H, Yokoo H, Kuwano H. Surgical resection of a solitary plasmacytoma originating in a rib. Ann Thorac Cardiovasc Surg 2013; 20 Suppl:609-12. [PMID: 24088906 DOI: 10.5761/atcs.cr.12-02235] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Plasma cell neoplasms can present as a single lesion (solitary plasmacytoma) or as multiple lesions (multiple myeloma). Solitary plasmacytoma is a rare plasma cell neoplasm. There are 2 separate entities, dependent on the location of the lesion originating in either bone or extramedullary soft tissue. It is defined as a proliferation of monoclonal plasma cells without evidence of significant bone-marrow plasma-cell infiltration. We present a 71-year-old woman who was diagnosed with a solitary plasmacytoma of the bone located in the right third rib after surgical resection. A chest roentgenogram showed a solitary expanding lesion in the right third rib. Chest computed tomography (CT) revealed an osteolytic chest wall tumor. Fluorodeoxyglucose positron emission tomography and CT (PET-CT) showed no abnormal uptake in the whole body, except for the third rib lesion. The patient underwent complete en-bloc resection of the chest wall including ribs, muscle, and parietal pleura. The patient is asymptomatic without any recurrence after one and a half years of follow up.
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Affiliation(s)
- Kouhei Tajima
- Department of Surgery, Haramachi Red Cross Hospital, Agatsuma-gun, Gunma, Japan
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von der Hoeh NH, Tschoeke SK, Gulow J, Voelker A, Siebolts U, Heyde CE. Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2013; 23:35-9. [PMID: 23989739 DOI: 10.1007/s00586-013-2922-2] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2013] [Revised: 04/03/2013] [Accepted: 07/15/2013] [Indexed: 01/19/2023]
Abstract
INTRODUCTION Solitary bone plasmacytoma (SP) is a rare diagnosis for which the primary treatment is local radiotherapy. There is no established consensus suggesting a total spondylectomy in spinal SP. MATERIALS AND METHODS We report the case of a 43-year-old woman with solitary plasmacytoma of the lumbar spine treated with complete vertebral resection. Radiographs, CT scan and MRI showed a single osteolytic lesion of the third lumbar vertebra. Further diagnostics following recommended algorithm for tumour screening were negative. Two times, biopsy showed no histological pathologies. Due to the instability of the spine with suspicious unknown lesion, we decided to perform a dorsal lumbar approach and instrumentation with complete resection of the posterior parts to prepare for a complete resection if mandatory. Resamples were taken and the bone surfaces sealed. Consecutive findings were positive for plasma cell infiltration of the respective vertebra, however not on the first pass, but after diagnostic pathological reference. Surgery was completed by total spondylectomy. Reference histological findings with restaging and cytogenetic risk analysis confirmed a non-high-risk solitary bone plasmacytoma, and the patient was scheduled for localized radiotherapy with 40 Gy. RESULTS Follow-up examinations (53 months) showed no local recurrence or disease progression. DISCUSSION There is no consensus in the literature regarding appropriate surgical approach and perioperative strategies in the treatment of solitary plasmacytoma. The finding of a solitary plasmacytoma of the spine was the determining factor for our decision to perform radical surgery with subsequent radiotherapy. The rationale for the chosen approach was to minimize the risk of local recurrence and to avoid conversion into multiple myeloma. The follow-up with 53 months is limited. However, discussion remains, if radical surgery in addition to local radiotherapy could be an alternative therapeutic approach depending on paraclinical parameters, age and cytogenetic risk analysis.
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Baghmar S, Mohanti BK, Sharma A, Kumar L, Prakash G, Kumar S, Gupta R, Kumar R, Raina V. Solitary plasmacytoma: 10 years’ experience at All India Institute of Medical Sciences, New Delhi. Leuk Lymphoma 2012; 54:1665-70. [DOI: 10.3109/10428194.2012.750725] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Carlson ER, Ghali GE, Herb-Brower KE. Diagnosis and management of pathological conditions. J Oral Maxillofac Surg 2012; 70:e232-71. [PMID: 23128003 DOI: 10.1016/j.joms.2012.07.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Kalayoglu-Besisik S, Yonal I, Hindilerden F, Agan M, Sargin D. Plasmacytoma of the nasolacrimal duct simulating dacryocystitis: an uncommon presentation for extramedullary relapse of multiple myeloma. Case Rep Oncol 2012; 5:119-24. [PMID: 22666199 PMCID: PMC3364047 DOI: 10.1159/000337431] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
The most common site for localized forms of plasma cell neoplasms (extramedullary plasmacytoma; EMP) is the upper respiratory tract, including the oropharynx, nasal cavities, sinuses and larynx. A 50-year-old woman with a history of myeloma in complete remission after autologous stem cell transplantation complained of two weeks of epiphora of the left eye with subsequent diplopia, bloody nasal discharge and progressive swelling around the nasolacrimal sac. A solitary mass in the left sinonasal area, extending to the nasolacrimal duct (NLD) was detected on MRI, whose histopathological examination was consistent with plasmacytoma. Further clinical investigation ruled out multiple myeloma (MM). The patient underwent debulking surgery and adjuvant chemotherapy followed by local radiotherapy in an attempt to achieve complete response. Despite being a rare entity, EMP of the NLD should be considered in the differential diagnosis of epiphora and dacryocystitis. To our knowledge, this is the first case of a plasmacytoma of the NLD presenting as isolated extramedullary relapse of MM. The follow-up in EMPs should include appropriate imaging studies, a systemic workup to rule out MM.
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Kilciksiz S, Karakoyun-Celik O, Agaoglu FY, Haydaroglu A. A review for solitary plasmacytoma of bone and extramedullary plasmacytoma. ScientificWorldJournal 2012; 2012:895765. [PMID: 22654647 PMCID: PMC3354668 DOI: 10.1100/2012/895765] [Citation(s) in RCA: 116] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 12/22/2011] [Indexed: 12/21/2022] Open
Abstract
Solitary plasmacytoma (SP) is characterized by a mass of neoplastic monoclonal plasma cells in either bone (SBP) or soft tissue without evidence of systemic disease attributing to myeloma. Biopsy confirmation of a monoclonal plasma cell infiltration from a single site is required for diagnosis. The common presentation of SBP is in the axial skeleton, whereas the extramedullary plasmacytoma (EMP) is usually seen in the head and neck. The ratio of SP seen at males to females is 2 : 1 and the median age of patients is 55 years. The incidence rate of SP in black race is approximately 30% higher than the white race. Incidence rate increases exponentially by advancing age. SBP has a significant higher risk for progression to myeloma, and the choice of treatment is radiotherapy (RT) that is applied with curative intent at min. 4000 cGy. By only RT application, long-term disease-free survival (DFS) is possible for approximately 30% of patients with SBP and 65% of patients with EMP.
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Affiliation(s)
- Sevil Kilciksiz
- Radiation Oncology Clinic, Okmeydani Training and Research Hospital, Ministry of Health, Istanbul, Turkey
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Ravo V, Calvanese MG, Manzo R, Cuomo MG, Cammarota F, Murino P, Muto P. Solitary Plasmacytoma of the Larynx Treated with Radiotherapy: A Case Report. TUMORI JOURNAL 2012. [DOI: 10.1177/030089161209800219] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background. Solitary plasmacytomas are rare tumors accounting for less than 10% of plasma cell neoplasms. On initial presentation they must be differentiated from multiple myeloma. This can be difficult because a high percentage of these tumors may be associated with subsequent development of multiple myeloma. We present a case of plasmacytoma of the larynx treated with surgery and radiotherapy. Case report. A 56-year-old man presented a solitary plasmacytoma of the larynx. The diagnosis was made by biopsy and the presence of a mass on the right side of the larynx was confirmed by computed tomography and whole-body positron-emission tomography. Soon after the biopsy the patient underwent a CO2 laser cordectomy. After the definitive histological confirmation, the patient was referred to our department for three-dimensional conformal radiotherapy (3DCRT) to the involved site with curative intent. The prescribed dose was 50 Gy. Results. Five months after the 3DRTE treatment there was no CT or PET evidence of tumor, and examination by the otorhinolaryngologist confirmed the success of laser cordectomy and 3DRTE treatment. There were no long-term side effects of the treatment. Conclusion. Radiation therapy following CO2 laser cordectomy can achieve excellent locoregional control of solitary plasmacytoma of the larynx.
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Affiliation(s)
- Vincenzo Ravo
- Department of Radiotherapy, PO Ascalesi ASLNA1, Naples
| | | | - Roberto Manzo
- Department of Radiotherapy, PO Ascalesi ASLNA1, Naples
| | - Maria Grazia Cuomo
- Department of Radiology and Radiotherapy, Seconda Università di Napoli, Naples
| | | | - Paola Murino
- Department of Radiotherapy, PO Ascalesi ASLNA1, Naples
| | - Paolo Muto
- Department of Radioterapy, INT Pascale, Naples, Italy
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Singal R, Dalal U, Dalal AK, Attri AK, Gupta S, Raina R. Solitary plasmacytoma of the rib: A rare case. Lung India 2011; 28:309-11. [PMID: 22084551 PMCID: PMC3213724 DOI: 10.4103/0970-2113.85699] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Localized solitary plasmacytoma of the bone is a rare disease and is characterized by only one or two isolated bone lesions with no evidence of disease dissemination. We report a case of solitary plasmacytoma of the rib in a 43-year-old female. The patient underwent complete en-bloc resection of the chest wall including rib, muscle, and parietal pleura. Patient is asymptomatic without any recurrence after two and half years of follow up.
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Affiliation(s)
- Rikki Singal
- Department of Surgery, Maharishi Markandeshwer Institute of Medical Sciences and Research, Mullana (Distt-Ambala) Haryana, India
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Abstract
OBJECTIVE The purpose of this article is to highlight the role of radiography, CT, PET/CT, and MRI in the diagnosis and management of chest wall lesions. Chest wall masses are caused by a spectrum of clinical entities. The lesions highlighted in this selection of case scenarios include neoplastic, inflammatory, and vascular lesions. CONCLUSION Imaging evaluation with radiography, CT, MRI, and PET/CT plays an important role in the accurate diagnosis of chest wall lesions. It can also facilitate percutaneous biopsy, when it is indicated. Imaging enables accurate staging and is a key component of treatment planning for chest wall masses.
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Reed V, Shah J, Medeiros LJ, Ha CS, Mazloom A, Weber DM, Arzu IY, Orlowski RZ, Thomas SK, Shihadeh F, Alexanian R, Dabaja BS. Solitary plasmacytomas: outcome and prognostic factors after definitive radiation therapy. Cancer 2011; 117:4468-74. [PMID: 21437886 DOI: 10.1002/cncr.26031] [Citation(s) in RCA: 74] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2010] [Revised: 12/22/2010] [Accepted: 01/03/2011] [Indexed: 02/03/2023]
Abstract
BACKGROUND The objective of this study was to review the outcome of patients with solitary plasmacytoma (SP) after definitive radiation therapy. METHODS The authors retrospectively reviewed 84 patients with SP who were diagnosed and treated at The University of Texas MD Anderson Cancer Center during 1988 to 2008. The impact of tumor anatomic site, tumor size, and the presence of serum and urinary paraprotein at diagnosis was assessed on local control, survival, and the risk of developing multiple myeloma (MM). RESULTS Fifty-nine patients (70%) had bone SP, and 25 patients (30%) had extramedullary SP. Serum paraprotein was present in 39 patients (46%). The median radiation dose was 45 grays (Gy) (range, 36-53.4 Gy). Local control was achieved in 77 patients (92%). Neither radiation dose nor tumor size predicted local control. The 5-year rate of progression to MM was 47% and was higher for patients with bone SP (56% vs 30% for extramedullary SP; P = .021), and patients who had serum paraprotein detected at diagnosis (60% vs 39%; P = .016). On univariate analysis, patients aged <60 years and men had higher rates of progression to MM, although the differences were not significant (P = .048 and P = .29, respectively). Multivariate analysis revealed that bone location and serum protein at diagnosis were associated statistically with progression to MM. The 5-year overall survival rate for the entire patient cohort was 78%, and no difference was observed between patients who had bone SP versus extramedullary SP (76% vs 85%, respectively; P = .274). CONCLUSIONS The current results indicated that definitive radiation therapy for SP can provide excellent local control. Progression to MM remains the main problem and is more common among patients with bone SP and those who have serum paraprotein detected at diagnosis.
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Affiliation(s)
- Valerie Reed
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, Texas, USA
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Karakullukcu B, De Boer JP, Van Veen R, Wegman J, Tan B. Surgical debulking combined with photodynamic therapy to manage residual extramedullary plasmacytoma of the nasopharynx. Photodiagnosis Photodyn Ther 2011; 8:264-6. [PMID: 21864800 DOI: 10.1016/j.pdpdt.2011.03.340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2010] [Accepted: 03/14/2011] [Indexed: 10/18/2022]
Abstract
Extramedullary plasmacytomas (EMP) are rare plasma cell neoplasms that are mostly located in the mucosal surfaces of the upper aerodigestive tract. The standard treatment is radiotherapy (RT), with surgical resection reserved as salvage procedure. In this report a patient with a EMP, located in the nasopharynx and refractory to curative RT. Because of the technical difficulty of a radical resection in the nasopharynx area the EMP is managed by endoscopic debulking and temoporfin mediated photodynamic therapy. The patient remains disease free since six years.
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Affiliation(s)
- Baris Karakullukcu
- The Netherlands Cancer Institute, Antoni van Leeuwenhoek Hospital, Plesmanlaan 121, 1066 CX Amsterdam, The Netherlands.
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Chargari C, Hijal T, Bouscary D, Caussa L, Dendale R, Zefkili S, Fourquet A, Kirova YM. The role of helical tomotherapy in the treatment of bone plasmacytoma. Med Dosim 2011; 37:26-30. [PMID: 21705210 DOI: 10.1016/j.meddos.2010.12.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Revised: 10/23/2010] [Accepted: 12/08/2010] [Indexed: 01/02/2023]
Abstract
We evaluated the early clinical outcome of patients with solitary bone plasmacytoma (SP) or a solitary lesion of multiple myeloma (MM) treated with helical tomotherapy (HT) compared with 3D conformal radiotherapy (3D-CRT), in terms of target coverage and exposure of critical organs. Ten patients with SP and 3 patients with a solitary lesion of MM underwent radiation therapy (RT) delivered by HT, to a dose of 40 Gy in 20 fractions. Treatment planning was then performed with 3D-CRT and the dosimetric parameters of both techniques were compared. Patients were also assessed for response to treatment and acute toxicities. With a median follow-up of 13 months, 78% of patients with pain before RT had resolution of their symptoms. Coverage of target lesion was adequate with both techniques in 12 of 13 patients. Target coverage was significantly lower for HT (V(95%) = 98.55% vs. 97.15%; p = 0.04, for 3D-CRT and HT, respectively). Target overdoses were also lower with HT (V(105%) = 2.01% vs. 0.19%; p= 0.16), although nonsignificant. Finally, there were no significant differences in organs-at-risk irradiation between both techniques. The early treatment tolerance was excellent, with no toxicity higher than grade I. RT of SP and MM with a solitary lesion can be safely delivered with HT, with no major acute side effects and good symptomatic control. Finally, HT provides a dosimetry similar to that of 3D-CRT in terms of organs-at-risk sparing and target volume coverage.
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Affiliation(s)
- Cyrus Chargari
- Department of Radiation Oncology, Institut Curie, Paris, France
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Place of modern imaging modalities for solitary plasmacytoma: toward improved primary staging and treatment monitoring. Crit Rev Oncol Hematol 2011; 82:150-8. [PMID: 21621417 DOI: 10.1016/j.critrevonc.2011.04.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2011] [Revised: 03/26/2011] [Accepted: 04/14/2011] [Indexed: 02/08/2023] Open
Abstract
Radiation therapy (RT) is the mainstay of treatment of solitary plasmacytoma. In most cases, doses ranging from 40 to 50 Gy yield in a local control more than 80%. However, the prognosis of patients with SP is marked by a high rate of transformation to multiple myeloma (MM), and there is no demonstrated benefit of adjuvant chemotherapy for decreasing this probability. However, clinical benefits could be reached from improving screening for other primary sites of plasmacytoma and earlier discovering signs suggestive of MM. Since such strategy could provide significant information regarding both prognosis and therapy, it has become first importance to improve initial staging of tumor widespread. Although conventional skeletal X-ray survey remains standard, usual sensitivity of radiographies does not permit diagnosing early myeloma lesions and a significant number of patients with supposed SP might be understaged and do not receive the appropriate treatment. The development of more sensitive and specific imaging modalities will make it feasible to earlier detect subclinical lesions, thus leading lead to new approaches in the treatment strategies. Here, we discuss the benefits and limitations of magnetic resonance imaging and positron emission tomography for primary staging of patients with solitary plasmacytoma. Both imaging modalities could also improve target volume delineation and assessment of tumor response after RT.
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Shindo M, Sato K, Yamamoto M, Toki Y, Hatayama M, Ito S, Ichiki K, Okamura N, Hosoki T, Ikuta K, Inamura J, Watanabe S, Torimoto Y, Kohgo Y. Development of POEMS syndrome after an initial manifestation of solitary plasmacytoma. Int J Hematol 2011; 93:815-821. [PMID: 21553018 DOI: 10.1007/s12185-011-0863-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2010] [Revised: 04/18/2011] [Accepted: 04/19/2011] [Indexed: 12/30/2022]
Abstract
A 44-year-old male was admitted for numbness in the left arm. CT showed a tumor impacting on the spinal cord with an adjacent thoracic vertebral osteosclerotic lesion. The histopathology of the tumor showed diffuse proliferation of atypical plasma cells with expressed vascular endothelial growth factor (VEGF), which is a known etiological factor in POEMS syndrome. Though serum VEGF (sVEGF) level was elevated, a diagnosis of solitary plasmacytoma with an osteosclerotic lesion was made as the patient presented no polyneuropathy, organomegaly, endocrinopathy, or skin changes. The patient experienced muscle weakness of the lower limbs and skin pigmentation/hemangioma one year after irradiation of the osteosclerotic lesion. Laboratory tests revealed hypothyroidism, hyperglycemia, serum monoclonal gammopathy, further elevation of sVEGF, and increased atypical bone marrow plasma cells. CT imaging showed splenomegaly, and a nerve conduction test revealed demyelinating motor peripheral neuropathy. The patient was therefore diagnosed with POEMS syndrome. Plasmacytoma is very rare as an initial manifestation of POEMS syndrome. Patients presenting with plasmacytoma with an osteosclerotic lesion should be carefully observed and evaluated for the expression of sVEGF and development of POEMS syndrome, as most bone plasmacytomas in POEMS syndrome patients are reported to be osteosclerotic. This is to our knowledge the first case of osteosclerotic plasmacytoma that progressed to POEMS syndrome, with an increase of sVEGF.
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Affiliation(s)
- Motohiro Shindo
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kazuya Sato
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan.
| | - Masayo Yamamoto
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
| | - Yasumichi Toki
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
| | - Mayumi Hatayama
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
| | - Satoshi Ito
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
| | - Kazuhiko Ichiki
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
| | - Naoka Okamura
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
| | - Takaaki Hosoki
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
| | - Katsuya Ikuta
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
| | - Junki Inamura
- Asahikawa Kosei Hospital, Asahikawa, Hokkaido, Japan
| | | | - Yoshihiro Torimoto
- Oncology Center, Asahikawa Medical University Hospital, Asahikawa, Hokkaido, Japan
| | - Yutaka Kohgo
- Division of Gastroenterology and Hematology/Oncology, Department of Medicine, Asahikawa Medical University, 1-1 Midorigaoka Higashi 2-jo 1-chome, Asahikawa, Hokkaido, 078-8510, Japan
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Nakanishi K, Kashiwagi N, Hamada K, Yagi T, Tomita Y. Solitary plasmacytoma of the sternum detected incidentally by MR imaging of the cervical spine. Magn Reson Med Sci 2011; 9:227-31. [PMID: 21187692 DOI: 10.2463/mrms.9.227] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
We incidentally detected a case of solitary plasmacytoma of the sternum by magnetic resonance (MR) imaging of the cervical spine. At detection, the patient had no symptoms, the lesion was localized in the bone marrow of the sternum, and there were no findings of bone destruction. The lesion showed high contrast on diffusion-weighted images, gradually enlarged over 3 years, and was confirmed as a solitary plasmacytoma at open biopsy 3 years after detection. Radiologists should pay attention to incidental findings in the upper part of the sternum at MR imaging examination of the cervical spine.
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Affiliation(s)
- Katsuyuki Nakanishi
- Department of Diagnostic Radiology, Osaka Medical Center for Cancer and Cardiovascular Diseases, Higashinari-ku, Osaka, Japan.
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Utzschneider S, Schmidt H, Weber P, Schmidt GP, Jansson V, Dürr HR. Surgical therapy of skeletal complications in multiple myeloma. INTERNATIONAL ORTHOPAEDICS 2010; 35:1209-13. [PMID: 20862584 DOI: 10.1007/s00264-010-1127-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2010] [Revised: 08/31/2010] [Accepted: 09/06/2010] [Indexed: 10/19/2022]
Abstract
Patients with multiple myeloma are often treated surgically as though they have bone metastases. Due to major differences in oncological therapy and comparatively long survival times these patients should be considered separately. Seventy-five multiple myeloma patients were treated surgically (83 interventions) for skeletal complications of the disease. Location and dissemination, symptoms, method of surgery, complications, recurrence and survival time were evaluated retrospectively. Most of the lesions were in the axial skeleton or the proximal extremities apart from one distal lesion of the fibula, and most surgery was performed in the spine (35 patients). The mean follow-up of patients was 5.4 years (range 1-25 years). Survival proved to be very favourable (37% at five years). Patients with a single bone lesion, a negative bone marrow biopsy, no paraproteinaemia in serum or a Salmon-Durie-stage I had a better survival probability. Surgical treatment in patients with multiple myeloma was mostly limited to a palliative approach but survival time was better (37% at five years) than in patients with metastatic bone disease which has to be considered in their surgical treatment.
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Affiliation(s)
- Sandra Utzschneider
- Orthopaedic Oncology, Department of Orthopaedics, Grosshadern Medical Center, Ludwig-Maximilians-University of Munich, Marchioninistr. 15, 81377 Munich, Germany
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Abstract
We present the uncommon case of a subcutaneous fascia-based extramedullary plasmacytoma in the leg, which was confirmed by the pathology report and followed up until its remission. We report the differential diagnosis with other more common soft tissue masses. Imaging findings are nonspecific but are important to determine the tumour extension and to plan the biopsy.
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Antunes MI, Bujor L, Grillo IM. Anal canal plasmacytoma-An uncommon presentation site. Rep Pract Oncol Radiother 2010; 16:36-9. [PMID: 24376953 DOI: 10.1016/j.rpor.2010.12.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2010] [Accepted: 12/05/2010] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Extramedullary plasmacytomas (EMP) are rare plasma cell tumors that arise outside the bone marrow. They are most often located in the head and neck region, but may also occur in the other locations. The lower gastrointestinal EMP represents less than 5% of all cases, and location in the anal canal is exceedingly rare. AIM We present an exceedingly rare case of anal canal plasmacytoma, aiming to achieve a better understanding of this rare entity. METHODS We report a case of a 61-year-old man with a bulky mass in the anal canal. The lesion measured about 6 cm and invaded in all layers of the anal canal wall. The biopsy was performed and revealed a round and plasmocitoid cell population with a solid growth pattern and necrosis. The tumoral cells have express CD79a and CD138 with lambda chains. There was no evidence of disease in other locations and these features were consistent with the diagnosis of an extra-osseous plasmacytoma. The patient was submitted to conformal radiotherapy 50.4 Gy total dose, 1.8 Gy per fraction. After 24 months, the patient is asymptomatic and the lesion has completely disappeared. CONCLUSIONS EMP accounts for approximately 3% of plasma cell malignancies. The median age is about 60 years, and the majority of patients are male. The treatment of choice for extramedullary plasmacytoma is radiation therapy in a dosage of about 50 Gy. Patients should be followed-up for life with repeated bone marrow aspiration and protein studies to detect the development of multiple myeloma.
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Affiliation(s)
- Maria Inês Antunes
- Radiotherapy Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Laurentiu Bujor
- Radiotherapy Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal
| | - Isabel Monteiro Grillo
- Radiotherapy Department, Hospital de Santa Maria, Centro Hospitalar Lisboa Norte, Lisboa, Portugal ; Faculty of Medicine, Lisbon University, Portugal
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Yetiser, Derya Talas, Abdullah Akka S. Plasmacytoma of the Temporal Bone: Management with a Combination of Surgery and Radiotherapy. Acta Otolaryngol 2009. [DOI: 10.1080/00016480127373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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