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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References
Dores GM, Landgren O, McGlynn KA, Curtis RE, Linet MS, Devesa SS (2009) Plasmacytoma of bone, extramedullary plasmacytoma, and multiple myeloma: incidence and survival in the United States, 1992–2004. Br J Haematol 144:86–94. doi:10.1111/j.1365-2141.2008.07421.x
Knowling MA, Harwood AR, Bergsagel DE (1983) Comparison of extramedullary plasmacytomas with solitary and multiple plasma cell tumors of bone. J Clin Oncol 1:255–262
Soutar R, Lucraft H, Jackson G, Reece A, Bird J, Low E et al (2004) Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Br J Haematol 124:717–726
Dimopoulos MA, Moulopoulos LA, Maniatis A, Alexanian R (2000) Solitary plasmacytoma of bone and asymptomatic multiple myeloma. Blood 96:2037–2044
Taneichi H, Kaneda K, Takeda N, Abumi K, Satoh S (1997) Risk factors and probability of vertebral body collapse in metastases of the thoracic and lumbar spine. Spine 22:239–245
McLain RF, Weinstein JN (1989) Solitary plasmacytomas of the spine: a review of 84 cases. J Spinal Disord 2:69–74
Frassica DA, Frassica FJ, Schray MF, Sim FH, Kyle RA (1989) Solitary plasmacytoma of bone: Mayo Clinic experience. Int J Radiat Oncol Biol Phys 16:43–48
Holland J, Trenkner DA, Wasserman TH, Fineberg B (1992) Plasmacytoma. Treatment results and conversion to myeloma. Cancer 69:1513–1517
Knobel D, Zouhair A, Tsang RW et al (2006) Prognostic factors in solitary plasmacytoma of the bone: a multicenter Rare Cancer Network study. BMC Cancer 6:118. doi:10.1186/1471-2407-6-118
Dimopoulos MA, Hamilos G (2002) Solitary bone plasmacytoma and extramedullary plasmacytoma. Curr Treat Options Oncol 3:255–259
Ozsahin M, Tsang RW, Poortmans P et al (2006) Outcomes and patterns of failure in solitary plasmacytoma: a multicenter Rare Cancer Network study of 258 patients. Int J Radiat Oncol Biol Phys 64:210–217. doi:10.1016/j.ijrobp.2005.06.039
Bataille R, Sany J (1981) Solitary myeloma: clinical and prognostic features of a review of 114 cases. Cancer 48:845–851
Jackson A, Scarffe JH (1990) Prognostic significance of osteopenia and immunoparesis at presentation in patients with solitary myeloma of bone. Eur J Cancer 26:363–371
Weber DM (2005) Solitary bone and extramedullary plasmacytoma. Hematology Am Soc Hematol Educ Program: 373–376. doi:10.1182/asheducation-2005.1.373
Wilder RB, Ha CS, Cox JD, Weber D, Delasalle K, Alexanian R (2002) Persistence of myeloma protein for more than one year after radiotherapy is an adverse prognostic factor in solitary plasmacytoma of bone. Cancer 94:1532–1537
Tomita K, Kawahara N, Kobayashi T, Yoshida A, Murakami H, Akamaru T (2001) Surgical strategy for spinal metastases. Spine 26:298–306
Boriani S, Weinstein JN, Biagini R (1997) Primary bone tumors of the spine. Terminology and surgical staging. Spine 22:1036–1044
Tsang RW, Gospodarowicz MK, Pintilie M et al (2001) Solitary plasmacytoma treated with radiotherapy: impact of tumor size on outcome. Int J Radiat Oncol Biol Phys 50:113–120
Sawyer JR (2011) The prognostic significance of cytogenetics and molecular profiling in multiple myeloma. Cancer Genet 204:3–12. doi:10.1016/j.cancergencyto.2010.11.002
Huang W, Cao D, Ma J (2010) Solitary plasmacytoma of cervical spine: treatment and prognosis in patients with neurological lesions and spinal instability. Spine 35:E278–E284. doi:10.1097/BRS.0b013e3181c9b431
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von der Hoeh, N.H., Tschoeke, S.K., Gulow, J. et al. Total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of literature. Eur Spine J 23, 35–39 (2014). https://doi.org/10.1007/s00586-013-2922-2
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DOI: https://doi.org/10.1007/s00586-013-2922-2