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Plasmacytoma


KEY FACTS

Terminology

  • Solitary monoclonal plasma cell tumor of bone or soft tissue

  • Diagnosis of solitary bone plasmacytoma (SBP) requires

    • Solitary lesion, biopsy showing plasma cells

    • Negative skeletal survey, negative MR spine, pelvis, proximal femora/humeri

    • Negative clonal cells in marrow aspirate

    • No anemia, hypercalcemia, or renal involvement suggesting systemic myeloma

Imaging

  • Axial skeleton > extremities

    • Thoracic vertebral body most common site

  • Radiographs/CT

    • Lytic, multicystic-appearing lesion ± vertical dense striations

    • Pathologic compression fracture common

  • T1 hypointense, T2/STIR hyperintense marrow with low signal, curvilinear areas

    • Posterior elements involved in most cases

    • ± associated soft tissue mass (paraspinous or epidural with draped-curtain sign)

Pathology

  • SBP may reflect early (stage I) multiple myeloma

  • SBPs considered clinical stage I Durie-Salmon lesions

Clinical Issues

  • Most common symptom = pain due to bone destruction

  • Epidural extension may cause compression of cord or nerve root

  • Mean age = 55 years (younger than age of patients with multiple myeloma)

Diagnostic Checklist

  • Must exclude 2nd unanticipated lesion (33% of cases)

Sagittal graphic shows collapse of a thoracic vertebral body due to tumor infiltration. There is retropulsion of the anterior and posterior margins. Posterior retropulsion and tumor mass may result in cord compression.

Sagittal T2WI MR demonstrates a heterogeneously hyperintense thoracic vertebral body lesion with hypointense ventral epidural
and paravertebral
soft tissue components producing cord compression.

Sagittal bone CT exhibits the characteristic appearance of thickened cortical struts
, a result of stress phenomenon from the lytic process forcing remaining bone to increase thickness as a compensatory response to weakening bone.

Axial T1WI C+ MR depicts tumor infiltration of a thoracic vertebral body, with extension into the paravertebral
and epidural
spaces. The latter significantly narrows the canal.

TERMINOLOGY

Synonyms

  • Solitary bone plasmacytoma (SBP), solitary myeloma, solitary plasma cell tumor

Definitions

  • Solitary monoclonal plasma cell tumor of bone or soft tissue, without evidence of multiple myeloma (MM)

  • Diagnosis requires

    • Solitary lesion, biopsy showing plasma cells

    • Negative skeletal survey, negative MR spine, pelvis, proximal femora/humeri

    • Negative clonal cells in marrow aspirate

    • No anemia, hypercalcemia, or renal involvement suggesting systemic myeloma

IMAGING

General Features

  • Best diagnostic clue

    • T1 hypointense marrow with curvilinear hypointensities

  • Location

    • Axial skeleton most common site of involvement (25-60%), followed by extremities

      • –

        Vertebral body = most common site of SBP

      • –

        Thoracic > lumbar > cervical

Radiographic Findings

  • Radiography

    • Can be normal early

    • Lytic, multicystic-appearing lesion ± vertical dense striations

    • Pathologic compression fracture common

    • No periosteal reaction

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