Solitary Plasmacytoma Of Bone Research Articles

Clinicopathological Analyses of Solitary Plasmacytoma in a Single Institution of China

Background: Solitary plasmacytoma (SP), accounting for less than 5% of all plasma cell dyscrasias, is a rare disorder with localized proliferation of neoplastic monoclonal plasma cell. Due to the rarity of SP, further understanding of the spectrum of clinicopathologic features is needed. Methods: A 5-year retrospective analysis of cases from a single institution was conducted. Specifically, clinical characteristics of all SP patients were collected, and quantitative immunohistochemical analysis on tissue microarray was performed. Findings: Thirteen cases were identified from our pathology archives, with solitary plasmacytoma of bone (SPB) accounting for 30.8% and extraosseous plasmacytoma (EP) for 69.2% of the cases. The mean age of EP is one decade older than SPB. No gender disparity is identified. The most common sites involved are the vertebrae and nasopharynx. Histologically, the tumors consist of plasmacytoid cells diffusely infiltrating the involved tissue, and can be classified into two grades based on the degree of differentiation. Immunohistochemically the tumor cells are positive for CD38, CD138, MUM-1, and exhibit light chain restriction. Ki-67 proliferation index averages at 30%. Quantitative immunohistochemistry stain analysis showed the neoplastic cells exhibiting decreased CD38 in integrated optical density (IOD). Epstein-Barr virus-encoded small RNAs (EBER) was negative in all six cases tested. Two cases were positive for IgH gene rearrangement. Interpretation: SP is a rare plasmacytoid tumor that occurs more frequently in older patients. Diagnosis requires a systematic approach, combined with the pathological characteristics of plasmacytoid morphology, immunophenotype and the light chain restriction. Furthermore In our study the data shows that the cases of EP is more than SPB, Which is opposite from the litterature. Further studies with more patients and long-time follow-up may provide more information to understand risk of recurrence and progression from SP to multiple myeloma (MM). Funding: Department of Science and Technology, Hubei Provincial People's Government (2020CFB343). Declaration of Interest: None to declare. Ethical Approval: This study was approved by the Ethics Committee of Zhongnan Hospital for discarded diagnostic material (no consent required).

Solitary extramedullary plasmacytoma: A rare gingival lesion

Plasma cell tumors consist of extramedullary plasmacytoma (EMP), multiple myeloma (MM), and solitary bone plasmacytoma (SBP). EMP is defined as neoplastic proliferation of plasma cells in soft tissues. It presents as a solitary discrete mass either in soft tissue as EMP or in bone as SBP or as disseminated MM. It is a very rare manifestation. It accounts for <1% of all head-and-neck malignancies with oral cavity being the rarest.

Multiple Solitary Plasmacytoma: A Rare Presentation

Plasmacytomas are localized tumors of monoclonal plasma cells, typically affecting the axial skeleton and present as solitary bone lesions known as solitary bone plasmacytomas (SBP). Another type of plasmacytomas are extramedullary plasmacytomas (EP) that are localized plasma cell neoplasms affecting the soft tissues such as skin, brain lymph nodes etc. These tumors are account for 5-10% of all plasma cell disorders and among these tumors a rare entity is a multiple solitary plasmacytoma (MSP). MSPs are rare and account for only 5% of all SBPs. MSP presents with multiple SBPs with or without EPs with no bone marrow involvement as multiple myeloma. Literature is limited on MSP as it is a rare diagnosis. Here, we present a case of a 64-year-old male who presented with shoulder pain after a fall, found to have an SBP of the right shoulder, SBP of left femur and a left hypopharyngeal EP. The tumors were excised and he was treated with 6 cycles of bortezomib and dexamethasone. After chemotherapy and radiation patient showed good response and remained in remission on follow up

Plasmacytoma of the iliac bone in a seven- year-old girl: A rare tumor with no to ignore

Abstract Solitary bone plasmacytoma is a rare plasmocytic neoplasm accounting for about 5% of all plasmocytic neoplasms. It is usually presented as a lytic lesion mainly localized in the axial skeleton. Its presence in adolescents is extremely rare. It is unheard of in children. We report a case of solitary plasmacytoma of the iliac bone in a 7-year-old girl with a history of trauma to the iliac bone.

POEMS SYNDROME ET COVID 19: LES RETOMBEES DUNE PANDEMIE !

POEMS syndrome defines a rare multisystem syndrome due to the paraneoplastic manifestation of plasma cell dyscrasia. The diagnosis is based on the clinic and the laboratory: this acronym includes part of all the current criteria on this disease: Polyradiculoneuropathy, Organomegaly, Endocrinopathy, Monoclonal plasma cell disease (PCD) and Skin changes. Peripheral neuropathy is often the revealing symptom of the disease. Bone involvement is present in 54 to 97% and is typically osteosclerotic. POEMS syndrome with plasmacytoma lytic bone lesion remain exceptional. In the case of patients with less than three solitary bone plasmacytomas, radiotherapy is recommended as a therapeutic approach with variable efficacy. Relapses remain frequent requiring systemic treatment. The management of the pandemic had indirect effects on serious diseases in fact, fear of the crisis caused by the epidemic is pushing a large number of patients to delay their request for care. In addition to chronic patient monitoring, the practitioners primary concern is to detect emergency situations. We report the case of a 45-year-old right-handed patient with a progressive symmetrical ascending four-limb sensory motor deficit over the past five months, suggesting polyradiculoneuropathy, associated with rib pain from the 7th to the 9th right ribs. The assessment confirms demyelinating and axonal polyradiculoneuropathy and demonstrates the presence of a monoclonal IgG λ gammopathy, in connection with a solitary osteolytic right costal plasmacytoma of the 7th rib, without organomegaly on thoraco-abdomino-pelvic CT scan. We suspected the diagnosis of POEMS syndrome which was confirmed by elevated serum VEGF dosage. He is receiving corticosteroid therapy with localized radiotherapy with good clinical outcome and biological stabilization. However, the patient had presented during confinement for Covid-19 a worsening of the progressive symptomatology evolving for 6 months. He presented to the emergency room with a picture of flaccid quadriplegia and fatal respiratory distress.

Plasmacytoma Masquerading as Meningioma

AbstractSolitary bone plasmacytoma is a rare disease in the skull. We present a 70-year-old patient who presented with a skull deformity due to the left parietooccipital tumor. Neurological examination found no deficit. The systemic scanning revealed no additional lesion. The surgery was planned, and the tumor was removed totally with the marginal bone around it. Histopathological examination confirmed solitary bone plasmacytoma. The patient is being followed-up without recurrence or progression to multiple myeloma. As the calvarial solitary bone plasmacytomas can be easily misdiagnosed preoperatively, the detailed examination of the CT features may be helpful for the planning and course of the surgery.

Radiotherapy for the treatment of solitary plasmacytoma: 7-year outcomes by a mono-institutional experience.

Solitary plasmacytoma (SP) is characterized by a single mass of clonal plasma cells. Definitive RT can result in long-term local control of the SP. Due to the small number of patients and narrow range of doses, phase III randomized trials are lacking. The aim of this study is to further support the potential use of RT for the treatment of SP. Clinical data of all patients treated for SP at our Institution between 1992 and 2018 were reviewed. A total of 42 consecutive patients were analyzed. The median follow-up was 84.8months. Radiation dose did not differ significantly as a function of sex, type of SP (solitary bone plasmacytoma or as extramedullary plasmacytoma), tumor size; conversely differs significantly as a function of age (p = 0.04). The 5y-OS and 10y-OS were, respectively, 96 and 91%. Local recurrences developed in 21.4% of patients (9/42). 16 patients progressed to MM (38.1%). The 5y-progression to MM free survival (PMFS) and the 10y-PMFS were, respectively, 68.6 and 61.9%. Our data confirm that good results are achievable with RT to treat SP, but they don't allow defining a dose-effect correlation; therefore, it remains uncertain which is the most effective dose and whether lower doses can guarantee adequate disease control.

Population-Level Projections for Multiple Myeloma Patients By Line of Therapy in the USA

Introduction: Treatment for multiple myeloma (MM) has evolved over time, leading to improved survival outcomes for patients. However, information on real world clinical practice, such as the proportion of patients receiving each treatment regimen or the number of patients eligible for a given line of therapy (LOT), is limited. The purpose of this analysis is to report the results of a patient epidemiology model for MM treatment by LOT in the USA. Methods: This study was a retrospective, population-based, secondary data analysis of MM in the USA combining data from the Surveillance, Epidemiology, and End Results (SEER) registry and physician survey results from the CancerMPact® (CMP) database. Age- and gender-specific incidence rates were obtained from SEER for all available years through 2016 using the ICD-O-3 histology codes of 9731 (solitary plasmacytoma of bone), 9732 (plasma cell myeloma), and 9734 (extraosseous plasmacytoma). Based on the observed trend in the historical incidence rates through 2016, the incidence rates were projected to 2025. These projected rates were multiplied by the respective age- and gender-specific USA population from the 2010 U.S. Census, moderate projection to calculate the estimated number of incident MM patients between 2020-2025. Complete prevalence was calculated using the National Cancer Institute's Complete Prevalence (ComPrev) software. Annual prevalent patients by LOT were defined as the number of MM patients who received a line therapy at any point in the given year, and who had not yet progressed to the next LOT. To calculate the number of unique patients during a given year who were on a specific LOT, the mean progression-free survival (PFS) of the LOT in months was calculated based on data from the 2018-2019 CMP Treatment Architecture (TA) physician surveys. The total estimate of MM patients on a LOT among prevalent patients was calculated using the annual estimate of patients initiating a line by year, divided by total months per year, then multiplied by the average PFS in months for that line. Results: Projected complete MM prevalence in the USA in 2020 was estimated at 144,922, further increasing to 162,339 by 2025. Projected unique MM patients by LOT in 2020 was estimated as 53,176 (1st LOT), 19,407 (2nd LOT), 6,481 (3rd LOT), 1,649 (4th LOT), and 426 (5th LOT) (refer to Table 1 for ranges). It is estimated the number of unique prevalent patients will increase over time for each line (total of 13% across 5 years). Conclusions: With different treatment options available, the choice of therapeutic approach for MM patients is an increasingly complex process. As more new anti-neoplastic agents are introduced and survival duration for patients with MM continues to increase with longer intervals between disease progression, patients are potentially able to receive multiple lines of therapy. In this study, the proportion of prevalent cases by line decreased with each additional LOT. The current study estimated overall lower proportions than previous studies for third line and beyond (Ruzafa 2016, Raab 2018). These differences can be attributed to the underlying assumptions and different methodologies used. The physicians responding to the TA survey are basing their responses on their own recall and clinical experience across all the multiple myeloma patients they treated over the past 6 months. Few published studies have reported on contemporary proportions of treated MM patients by LOT combining data from both registry sources and physician surveys in an epidemiology model. The results of this study show that incidence and prevalence by LOT for MM patients in the USA are estimated to increase between 2020-2025. While several factors can contribute to the increase of MM incidence and treated patients projected into the future, a key consideration is the underlying aging of the population (Vespa 2020). Between 2020-2025, the total incidence as well as the total unique patients treated by line increased substantially and the assumption is that this trend will continue. Funding: GSK (study: 213443). Disclosures Kanas: Kantar: Consultancy. Clark:Kantar: Consultancy, Current Employment, Honoraria. Keeven:Kantar: Consultancy, Current Employment. Nersesyan:Kantar: Consultancy, Current Employment. Sansbury:GSK: Current Employment, Current equity holder in publicly-traded company. Hoggea:GSK: Current Employment, Current equity holder in publicly-traded company.

Survival trends and prognostic factors in patients with solitary plasmacytoma of bone: A population-based study.

Solitary plasmacytoma of bone (SPB) is a single, isolated plasmacytoma originated from the bone. The survival trends of patients with SPB in recent years remain unknown. And the prognostic system of SPB may also need to be refined. The 18 Surveillance, Epidemiology, and End Results (SEER) databases of the National Cancer Institute in the United States were used to extract data for this study. The third edition of the International Classification of Disease for Oncology (ICD‐O‐3) code 9731 was used to identify cases of SPB. For each case, factors including age at the time of diagnosis, sex, race, marital status, insurance status, primary sites of tumors, and the use of surgery were collected. The outcomes of patients with SPB were compared between two groups. And the prognostic impacts of baseline characteristics and use of surgery was studied. A total of 4103 (from 1976 to 2016) cases of SPB were identified. The median age was 65 years old. Patients in time period‐2 (2008–2016) show better survival as compared to those in time period‐1(1976–2007) (median overall survival: 88 months vs. 73 months, p = 0.0332). Age ≤ 65 years and being male were associated with better outcomes. The widowed individuals had significantly inferior survival and myeloma‐specific survival than the single, married, or divorced individuals (p values all <0.0001). Patients with lesions in bones of skull and face and associated joints had longer survival as compared with those with bone lesions in other sites (median overall survival: 107 months vs. 79 months, p = 0.0694). The use of surgery was significantly associated with improved survival (median survival: surgery performed 98 months vs. not performed 73 months, hazards ratio [HR]: 0.7623, 95% CI: 0.7009–0.8472; p < 0.0001) and myeloma‐specific survival (median myeloma‐specific survival: surgery 160.0 months vs. no surgery 143.0 months, HR: 0.8469, 95% CI: 0.7493–0.9572; p = 0.0078). Multivariable analysis revealed that surgery, marital status, and age were independent prognostic factors for overall survival in patients with SPB. The improvement in the survival of patients with SPB has been observed in recent years. And several potential prognostic factors were identified. Future prospective studies are warranted to explore the roles of novel agents, surgery, and systemic chemotherapy in the treatment of SPB.

Tumor of proximal clavicle-solitary plasmacytoma of bone, an extremely rare case

Solitary plasmacytoma of bone (SPB) was defined as solitary osteolytic bone lesion with plasma cells collection, and lack of evidence of systemic myeloma. SPB has a higher risk of multiple myeloma (MM) progression and lower survival rate compared to extramedullary plasmacytoma, which is another form of plasmacytoma with soft tissue infiltration. Most of the SPB were discovered at axial skeletons and diaphysis of long bones which red marrow is predominant. Thoracic and lumbar vertebrae are the most frequent disease distribution, while clavicle involvements were rarely seen. We reported a case of solitary plasmacytoma of proximal clavicle, an extremely rare presentation, sustained a pathologic fracture under a low-energy trauma mechanism treated with tumor excision, plate fixation, and adjuvant radiotherapy, and showed excellent stability and functional outcome in 1 year follow-up.

Solitary Plasmacytoma of the Frontal Bone

Extramedullary plasmacytoma and solitary plasmacytoma are localized neoplasms. Solitary plasmacytoma of bone consists about 4% of malignant plasma cell tumors. A plasmacytoma involving the frontal bone is unusual, and a limited number of cases have been reported. We present a rare case of a solitary plasmacytoma of the frontal bone manifesting as a forehead lump.

Management and Long-Term Outcomes of Patients with Refractory Solitary Plasmacytoma after Treatment with Definitive Radiation Therapy

Definitive radiation therapy (RT) is the current standard of care for the treatment of solitary plasmacytoma (SP), as RT typically affords excellent local control with possible long-term remission or even cure. Given the low rates of local failure after RT, the optimal management of RT-refractory SPs is unknown. With IRB approval, we reviewed our institutional records of all SP patients (pts) treated with RT and evaluated at our institution from Jan 2000-Sept 2019. All pts met criteria for SP or SP with minimal marrow involvement. Refractory disease was defined as persistent disease on post-RT biopsy/surgery or persistent, residual avid disease on PET-CT. Of 102 total pts, 17 (17%) were considered refractory to RT and included in the study. Median age at diagnosis was 54 (range 33-75). Sixteen of 17 pts had solitary bone plasmacytoma (vs extramedullary). At diagnosis, the median maximal tumor dimension was 6.2 cm (range 2.1-11.9), 11 pts had positive blood paraprotein (median 0.8 gm/dL) and 5 pts had positive Bence Jones proteinuria (median 152 mg/24hrs). On SP biopsy, four pts had associated amorphous material or amyloid; 1 pt had amyloid on fat pad biopsy. Median RT dose was 45 Gy (range 39.6-56 Gy). Most pts underwent PET-CT pre- (15 pts, median maximum standardized uptake value [SUVmax] 9.3, range 2.3-32) and post- (15 pts, median SUVmax 9.3, range 2.9-23) RT; SUVs decreased for 35% of pts (n = 6) after RT. For eleven pts with positive proteins and data available, ten had persistent blood/urine protein levels after RT until next intervention. Ten pts had pathologic confirmation of residual plasmacytoma at median 7 months (range 1.5-32) post-RT. Median follow-up was 27 months. Thirteen pts had at least one additional treatment for refractory disease; the median time to next treatment was 9 months. Pts had the following interventions: surgical resection (n = 4), additional RT (n = 2), systemic therapy without evidence of MM (n = 4), systemic therapy for progression to MM (n = 3) and observation (n = 4, median observation follow-up 7.5 months). Of the 2 pts treated with additional RT (cumulative doses of 110 Gy and 70 Gy), neither responded to RT and both had pathologic confirmation of residual disease after the second course. All pts with follow up after systemic therapy or surgery had an imaging-based response at the SP site. Two pts died: 1 cause unknown, 1 from osteosarcoma developed at the site of the twice-radiated sacral plasmacytoma. Patients with RT-refractory SPs can achieve good outcomes with alternative therapies such as surgery or systemic therapy. Additional RT does not seem to be effective. Given the known high rates of progression from SP to multiple myeloma, treatment of SP should not cause significant morbidity and close observation of asymptomatic persistent disease after RT for a limited time is reasonable.

Adenopathy and extensive skin patch overlying a plasmacytoma (AESOP): Two morphologic variants can be outlined

To the Editor: Adenopathy and extensive skin patch overlying a plasmacytoma (AESOP) syndrome associates a slowly enlarging erythematous skin patch overlying a solitary bone plasmacytoma (SBP) with locoregional adenopathy. It was initially reported in 1997 using the term “syndrome adéno-cutané associé au plasmocytome osseux.”1Schoenlaub P. Lipsker D. Massard G. Christmann D. Grosshans E. Syndrome adéno-cutané associé au plasmocytome osseux.Ann Dermatol Venereol. 1997; 124: 228-232PubMed Google Scholar In 2003, it was individualized and renamed AESOP.2Lipsker D. Rondeau M. Massard G. Grosshans E. The AESOP (adenopathy and extensive skin patch overlying a plasmacytoma) syndrome: report of 4 cases of a new syndrome revealing POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes) syndrome at a curable stage.Medicine (Baltimore). 2003; 82: 51-59Crossref PubMed Scopus (42) Google Scholar Along with the brief report of 2 new cases recently diagnosed in our institution (Figs 1 and 2), we provide a short review of the current literature about this rare but distinctive disorder to refine its clinical spectrum (21 cases in total, with data available at https://data.mendeley.com/datasets/ny945rfh3t/8).Fig 2Patient 2 diagnosed with adenopathy and extensive skin patch overlying a plasmacytoma (AESOP) syndrome. Note the brownish-red plicate and indurated plaque on the right flank, with irregular borders, overlying a plasmacytoma of the right rib, as a typical illustration of the second AESOP syndrome variant or morphea-like variant.View Large Image Figure ViewerDownload Hi-res image Download (PPT) AESOP syndrome mainly affects men (90%) with an average age of onset of 55 years. Skin involvement is distinctive in most cases, to the point of evoking in itself the diagnosis. From our own clinical experience, as well as from a careful review of pictures from the review of the literature, a continuum between 2 morphologic variants can be delineated: the classic variant presents as a smooth and shiny bright red patch, with sharp borders, and through which the underlying blood vessels can be seen; the second presents as a brownish-purple infiltrated plaque with less distinct edges, skin thickening, and a sclerotic appearance (Fig 1). The classical variant seems to occur preferentially on the thoracic region, while the morphea-like variant is generally observed in the hypochondrium regions. It can be finely scaling, warm, and itchy, and is rarely accompanied by paraesthesia. Though skin histology is nonspecific, there is an almost constant proliferation of dilated capillaries in the dermis (79%) associated with slight inflammatory infiltration of variable composition, and often with intradermal mucin deposition (37%). Firm, mobile, and homolateral enlarged lymph nodes are common (76%) but not essential to the diagnosis. In 67% of cases, an essentially sensorimotor severe polyneuropathy is associated—either demyelinating or mixed. Polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes (POEMS) syndrome is associated in 38% of cases. The SBP is most commonly of the lambda type (82% of the 11 evaluated cases) and mostly located on the ribs (57%). More than half of cases are accompanied by monoclonal gammopathy, most often immunoglobulin G lambda. Treatment has not been standardized, and many different strategies are used (chemotherapy, surgery, and radiotherapy). Disappearance of the skin lesion is the rule after effective SBP treatment. All the patients treated with radiotherapy had a complete response without any relapse or POEMS occurrence, while both reported deaths were related to the subsequent development of POEMS syndrome in patients not treated with irradiation. This study of 21 cases of AESOP syndrome further supports its autonomy and its frequent association with POEMS syndrome, for which it could be an early warning sign. In practice, despite its rarity, we believe that AESOP should be considered when encountering an enlarging bright red patch over the rib cage or the presternal area or a brownish-red plicate plaque located on the hypochondrium. The criterion standard treatment of underlying SBP is radiotherapy,3Tsang R.W. Campbell B.A. Goda J.S. et al.Radiation therapy for solitary plasmacytoma and multiple myeloma: guidelines from the International Lymphoma Radiation Oncology Group.Int J Radiat Oncol Biol Phys. 2018; 101: 794-808Abstract Full Text Full Text PDF PubMed Scopus (77) Google Scholar which we hypothesize may prevent progression toward life-threatening POEMS syndrome.

Clinical presentation and outcomes of solitary plasmacytoma in a tertiary hospital in the UK

Solitary plasmacytoma is a rare localised neoplasm of monoclonal plasma cells. The standard treatment involves radical radiotherapy; however, a significant proportion of patients subsequently develop multiple myeloma. In this study, we evaluate the outcomes of solitary plasmacytoma in a retrospective cohort of patients treated in a single tertiary centre.The case records of plasmacytoma patients treated in a 15-year period were analysed and retrospectively followed up from the date of diagnosis. Thirty-four cases met the inclusion criteria; 27 (79%) solitary plasmacytoma of bone (SBP) and 7 (21%) extramedullary plasmacytoma (EMP). The thoracic vertebrae were the commonest sites for SBP while EMP occurred most frequently in the upper airway. Pain and spinal cord compression were the most frequent symptoms. A paraprotein was detectable in 18 (53%) patients. Over a median follow-up of 48 months, 13 (38%) developed multiple myeloma. The 5- and 10-year survival rates were 80% and 56%, respectively; median progression-free survival was 77 months. Four patients (12%) developed a second malignancy.Progression to multiple myeloma remains a formidable challenge in the management of solitary plasmacytoma, hence adjunct therapies are needed.

Sternal Tumor Resection and Reconstruction Using Iliac Crest Autograft.

Background:Primary malignant tumors of the sternum are rare among bone tumors. Even with radical resection, the survival rate for sternal tumors remains low. Resection often results in significant bone defects in the chest wall, and reconstruction must provide adequate protection for pulmonary and respiratory structures. Flexible materials have historically been used for sternal reconstructions following failed sternotomies in cardiac surgery. Although these have had some success, they fail to provide adequate support for patients undergoing reconstruction secondary to tumor resection, who are otherwise healthy and active. Although rigid materials offer greater protection, they frequently cause chronic pain and respiratory complications. More recently, bone grafts have been used to reconstruct sternal defects, and the limited published reports are promising.Methods:We present the case of a patient diagnosed with an extramedullary solitary bone plasmacytoma who underwent a sternal resection and reconstruction with an autogenous bone graft taken from the iliac crest and secured in place with 5 plates (3 sternal and 2 mandibular).Results:At 9-month follow-up, bone marrow biopsy showed no evidence of multiple myeloma. X-ray, computed tomography, and Pulmonary Function Test (PFT) scans confirmed graft stability, and the patient has returned to normal activities.Conclusions:Sternal resection and reconstruction is an effective method for treating extramedullary solitary plasmacytoma when radiation is ineffective. In cases of significant segmental defects, iliac crest bone graft may be a viable option for repairing sternal defects following tumor resection.

Retrospective analysis of plasmacytoma in Kansai Myeloma Forum Registry.

We retrospectively analyzed 51 patients with solitary plasmacytoma diagnosed from October 2002 to September 2018 from a cohort of 3575 patients with plasma cell dyscrasias registered in the Kansai Myeloma Forum. Twenty-seven patients had solitary bone plasmacytoma (SBP) and 24 had extramedullary plasmacytoma (EMP), with prevalence of 0.8% and 0.7%, respectively. The most frequent M protein was IgG (40%) in SBP, whereas non-secretory proteins were most frequent (50%) in EMP. Five-year overall survival was 78.2% in SBP and 80.8% in EMP (P = 0.894). Among patients with SBP, 44% progressed to MM with a median time of 10.5months (2.4-93.3months), whereas 8% of EMP patients progressed to MM with a median time of 18.6months (13.0-24.2months). The most frequent treatment was radiotherapy (41%) or observation (41%) in SBP, and chemotherapy (54%) in EMP. No statistically significant difference was observed upon univariate analysis of prognostic factors including age, sex, performance status, and IgG M protein. Our results suggest that there are biological differences between SBP and EMP in real-world settings.

Paraplegia Secondary to Plasmacytoma of the Lumbar Spine.

Solitary plasmacytoma of bone has a predilection for the axial skeleton, most commonly affecting the thoracic spine. We report the case of a patient who presented with acute on chronic back pain and developed severe neurologic deficits within several hours of admission secondary to a pathologic fracture of L1. The patient underwent an urgent magnetic resonance imaging scan followed by T12 to L2 posterior decompression and T11 to L3 posterior instrumented stabilization. Subsequent histopathologic examination of specimens taken at the time of surgery found this to be secondary to a plasmacytoma affecting the lumbar spine. At follow-up, recovery has been rapid and extensive, with the patient remaining under hematologic review because of the risk for developing multiple myeloma. The unique features of this case relate to the location of the plasmacytoma and the neurologic signs; to our knowledge this is the first reported case in the literature of paraplegia secondary to a lumbar spine plasmacytoma.

Syndecan-1, CD117 and CD56 Immunohistochemical Evaluation of Plasmacytoma

Background and Objective: World Health Organization (WHO) describes two types of plasmacytomas which are solitary bone plasmacytoma (SBP) and extramedullary plasmacytoma (EMP). 17% to 33% of plasmacytomas, will progress into multiple myeloma (MM). The early diagnosis is very important as the plasmacytoma may be primary or metastatic lesion of MM. Prognosis of solitary plasmacytoma could be worse if it recurred as in case of its evolution toward systemic MM. Methodology: 10 patients with plasmacytoma in the National Cancer Institute and Histopathological laboratory of Minia University were analyzed immunohistochemically for detection of syndecan-1 as a diagnostic marker for plasmacytoma and detection of plasmacytoma behavior through interpretation the expression of both CD117 and CD56. Results: All cases showed strong positive immunoreaction for Syndecan-1(grade 3) according to scoring system for immunohistochemical expression. The expression of CD117 in plasmacytoma was similar to the expression of CD56, (60%) showed grade 1, while (40%) were grade 0. Conclusion: We concluded that the importance of histopathological biopsy for early diagnosis and prognostic evaluations are important in that the plasmacytoma may be a primary or metastatic lesion of MM. and Syndecan-1can be used as diagnostic marker for plasma cells, while CD56 and CD117 expressed only in neoplastic plasma cells and their expression indicate good prognosis.

Successful Treatment for Solitary Bone Plasmacytoma of the Maxilla: A Rare Case Report

Introduction: Plasma cell tumors are monoclonal neoplastic proliferation of plasma cells which are divided into three groups: solitary bone plasmacytoma (SBP) and extramedullary plasmacytoma (EMP) which are localized forms, and multiple myeloma (MM) which is the disseminated form. Skull, long bones, and vertebrae are common sites for SBP and its presence in maxillofacial area is rare. There is a possibility that SBP converts to MM and some authors believe that it can be the early stage of MM. Case Presentation: Here, we present a 59-year old male patient with a mass in maxillary bone enlarging after tooth extraction. Cone beam computed tomography (CBCT) confirmed the existence of a poorly defined lesion in the left maxilla. The microscopic evaluation and immunohistochemical studies confirmed the diffuse and monoclonal population of cells, indicating the diagnosis of plasma cell tumor. There was also no evidence of bone marrow involvement in the aspiration. Conclusions: Early and precise diagnosis of SBP is a crucial element to rule out the possibility of MM. It must be kept in mind that there is possibility of recurrence or progression to MM after treatment which can completely change the course of disease, and this emphasizes the importance of regular follow up.

A Solitary Bone Plasmacytoma In the Mandible: A Case Report

A Solitary Bone Plasmacytoma In the Mandible: A Case Report