Solitary Plasmacytoma Of Bone Research Articles

Solitary Bone Plasmacytoma: The Role of Imaging in a Case Study

Solitary Bone Plasmacytoma: The Role of Imaging in a Case Study

Solitary Bone Plasmacytoma in the Bones of the Hand - Case Report

Solitary Bone Plasmacytoma in the Bones of the Hand - Case Report

Solitary Bone Plasmacytoma of the Skull Base With an Unusual Presentation.

Solitary bone plasmacytoma (SBP) is a rare hematological malignancy that usually occurs in the spine and rarely in the skull. It rarely presents in the skull base, but presenting symptoms are associated with cranial nerve involvement depending on the site of the disease. We present the case of a 61-year-old man with an unusual presentation of hoarseness secondary to vocal fold palsy. Imaging showed a large bony lesion in the temporo-occipital region with involvement of the jugular foramen. Further detailed diagnostic procedures confirmed SBP of the skull base. Radiotherapy was given with an uneventful recovery of vocal fold function. Skull base plasmacytoma can be considered as a differential diagnosis of causes of unilateral vocal fold palsy. Early therapeutic management may improve vocal fold function.

Development and validation of a machine learning-based postoperative prognostic model for plasma cell neoplasia with spinal lesions as initial clinical manifestations: a single-center cohort study.

Spinal multiple myeloma (MM) and solitary plasmacytoma of bone (SPB), both plasma cell neoplasms, greatly affect patients' quality of life due to spinal involvement. Accurate prediction of surgical outcomes is crucial for personalized patient care, but systematic treatment guidelines and predictive models are lacking. This study aimed to develop and validate a machine learning (ML)-based model to predict postoperative outcomes and identify prognostic factors for patients with spinal MM and SPB. A retrospective analysis was conducted on patients diagnosed with MM or SPB from 2011 to 2015, followed by prospective data collection from 2016 to 2017. Patient demographics, tumor characteristics, clinical treatments, and laboratory results were analyzed as input features. Four types of ML algorithms were employed for model development. The performance was assessed using discrimination and calibration measures, and the Shapley Additive exPlanations (SHAP) method was applied for model interpretation. A total of 169 patients were included, with 119 for model training and 50 for validation. The Gaussian Naïve Bayes (GNB) model exhibited superior predictive accuracy and stability. Prospective validation on the 50 patients revealed an area under the curve (AUC) of 0.863, effectively distinguishing between 5-year survivors and non-survivors. Key prognostic factors identified included International Staging System (ISS) stage, Durie-Salmon (DS) stage, targeted therapy, and age. The GNB model has the best performance and high reliability in predicting postoperative outcomes. Variables such as ISS stage and DS stage were significant in influencing patient prognosis. This study enhances the ability to identify patients at risk of poor outcomes, thereby aiding clinical decision-making.

De Novo Plasmacytoma at the Site of Previous Anterior Cervical Fusion

BACKGROUND AND IMPORTANCE: Solitary plasmacytoma of bone (SPB) is a rare tumor that forms from monoclonal plasma cells within bone. These tumors are typically found in patients in their fifth to sixth decade of life and often progress to multiple myeloma. Previous reports have noted the formation of these tumors at the site of previous procedures or trauma, yet none have reported the development of SPB at the same site of a previous spinal surgery. CLINICAL PRESENTATION: The authors report on a 47-year-old woman who developed a de novo plasmacytoma 6 years after anterior cervical discectomy and fusion at the surgical site. CONCLUSION: Although SPB is a rare tumor primarily seen in bone that has been unaffected by surgery, it should be included in the differential after finding a tumor at the site of a previous spine surgery. Furthermore, biopsy should be considered once a lesion is identified in the area of a previous spine surgery, as SPB may progress to multiple myeloma, resulting in worse outcomes.

Enhanced clinical outcomes with radiotherapy in diagnostically challenging intracranial plasmacytomas: Analysis of 190 cases.

Intracranial plasmacytomas are rare tumors arising from plasma cells with approximately half of the cases progressing to multiple myeloma (MM). However, there is a lack of comprehensive clinical cohort analysis on the clinical and pathological features, progression, and outcomes of intracranial plasmacytomas. A retrospective analysis of 190 cases was conducted, combining data from 38 cases in a single institution and 152 cases from the literature. Patient demographics, clinical presentations, tumor locations, imaging features, surgical treatments, and follow-up outcomes were collected and analyzed. Survival analysis and Cox regression analysis were performed to identify prognostic factors. A total of 190 intracranial plasmacytoma patients with an average age of 55.4 years were included in the study. The preoperative misdiagnosis ratio was high at 55.3%, and 59.7% of the tumors affected the calvaria convexity, compared to 40.3% located at the skull base. Resection and biopsy were achieved in 72.4% and 27.6% patients, respectively. Among them, 34.2% (65/190) of patients were initially diagnosed with MM with intracranial plasmacytoma as their first presentation (MM-IPFP), while 63.2% (120/190) of patients were diagnosed with solitary intracranial plasmacytoma (SIP), including 61 extramedullary plasmacytomas and 59 solitary bone plasmacytomas. In the SIP group, 22.4% (24/107) of patients experienced disease progression leading to the development of MM during a median follow-up time of 42.6 months (range 1-230 months). Multivariate analysis unveiled that radiotherapy (HR, 0.05; 95% CI, 0.00-0.87; p = 0.04), not surgery, was a protective prognostic factor for overall survival in MM-IPFP patients. Comparison between the SIP progression group and non-progression group revealed a significant difference of Ki-67 index (non-progression vs. SIP progression, 8.82% ± 7.03 vs. 16.5% ± 10.5, p < 0.05). AUC analysis determined that a cutoff value of 9.0% was the best predictor of SIP progression, with an area under the curve of 0.712. This retrospective clinical analysis highlights the potential role of radiotherapy, rather than surgical resection, in improving the outcomes of intracranial plasmacytoma. Additionally, the Ki-67 index is identified as a valuable marker for predicting disease progression. This would provide some evidence for the paradigm of diagnosis and treatment modalities for intracranial plasmacytomas from the large cohort.

Solitary bone plasmacytoma of spine with involvement of intervertebral disk: a case report and literature review.

Primary malignant bone tumors of the spine are exceedingly rare, with solitary bone plasmacytoma (SBP) representing approximately 30% of all cases. Radiological assessments are crucial for localizing SBP and for ruling out a diagnosis of multiple myeloma (MM). Imaging features resembling a "mini-brain" appear to be distinctive for SBP. Vertebral lesions accompanied by adjacent disc space involvement typically suggest spinal infections, while the potential for SBP involvement is often overlooked. We present a case of a 61-year-old female with SBP who exhibited thoraco-lumbar spine destruction and adjacent disc space involvement. The patient sought treatment at our medical center due to lumbodorsal pain radiating bilaterally to the inguinal regions. Radiological findings revealed an osteolytic lesion involving the intervertebral disc, making it challenging to distinguish between tumor and inflammation. A biopsy of the vertebral lesion confirmed the diagnosis of SBP, which was further supported by laboratory results. Post-diagnosis, the patient underwent radiotherapy, receiving a total dose of 4000Gy, which alleviated her symptoms. We also provide a comprehensive literature review on SBP with disc involvement to aid both clinical and radiological diagnoses.

Solitary Bone Plasmacytoma of Spine

A 54-year-old male presented a chronic intense back pain that progressed to paraplegia and urinary disorders. His lateral spinal x-ray showed osteolytic destruction of T1 and T2 vertebrae with intervertebral space stenosis. MRI detected a single malignant osteolytic process of the spine involving T1 and T2 with a pathologic fracture leading to segmental kyphosis. Epidural soft tissue mass with typical curtain sign was causing spinal cord compression Figure 1.

A Case of Extramedullary Plasmacytoma in Both Maxillary Sinuses

Plasmacytoma is a rare hematolymphoid malignancy. The three types of plasmacytoma, according to clinical features and morphological characteristics, include solitary bone plasmacytoma, extramedullary plasmacytoma (EMP), and multiple myeloma (MM). Although EMP of the head and neck region accounts for approximately 3% of all plasma cell tumors, the involvement of both paranasal sinuses is extremely rare. Herein, we describe a rare case of EMP involving both maxillary sinuses in a 73-year-old male patient who had achieved complete remission from MM following chemotherapy 2 years ago. The EMP was treated successfully with radiotherapy.

Predictors of Relapse after Definitive Treatment of Solitary Plasmacytoma: A Systematic Review

Introduction Solitary plasmacytoma refers to a rare form of mature B-cell malignancy that can present either extraosseous i.e., solitary extramedullary plasmacytoma (SEP), or the more common type, intraosseous i.e., solitary bone plasmacytoma (SBP). According to the National Comprehensive Care Network, the primary treatment of solitary plasmacytoma is radiotherapy with 40-50 Gy to the involved field +/- surgery (if the patient is unstable or has symptoms indicative of neurological compression), or chemotherapy (if the patient has bulky disease defined as ≥5 cm or unresponsive to radiotherapy). This systematic review aimed to assess relapse predictors of solitary plasmacytoma following definitive treatment. Methods A systematic review was conducted in adherence to the PRISMA guidelines with a pre-specified study protocol registered on PROSPERO (CRD42023432422). A literature search was performed utilizing Medline, ScienceDirect, Google Scholar, Cochrane, and Clinicaltrials.gov, on April 15, 2023. The MeSH terms “plasmacytoma”, “recurrence”, “relapse”, “prognosis”, and “treatment” were used. The inclusion criteria were defined as retrospective, randomized, or non-randomized controlled studies published in English that include patients with solitary plasmacytomas of any site, who received radiotherapy, chemotherapy, and/or surgery, and have outcomes of overall survival, progression-free/relapsed-free survival (PFS/RFS), and time to progression to multiple myeloma. Results After meeting the inclusion criteria, twenty-seven studies were included. Among 1412 patients,1034 (73%) SBP, 427 (30%) SEP, and 844 (60%) males were studied. Most articles were published in the USA (15%), followed by Italy (11%) and France (11%). Several overlapping predictors of relapse were observed (Table 1), with younger age (age &amp;lt;60) and tumor size &amp;lt;5 cm the most common significant better prognostic factors; mentioned in 10 (37%) and 7 (26%) studies, respectively. Interestingly, SBP tumor type was associated with worse prognosis in 3 (11%) studies, while SEP tumor type had mixed prognostic association; worse prognostic association in 4 (15%), and better in 3 (11%) studies. Less common negative prognostic indicators included immunoparesis at diagnosis, occult marrow disease, positive serum M protein, persistent M spike, positive serum B2 microglobulin, positive Bence Jones protein, and positive urinary monoclonal light chains. Radiotherapy exhibited a better prognosis alone, with surgery, and with chemotherapy. In addition, a higher radiation dose (&amp;gt;40 Gy) was associated with better prognosis, supported by another study that showed a worse prognosis with a lower radiation dose (&amp;lt;50 Gy). Four studies did not demonstrate a statistically significant prognostic factor. Conclusion Tumor size and age appear to be the most common significant prognostic indicators for solitary plasmacytoma when indexed to outcomes of OS, PFS, MMFS, and median time to MM progression. Several other prognostic indicators have been reported but require further research to ascertain their strength of association and possibly direct future screening and management.

A population-based study on incidence trends of myeloma in the United States over 2000–2020

Myeloma is one of the most common types of haematological malignancies. We aimed to investigate the incidence rates of myeloma by sex, race, age, and histological subgroups in the United States (US) over 2000–2020. Data were retrieved from the the Surveillance, Epidemiology, and End Results (SEER) 22 database. The International Classification of Diseases for Oncology version 3 morphological codes 9731, 9732, and 9734 were assigned for solitary plasmacytoma of bone, plasma cell myeloma, and extraosseous plasmacytoma, respectively. Average annual percent change (AAPC) and the pairwise comparison with the parallelism and coincidence were reported. All estimates were reported as counts and age-adjusted incidence rates per 100,000 individuals. Over 2000–2019, most of myeloma cases were among those aged at least 55 years (85.51%), men (54.82%), and non-Hispanic Whites (66.67%). Among different subtypes, plasma cell myeloma with 193,530 cases had the highest frequency over the same period. Also, there was a significant decrease in the age-standardized incidence rate of myeloma across all races/ethnicities in both sexes within all age groups (AAPC: − 8.02; 95% confidence interval (CI): − 10.43 to − 5.61) and those aged < 55 (AAPC: − 8.64; 95% CI − 11.02 to − 6.25) from 2019 to November 2020. The overall trends of myeloma incidence rates were not parallel, nor identical. There was an increase in myeloma incidence in both sexes, with a highly increasing rate, particularly among younger Hispanic and non-Hispanic Black women over 2000–2019. However, a remarkable decline was observed in the incidence rates following the COVID-19 pandemic in 2020.

Characterization of patients with Philadelphia negative myeloproliferative neoplasms and concomitant monoclonal gammopathies: Just coincidence?

Retrospective observational study of case series. The MPN Ph (-) database of our center between 2015 and 2020 was consulted. The clinical records were reviewed, obtaining demographic, clinical, and management determinants. Descriptive statistical analysis was performed. Among 144 patients, 6 patients diagnosed with MG and MPN were found, all of them female. The median age was 71 years at diagnosis of MPN Ph (-) and 70 years at diagnosis of MG. Two were diagnosed concomitantly with both pathologies, in 2 the MG preceded the MPN, and in 2 the MPN was previously diagnosed. No patient has progressed to acute leukemia or myelofibrosis. Regarding the treatments received, all received Hydroxicarbamide, some with aspirin and one with anticoagulation. Of the MGs, one patient with solitary bone plasmacytoma progressed to multiple myeloma, requiring treatment after 2 years. Two had a thrombotic event, both arterials. The observed MG frequency of 4% was similar to what was expected for the age of the patients. Although it is noteworthy that 2 had thrombotic events, further studies are needed to evaluate this association.

Chronic acquired polyneuropathy as presentation of skull based solitary bone plasmacytoma

Plasmacytomas can be solitary or multiple (osteosclerotic myeloma). Neuropathy resembling chronic inflammatory demyelinating polyradiculoneuropathy or POEMS syndrome has rarely been reported in literature in association of cranial vault plasmacytoma. A female patient with severe demyelinating sensori-motor polyneuropathy with conduction block, was found to have solitary skeletal lesion in the left frontal bone which confirmed to be a plasma cell neoplasm on biopsy. She had significant improvement in neurological signs and symptoms following local radiation and chemotherapy over next 3 months. Solitary bone plasmacytoma (SBP) is rare, accounting for 2-5% of all plasma cell neoplasms. The axial skeleton, especially vertebral body, is the most common site and cranial vault is one of the least commonly reported. Radiation therapy (RT) is the treatment of choice for SBP. There is no evidence that plasma exchange, IVIg or other immunosuppressive agents are effective when used alone in treatment of SBP-associated neuropathy.

Solitary plasmacytoma masquerading as a benign lesion

Plasmacytoma refers to a distinct and localized growth of plasma cells that are neoplastic and monoclonal in nature. Solitary plasmacytomas (SP) can be categorized into two groups based on their location: solitary bone plasmacytoma (SBP), which most commonly occurs in the vertebrae and secondarily in long bones, and extramedullary plasmacytoma (EMP), encompassing SPs found outside the bone. Long bones are frequently affected in solitary plasmacytomas. SBP specifically in the jaw is a rare condition, leading to challenges in diagnosis and often resulting in misdiagnosis. SBP carries a higher risk of progression to myeloma, and the primary treatment option is radiotherapy (RT). By employing RT alone, approximately 30% of SBP patients and 65% of EMP patients can achieve long-term disease-free survival (DFS). This article presents a case of a 40-year-old female patient diagnosed with solitary plasmacytoma of the mandible, with detailed documentation of clinical, radiographic, and histological features.

Solitary occipital bone plasmacytoma with unusual ocular signs

Solitary occipital bone plasmacytoma at the level of the confluence of sinuses is a rare condition. We report a case of an unusual combination of occipital bone plasmacytoma, ocular motility abnormalities, and papilledema. To the best of our knowledge, no case has been reported in the literature on such a combination of nosology, location and clinical course.

P-448 Impact of molecular cytogenetic abnormalities on the risk of disease progression in solitary bone plasmacytomas

P-448 Impact of molecular cytogenetic abnormalities on the risk of disease progression in solitary bone plasmacytomas

Impact of cytogenetic abnormalities on the risk of disease progression in solitary bone plasmacytomas

AbstractMost patients with solitary bone plasmacytomas (SBP) progress to multiple myeloma (MM) after definitive radiation therapy as their primary treatment. Whether the presence of high-risk (HR) cytogenetic abnormalities by fluorescence in situ hybridization (FISH) in the clonal plasma cells, obtained either directly from the diagnostic SBP tissue or the corresponding bone marrow examination at the time of diagnosis, is associated with a shorter time to progression (TTP) to MM is unknown. This study evaluated all patients diagnosed with SBP at the Mayo Clinic from January 2012 to July 2022. The presence of del(17p), t(14;16), t(4;14), or +1q (gain or amplification) by FISH in clonal plasma cells was defined as HR. A total of 114 patients were included in this cohort, and baseline FISH was available for 55 patients (48%), of which 22 were classified as HR (40%). The median TTP to MM for patients with SBP and HR FISH was 8 months (95% confidence interval [CI], 6.3-26) compared with 42 months (95% CI, 25-not reached [NR]) in patients with SBP without HR FISH (P < .001). In a multivariate analysis, only HR FISH was a significant predictor for shorter TTP to MM, independent of minimal marrow involvement and an abnormal serum free light chain ratio at diagnosis. Deletion (17p) and gain 1q abnormalities were the most common FISH abnormalities responsible for the short TTP to MM. Thus, assessing for HR FISH abnormalities in clonal plasma cells derived from either the diagnostic SBP tissue or the staging bone marrow examination of patients with newly diagnosed SBP is feasible and prognostic for a shorter TTP to MM.

Predictors of response to radiation therapy and of progression to multiple myeloma in patients with solitary bone and extramedullary plasmacytomas

Introduction: Radiation therapy (RT) plays an important role in treating Solitary Extramedullary (EMP) and Solitary Bone (SBP) Plasmacytomas. The objective of this study is to review the effectiveness of RT in locally controlling the disease and looking at factors that predict progression to Multiple Myeloma (MM) in the PET scan-era. Methods: We performed a retrospective analysis of consecutive plasmacytoma patients (pts) treated at our high-volume center. We identified 94 pts, of which 62 were diagnosed with SBP and 32 with EMP, without evidence of MM at diagnosis (end-organ damage, >10% bone marrow involvement, >1 plasmacytoma). We identified 94 total pts, largest series to date in the literature, treated with RT (no pts received systemic therapy) between January 1, 2000, through December 31, 2020. Of the 94 pts, 62 were diagnosed with SBP and 32 with EMP, without evidence of MM at diagnosis (end-organ damage, >10% bone marrow involvement, >1 plasmacytoma). We utilized radiographic staging including PET scans and clinical assessments to determine patient outcomes. Outcomes include initial radiographic responses using the European Expert Panel Response Criteria, local control (LC), overall survival (OS), and progression to MM. Kaplan-Meier was used to assess LC and OS. Univariable analysis was done using age, sex, race, plasmacytoma type (EMP vs. SBP), PET scan at staging versus other modalities, first post-RT response (CR, no CR), Pre-RT SUV of lesion, RT dose (≥45 Gy) and overall response to RT (if CR was achieved). Results: Patient and treatment characteristics are summarized in table 1. 24 (66%) EMPs and 54 (84%) SBPs received a radiation dose ≥45 Gy. After excluding 8 patients who were lost to follow up, 81% of patients with EMPs and 81% with SBPs achieved complete response (CR) with a median time to CR being 11 months (range 0.53–38.9) for EMP and 8 months (range 0.6–89.2) for SBP. All pts achieving a CR were treated with doses ≥40 Gy. Only 1 (3%) EMP and 2 (3%) SBPs had an in-field failure after CR. The 5-year OS was 68% for EMPs and 94% for SBPs [p = 0.007]. Out of 94 pts, 19 died, and cause of death was not related to the plasma cell neoplasm in 7 EMP pts. The 5-year rate of progression to MM was 28% in the EMP group, and 64% in the SBP group [p = 0.006], with progression-free survival (PFS) of 61% In the EMP group and 35% in the SBP group [p = 0.041]. On univariate analysis, sex, age, RT dose (<45 Gy, ≥45 Gy), staging PET, location [EMP vs. SBP] and achieving a CR after RT (at first post-RT response and CR at any time) were analyzed. Pts with EMP were at significantly lower risk for progression to MM (HR 0.3, 95% CI: 0.2, 0.8; p = 0.009) Additionally, Pts with CR on first post-RT imaging were at lower risk for progression to MM (HR 0.6, 95% CI: 0.3, 1.0, p = 0.05). Conclusion: Our data indicates that definitive RT for EMP and SBP can provide excellent LC. Progression to MM remains the main problem and is more common among pts with SBP, which is concordant with previously published literature. Keyword: Multiple Myeloma Conflicts of interests pertinent to the abstract. B. Imber Honoraria: GT Medical Technologies

Survival outcomes, clinical features and treatment patterns of solitary plasmacytoma in the United States: A National Cancer Database (NCDB) analysis of years 2004-2017.

e20060 Background: Due to its rarity, comprehensive studies on plasmacytoma are limited. There are two main subtypes: solitary bone plasmacytoma (P-Bone) and extramedullary plasmacytoma (P-EM). In this IRB approved retrospective analysis, the NCDB was used to evaluate the clinical features and factors affecting the overall survival of patients with plasmacytoma who were treated at commission on cancer (CoC) accredited facilities across the USA. Methods: Using the NCDB, we identified N = 6,579 patients with plasmacytoma from 2004 to 2017, after excluding multiple myeloma patients. N = 4,816 patients had P-Bone &amp; N = 1,763 patients had P-EM. Descriptive statistics were used and multivariable cox regression analysis was utilized to identify the independent survival factors, using significance level of p &lt; 0.05. Kaplan-Meier curves were produced. SPSS was used to analyze the data. Results: P-Bone represented 73.2% of cases. Overall median survival time was 105 and 147 months for P-Bone and P-EM respectively; 56 and 149 months for &lt; 37 Gy and ≥ 37 Gy radiation dose respectively; 66, 112, 107 and 132 months for no treatment, surgery alone, radiation therapy alone and combination therapy (surgery + radiation) respectively. Multivariable cox regression revealed that there were 10 significant independent survival factors including age, ethnicity, facility type, insurance status, median income, education level, Charlson-Deyo score, year of diagnosis, plasmacytoma site and treatment pattern. Patients with P-EM were less likely to die compared to P-Bone (HR = 0.734, p &lt; 0.001). Hispanic patients were less likely to die compared to non-Hispanics (HR = 0.66, p &lt; 0.001). In addition to that, patients with private insurance were less likely to suffer death compared to patients with no insurance (HR = 0.71, p = 0.01). Subjects who were treated in academic facilities were less likely to die compared to the ones who received care in non-academic centers (HR = 0.86, p &lt; 0.001). Moreover, patients with median income ≥ $63,000 were less likely to die compared to patients with median income &lt; $38,000 (HR = 0.85, p = 0.04). Subjects with higher level of education (no high school diploma in &lt; 7%) were less likely to suffer death compared to subjects with lower level of education (no high school diploma in ≥ 21%) (HR = 0.82, p = 0.018). Patients who were treated with radiation alone (HR = 0.54, p &lt; 0.001), surgery alone (HR = 0.57, p &lt; 0.001), and combination therapy (HR = 0.43, p &lt; 0.001) were less likely to die compared to patients who did not receive any treatment. Detailed analysis will be presented. Conclusions: In this largest real-world plasmacytoma cohort ever reported, we found that patients with P-Bone and those with lower socio-economic status had worse outcomes. In addition use of combination therapy and the use of a higher radiation dose ≥ 37 Gy were associated with better outcomes.

Solitary Bone Plasmacytoma Mimicking Oral Cavity Neoplasm – A Rare Case

Plasmacytomas are localized monoclonal plasma cell lesions with no evidence of systemic involvement which are divided into solitary bone plasmacytoma (SBP) and extra-medullary plasmacytoma (EMP). The diagnosis of plasmacytomas (PCM) in the oral regions is challenging given the atypical clinical manifestations and low frequency. Here, we report an extremely rare case of plasmacytoma in an elderly male which initially appeared to be arising from the left buccal mucosa on clinical examination but after radiological imaging and intra-operative findings, the epicentre was found to be in the left infratemporal fossa (ITF). The patient underwent en-bloc compartment resection with high clearance of the ITF which proved to be an effective management strategy. It is crucial for the head and neck surgeon to be aware of the solitary bone plasmacytoma in the oral and maxillofacial region in order to identify it early and provide these patients with the best care possible before complications arise.