The prognosis of solitary plasmacytoma varies greatly, with some patients recovering after surgical removal or local fractional radiation therapy, and others progressing to multiple myeloma years later. Primary detection of progression to multiple myeloma is important in the treatment of solitary plasmacytoma. There have been several analyses of the risk factors involved in the early progression to multiple myeloma. We describe one case of solitary plasmacytoma of the lumbar vertebra that was treated with surgical decompression with stabilization and additional radiotherapy. The patient had no factors associated with rapid progression to multiple myeloma such as age, size, immunologic results, pathological findings, and serum free light chain ratio at the time of diagnosis. However, his condition progressed to multiple myeloma less than two months after the initial diagnosis of solitary plasmacytoma. We suggest that surgeons should be vigilant in watching for rapid progression to multiple myeloma even in case that the patient with solitary plasmacytoma has no risk factors for rapid progression to multiple myeloma.
Decompression, Surgical ; Diagnosis ; Humans ; Lumbar Vertebrae ; Multiple Myeloma* ; Plasmacytoma* ; Prognosis ; Radiotherapy ; Risk Factors ; Spine*

Extramedullary plasmacytoma is an uncommon neoplasm and it occurs most frequently in the upper respiratory tract. Among the extramedullary plasmacytomas, retroperitoneal plasmacytoma is an extremely rare tumor with only about 10 cases having been reported in the world. Herein, we reported on a extramedullary plasmacytoma in the retroperitoneum. A 68-year-old man presented with left flank pain. The initial clinical diagnosis was retroperitoneal tumor. Retroperitoneal tumor mass excision along with left nephrectomy was performed and the histopathology showed plasmacytoma. There was no evidence of multiple myeloma. After the operation, he was treated with radiotherapy and the out-patient department follow-up is going on.
Aged ; Diagnosis ; Flank Pain ; Follow-Up Studies ; Humans ; Multiple Myeloma ; Nephrectomy ; Outpatients ; Plasmacytoma* ; Radiotherapy ; Respiratory System ; Retroperitoneal Neoplasms

Solitary plasmacytoma consists of solitary bone plasmacytoma (SBP) and extramedullary plasmacytoma. Its frequency is about 7% among the total plasma cell neoplasm. Solitary bone plasmacytoma of the cranial cavity occurs in 0~18% of patients with SBP. We experienced a case of SBP originated from the middle cranial fossa in a 68-year-old man. After surgical removal of the mass, biopsy specimen revealed plasmacytoma, kappa type. There was no evidence of systemic involvement. Additional radiotherapy was performed. Twenty-one months after the diagnosis of SBP, pathologic fracture of the left humerus happened. Biopsy specimen of the operation revealed same diagnosis. At that time, Bence Jones proteinuria was detected in immuno-electrophoresis of urine and simple bone X-rays showed multiple osteolytic lesions.A case of SBP of the orbit and middle cranial fossa in a 68-year-old man is presented and the literature is reviewed.
Aged ; Biopsy ; Cranial Fossa, Middle* ; Diagnosis ; Fractures, Spontaneous ; Humans ; Humerus ; Neoplasms, Plasma Cell ; Orbit ; Plasmacytoma* ; Proteinuria ; Radiotherapy

Plasmacytomas are a localized proliferation of plasma cells in the bone marrow, and are less frequently seen in extraosseous organs or tissues. Extramedullary plasmacytoma is a rare malignant neoplasm, and is especially uncommon when it arises from the mediastinum. Here, we report on a case of posterior mediastinal extramedullary plasmacytoma in a 64-year-old man. He was admitted with an asymptomatic right apical mediastinal mass, which was provisionally diagnosed as a neurogenic mass. However, a subsequent investigation revealed that this tumor was a rare case of IgG kappa type extramedullary plasmacytoma arising from the posterior mediastinum. The patient was treated with local radiation to the mediastinum and is doing well without further evidence of disease.
Biopsy, Needle ; Bone Marrow ; Diagnosis, Differential ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging ; Male ; Mediastinal Neoplasms/*diagnosis/radiotherapy ; Middle Aged ; Plasmacytoma/*diagnosis/radiotherapy ; Radiography, Thoracic ; Tomography, X-Ray Computed

The extramedullary plasmacytoma is a neoplastic proliferation of plasmacytes in reticuloendothelial tissues, and it occurs most commonly in the head and neck area, especially in the upper respiratory tract and the oral cavity. The most frequent sites are the paranasal sinuses, nasal cavity and nasopharynx. If histologic diagnosis of plasmacytoma is confirmed, all screening tests are necessary to rule out multiple myeloma. The treatment and prognosis are different according to sites where the extramedullary plasmacytoma is originated. We experienced a case of extramedullary plasmacytoma that originated from the septum in a 60-year-old man. After the embolization, endoscopicgical removal of the mass was carried out. Its histopathologic finging revealed the plasmacytoma of lambda type. Systemic evaluations were done immediately and there was no evidence of systemic involvement. Additional radiotherapy (50 Gy) was performed. After ten months of treatment, there was no evidence of recurrence. So we report this case with a review of the literature.
Diagnosis ; Head ; Humans ; Mass Screening ; Middle Aged ; Mouth ; Multiple Myeloma ; Nasal Cavity ; Nasal Septum* ; Nasopharynx ; Neck ; Paranasal Sinuses ; Plasma Cells ; Plasmacytoma* ; Prognosis ; Radiotherapy ; Recurrence ; Respiratory System

Plasmacytoma refers to malignant plasma cell tumor, which consists of abnormal proliferation of plasma cells. It can be classified into several types, multiple myeloma, solitary medullary plasmacytoma and extramedullary plasmacytoma according to clinical and histological aspects of the tumor. Multiple myeloma is the most common plasmacytoma and its main feature is the infiltration of plasma cells into the bone marrow. Over 10% of plasma cell count among the nuclear cells in the bone marrow biopsy allows diagnosis of multiple myeloma. This involves multiple organs and extramedullary sites including the spleen, liver, lymph nodes and kidney; however, the involvement of nasal cavity and paranasal sinus is rare. Recently, we experienced a case of multiple myeloma, which was present in both nasal cavities and paranasal sinuses. The case was treated with chemotherapy and radiotherapy followed by autologous bone marrow transplantation. We report on it with literature review.
Biopsy ; Bone Marrow ; Bone Marrow Transplantation ; Diagnosis ; Drug Therapy ; Kidney ; Liver ; Lymph Nodes ; Multiple Myeloma* ; Nasal Cavity ; Paranasal Sinuses* ; Plasma Cells ; Plasmacytoma ; Radiotherapy ; Spleen

Extramedullary plasmacytoma (EMP) is a common plasma cell tumor often involving the upper aerodigestive tract. Although extremely rare, mediastinal involvement is possible. An 81-year-old man was presented to our emergency department with chest and back pain with weakness in both legs. Chest X-ray showed a large mass in the upper right mediastinum; subsequently, computed tomography and magnetic resonance imaging evaluated the mass. He was diagnosed with mediastinal EMP, which progressed to spinal cord compression. The patient was treated with radiotherapy and chemotherapy. Spinal cord compression, due to metastatic tumor, is an emergency clinical situation that requires prompt diagnosis and treatment. Emergency medicine physicians should be aware of the clinical presentation and complications associated with EMP.
Aged, 80 and over ; Back Pain ; Diagnosis ; Drug Therapy ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leg ; Magnetic Resonance Imaging ; Mediastinum ; Multiple Myeloma ; Plasmacytoma* ; Radiotherapy ; Spinal Cord Compression* ; Spinal Cord* ; Thorax

The diagnosis and management of extramedullary plasmacytoma require the same range of clinical and laboratory expertise as for multiple myeloma. The primary treatment is radiotherapy, but surgery may also be required. We report three cases of extramedullary plasmacytoma located in the nasopharynx, neck, and nasal cavity respectively. The case of nasopharyngeal plasmacytoma, developed in a 55-year-old man, was associated with multiple bilateral cervical lymphadenopathy. Diagnosis was made with MRI, endoscopic nasopharyngeal biopsy, and bone marrow aspiration biopsy. Radiotherapy of 45 Gy resulted in the partial remission of primary and cervical lesions. The second case presented with cervical and retropharyngeal masses. Radiotherapy had not been successful, so the tumors were surgically excised. The third case was developed in the nose of a 43-year-old man complaining of nasal obstruction and epistaxis. Nasal cavity mass was identified as an extramedullary plasmacytoma. The patient underwent radiotherapy with 50 Gy with complete remission.
Adult ; Biopsy ; Biopsy, Needle ; Bone Marrow ; Diagnosis ; Epistaxis ; Head* ; Humans ; Lymph Nodes ; Lymphatic Diseases ; Magnetic Resonance Imaging ; Middle Aged ; Multiple Myeloma ; Nasal Cavity ; Nasal Obstruction ; Nasopharynx ; Neck* ; Nose ; Plasmacytoma* ; Radiotherapy

OBJECTIVETo study the clinical, radiologic and pathologic features of solitary plasmacytoma of spine.

METHODSThe clinical, radiologic and pathologic features, as well as treatment and follow-up data, of 13 solitary plasmacytoma of spine cases were retrieved and analyzed. Immunohistochemical study using EnVision method for LCA, CD19, CD20, CD79a, CD3, CD7, PC, MUM1, CD138, IgG, IgM, kappa, lambda and Ki-67 was carried out.

RESULTSAll the tumours were primarily located in the vertebrae (including 9 cases in thoracic vertebrae and 4 cases in lumbar vertebrae). The male-to-female ratio was 3.3:1. The age of the patients ranged from 42 to 69 years (mean age = 56 years). The commonest symptom was pain in the surrounding regions. The degree of neurologic disturbance mostly depended on the extent of vertebral destruction and structural instability of the spine. Radiologic examination showed mainly osteolytic lesions in vertebrae. Magnetic resonance imaging demonstrated the presence of heterogeneous intensity inside the involved vertebrae (low in T1 weighted and high in T2 weighted images). Histologic examination showed diffuse infiltration by malignant cells. In well-differentiated plasmacytomas, the tumor cells resembled normal plasma cells. In poorly differentiated examples, the cellular morphology mimicked that of the centroblasts. The interstitial stroma was scanty and contained plenty of vessels, sometimes with formation of blood lakes. Amyloid deposition was present in some of the cases. Immunohistochemical study showed that the tumor cells were positive for CD79a and negative for CD20. Light chain restriction was detected in all the 13 cases studied. Plasma cell marker PC was expressed in all cases, while IgG was positive in 5 cases, IgM in 1 case, MUM1 in 10 cases and CD138 in 8 cases. Ki-67 index varied from 10% to 50%. All cases were operated, with adjuvant chemotherapy and radiotherapy given.

CONCLUSIONSCorrelation of clinical, radiologic and pathologic features is important in diagnosis of solitary plasmacytoma of spine. The possibility of multiple myeloma needs to be excluded. Early detection by radiologic examination, local surgical resection, post-operative chemoradiotherapy and long-term follow-up are prudent for successful management of this condition.

Adult ; Aged ; CD79 Antigens ; metabolism ; Chemotherapy, Adjuvant ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Humans ; Lumbar Vertebrae ; Lymphoma, Large B-Cell, Diffuse ; pathology ; Magnetic Resonance Imaging ; Male ; Middle Aged ; Neoplasm Recurrence, Local ; Osteosarcoma ; pathology ; Plasmacytoma ; diagnosis ; metabolism ; pathology ; surgery ; Radiotherapy, Adjuvant ; Spinal Neoplasms ; diagnosis ; metabolism ; pathology ; surgery ; Thoracic Vertebrae ; Tomography, X-Ray Computed