J Korean Neurosurg Soc.  2013 Nov;54(5):426-430. 10.3340/jkns.2013.54.5.426.

Rapid Progression of Solitary Plasmacytoma to Multiple Myeloma in Lumbar Vertebra

• Yang JS
• Cho YJ
• Kang SH
• Choi HJ

• KMID: 2138361
• DOI: http://doi.org/10.3340/jkns.2013.54.5.426

Abstract

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.

Keyword

Solitary plasmacytoma; Serum free light chain; Multiple myeloma; Lumbar vertebrae

MeSH Terms

Decompression, Surgical
Diagnosis
Humans
Lumbar Vertebrae
Multiple Myeloma*
Plasmacytoma*
Prognosis
Radiotherapy
Risk Factors
Spine*

Figure

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  Fig. 1 Preoperative CT (A : axial) and MRI contrast-enhanced T1-weighted images (B : axial) reveal a lytic lesion involving the right mid-posterior area of the L3 vertebral body and the right psoas muscle, and an epidural mass producing dural sac compression. Preoperative whole body PET/CT (C : coronal) shows a right paravertebral soft tissue mass with mildly increased FDG-tracer uptake, and no metastases.

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  Fig. 2 Postoperative plain X-ray after surgical decompression with stabilization (anterior to posterior) reveals expandable interbody cage and posterior pedicle screw fixation L1/2/4.

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  Fig. 3 Postoperative immunohistochemical staining of resected mass (A : Immunoglobulin restriction, B : CD138) shows Ig Kappa chain restriction and CD138 positive reaction.

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  Fig. 4 A repeated PET/CT reveals disseminated multiple bony lytic lesions with increased FDG uptake.

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