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Plasmacytoma

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Imaging of Primary Tumors of the Osseous Spine

Part of the book series: Medical Radiology ((Med Radiol Diagn Imaging))

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Abstract

Solitary plasmacytoma of bone is one of many existing types of bone tumors and is part of the plasma cell disorder spectrum. It is a local clonal plasma cell proliferation without evidence of symptomatic multiple myeloma. It occurs slightly more frequently in males with a median age at diagnosis of 55 years. The thoracic vertebrae are most frequently involved. The exact etiology is unknown, although a role for acquired B-cell defects is suggested. In children and young adults, preceding trauma might play a role in the development of solitary plasmacytoma of bone. Compared to extramedullary plasmacytoma, solitary plasmacytoma of bone has a significantly worse prognosis, progressing to symptomatic multiple myeloma in over 50% of cases. The survival rates are significantly worse in case of abnormal serum immunoglobulin free light chain ratio, in patients diagnosed after the age of 60 years and in female patients.

In one-third of presumed “solitary” plasmacytomas, an additional lesion is characterized with subsequent diagnostic imaging, marking the importance of further investigations when an apparent solitary plasmacytoma of bone is encountered. Conventional radiography plays a distinct role in the imaging and detection of solitary plasmacytoma of bone, mostly in the presence of clear clinical symptoms. It may show a “punched-out” lesion appearance with generally clear margins and normal surrounding bone. More advanced cases may be paired with marked erosion and cortical bone destruction, creating a “soap bubble” appearance. On CT, solitary plasmacytoma of bone presents as a uni- or multilocular lesion, causing focal trabecular destruction. A characteristic “mini brain” appearance may be observed. On conventional MRI, a plasmacytoma is iso- to hypointense on T1-weighted images and hyperintense on (fat-saturated) T2-weighted images compared to muscle and enhances homogeneously after gadolinium contrast administration. Specialized MRI techniques such as dynamic contrast-enhanced MRI and diffusion-weighted imaging also play an important role, especially in assessing disease extent and differentiation with multiple myeloma, where a focal solitary plasmacytoma of bone is accompanied by surrounding or distant bone marrow invasion. 18F-FDG PET/CT is useful in the evaluation and has a prognostic value both at diagnosis and in the evaluation of treatment.

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Abbreviations

ADC:

Apparent diffusion coefficient

BM:

Bone marrow

BMI:

Body mass index

b-Value:

Diffusion-sensitizing gradient

CRAB:

Calcemia, renal failure, anemia, bone lesions

DCE-MRI:

Dynamic contrast-enhanced MRI

DD:

Differential diagnosis

DWI(BS):

Diffusion-weighted whole-body imaging with background body signal suppression

EBV:

Epstein-Barr virus

EMP:

Extramedullary plasmacytoma

FDG:

Fluorodeoxyglucose

FLC:

Free light chain

Gd:

Gadolinium

Hb:

Hemoglobin

HE:

Hematoxylin and eosin

(i)AUC:

Initial-area-under-curve

Ig:

Immunoglobulin

IMWG:

International Myeloma Working Group

MDE:

Myeloma-defining events

MGUS:

Monoclonal gammopathy of undetermined significance

MM:

Multiple myeloma

M-protein:

Monoclonal protein

MRD:

Minimal residual disease

MVD:

Microvessel density

MYRADS:

Myeloma response assessment and diagnosis system

OS:

Overall survival

PC(D):

Plasma cell (disorder)

PET:

Positron emission tomography

PFS:

Progression-free survival

ROI:

Region-of-interest

(s)FLC:

(serum) Free light chain

SI:

Signal intensity

SLIM:

Sixty, light chains, MRI

SMM:

Smoldering multiple myeloma

SNR:

Signal-to-noise ratio

SP(B):

Solitary plasmacytoma (of bone)

STIR:

Short tau inversion recovery

SUV:

Standardized uptake value

T1-WI:

T1-weighted imaging

T2FS-WI:

Fat-saturated T2-weighted imaging

TCC:

Time-concentration curve

TIC:

Time-intensity curve

TTP:

Time-to-peak

WBLDCT:

Whole-body low dose computed tomography

WBMRI:

Whole-body magnetic resonance imaging

WBXR:

Whole-body conventional radiography

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Authors and Affiliations

  1. Department of Diagnostic Sciences, Faculty of Medicine and Health Sciences, Ghent University, Ghent, Belgium

    Thomas Van Den Berghe, Denim Brack, Alexander De Clercq, Jo Van Dorpe, Julie Dutoit, Filip M. Vanhoenacker & Koenraad L. Verstraete

  2. Department of Radiology and Medical Imaging, Ghent University Hospital, Ghent, Belgium

    Thomas Van Den Berghe & Koenraad L. Verstraete

  3. Department of Pathology, Ghent University Hospital, Ghent, Belgium

    Jo Van Dorpe

  4. Cancer Research Institute (CRIG), Ghent University Hospital, Ghent, Belgium

    Jo Van Dorpe

  5. Department of Radiology and Medical Imaging, General Hospital Groeninge—Campus Kennedylaan, Kortrijk, Belgium

    Julie Dutoit

  6. Department of Radiology and Medical Imaging, General Hospital Sint-Maarten Mechelen, Mechelen, Belgium

    Filip M. Vanhoenacker

  7. Department of Radiology and Medical Imaging, University Hospital Antwerp, Edegem, Belgium

    Filip M. Vanhoenacker

  8. Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium

    Filip M. Vanhoenacker

  9. Faculty of Medicine and Health Sciences, KU Leuven, Leuven, Belgium

    Filip M. Vanhoenacker

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  1. Thomas Van Den Berghe
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  2. Denim Brack
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  7. Koenraad L. Verstraete
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Correspondence to Thomas Van Den Berghe .

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  1. Department of Radiology, M Kassab Orthopedic Institute, Tunis, Tunisia

    Mohamed Fethi Ladeb

  2. Department of Radiology, AZ Sint-Maarten Mechelen, Mechelen, Belgium

    Filip Vanhoenacker

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Van Den Berghe, T. et al. (2023). Plasmacytoma. In: Ladeb, M.F., Vanhoenacker, F. (eds) Imaging of Primary Tumors of the Osseous Spine. Medical Radiology(). Springer, Cham. https://doi.org/10.1007/174_2023_452

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  • DOI: https://doi.org/10.1007/174_2023_452

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  • Print ISBN: 978-3-031-56885-5

  • Online ISBN: 978-3-031-56886-2

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