An elderly lady with severe back pain, treated with NSAIDS without significant results.
The patient had long standing, severe pain in the dorsal region. The patient had been treated with NSAIDS without significant results. She had undergone plain x-rays examination of the spine, which showed age-related changes, then a spinal MR examination was performed.
Plasmacytoma is a rare group of plasma cell neoplasm arising from the bone marrow or other various soft tissue sites, [1] divided into two groups, according to location: solitary bone plasmacytoma (SBP), and solitary extramedullary plasmacytoma (SEP).
SBP arises from bone marrow plasma cells, SEP from plasma cells of mucosal surfaces [2]. SBP is described as a single area of bone destruction, bone marrow plasma cell infiltration not > 5% of all nucleated cells, and no evidence of
myeloma elsewhere [3,4].
SBP affects fewer than 5% of patients with plasma cell disorders [3, 4] with a male-female ratio of 2:1 and a mean age of 55 years, which is 10 years earlier than multiple myeloma [2,5-8].
Pain, resulting from bony erosion by infiltrating plasma cells, is the most common symptom [3, 9]. SBP’s most common localization is the axial skeleton, (spinal disease in 34-72%), more commonly in the thoracic vertebrae [4]. Ribs, sternum, clavicle and scapula are involved in 20% of cases [10]. Patients with SBP may present with POEMS (polyneuropathy, anomegaly, endocrinopathy, M protein, and skin changes) syndrome [11]. As differential diagnosis with Non-Hodgkin lymphoma should be considered.
On plain radiographs, SBP classically has a lytic appearance with clear margins [3].
Rarely, it appears as cystic, trabeculated or sclerotic lesions [12], this latter associated with POEMS syndrome [13]. On MRI, SBP usually exhibits a low T1 signal intensity, high signal on T2-weighted/STIR images [14].
The treatment of choice is local radiotherapy; chemotherapy may be considered for unresponsive patients [3, 4, 6, 8, 15]. Local control is achieved in 88-100% of patients. The local tumour recurrence rate is approximately 10%. The usefulness of surgery is controversial: some authors claim it is contraindicated in the absence of structural instability or neurologic compromise [15] while other authors state that the curative rates of radiotherapy are higher when combined with surgical excision [16].
Up to 84% of patients progress to multiple myeloma over 3-10 years, and up to 65-100% at 15 years [15, 17]. The median overall survival time is 10 years [6], with a 10-year disease-free survival rate of 15-46%. Prognostic features for conversion of SBP to multiple myeloma, include: lesion size =/> 5 cm, patients > 40 years, high M protein levels, and its persistence after treatment [8].
Solitary bone plasmacytoma, SBP, Plasmacytoma
According to the provided MRI images (sagittal sequence), a round or irregular lesion can be observed in the thoracic vertebral body. It appears as low signal on T1 and high signal on T2/STIR sequences with relatively well-defined borders. Compared to the surrounding bone, there is local bone destruction or reduced bone density. A mild alteration in vertebral body morphology is noted in the lesion area, but there is no evident vertebral collapse or significant structural instability. Slightly thickened or slightly high-signal soft tissue can also be seen around the region, suggesting a small amount of soft tissue involvement. No marked stenosis of the spinal canal or obvious spinal cord compression is visible, and no significant abnormalities are found in the adjacent intervertebral discs.
This type of lesion commonly appears in the axial skeleton (e.g., thoracic or lumbar vertebrae), typically presenting as a local osteolytic lesion. On MRI, it usually shows low T1 signal and high T2 signal. The patient’s persistent back pain and advanced age fit the epidemiological profile of SBP.
In elderly patients presenting with osteolytic or destructive lesions in the vertebral body, the possibility of metastatic disease must be considered. However, this case appears to involve only a single or localized lesion. If the primary tumor is unclear, further evaluation of the patient's overall condition is warranted.
Multiple myeloma typically features multiple bone lesions along with abnormal serum proteins. Should this patient develop additional bone lesions or exhibit elevated serum/urine M protein levels, the diagnosis of multiple myeloma should be considered.
When lymphoma involves the vertebral body, it can show bone destruction and a soft tissue mass. Clinically, it should be differentiated from plasmacytoma. Pathological or histological analysis is often needed for a definitive diagnosis.
Based on the patient’s age (73 years), chief complaint of back pain, MRI findings of localized vertebral bone destruction with low T1 signal and high T2 signal, and the lack of significant relief from NSAIDs, in addition to relevant diagnostic processes for myeloma (e.g., serum protein electrophoresis, urine protein electrophoresis, bone marrow aspiration), the most likely diagnosis is Solitary Bone Plasmacytoma (SBP). If future examinations reveal lesions in other skeletal sites or elevated serum/urine M protein levels, further evaluation is necessary to rule out or confirm multiple myeloma.
After radiotherapy or surgery, to facilitate recovery of bodily functions, an individualized and progressive exercise program is recommended, guided by the FITT-VP principle:
Special precautions include:
This report is a reference analysis based on existing imaging and patient history. It does not replace in-person consultation or professional medical advice. If you have any further concerns or experience changes in symptoms, please seek prompt medical evaluation and treatment.
Solitary bone plasmacytoma, SBP, Plasmacytoma
