Diagnosis and management of solitary spine plasmacytoma：a report of 20 cases

English Keywords:Spine  Myeloma  Plasmacytoma  Diagnosis  Treatment

English Abstract:

  【Abstract】 Objective：To investigate the diagnosis and management of solitary bone plasmacytoma（SBP）.Method：Between January 1998 and September 2009，20 patients with SBP undergoing surgery in Orthopaedic Department of Peking University Third Hospital were reviewed retreospectively.There were 11 males and 9 females，with the average age of 48.2 years old （33-74 years）.7 cases had lesions in cervical vertebrae，10 in thoracic，2 in lumbar and 1 in sacrum.19 cases presented with pain and 13 with neurologic deficits（11 myelopathy and 2 radiculopathy）.CT guided percutaneous biopsy was performed in 14 patients，13（92.9%） of which was myeloma.The first-choice treatment was radiotherapy，and surgery was indicated when severe or progressed neurologic deficits，spinal instability，unclear diagnosis and no response to radiotherapy.4 patients received radiotherapy alone，while surgery was performed in 16 cases（including 13 cases with combined radiotherapy，of these，2 patients underwent radiotherapy before surgery，10 immediately after surgery，and 1 after local recurrence）.12 cases received supplementary chemotherapy，10 when confirmation of diagnosis and 2 when progression to multiple myeloma（MM）.Result：All patients were followed up for an average of 49.3 months （range，12 to 113）.Pain relief was achieved in all cases and 6 had completely pain relief.11 of 13 cases with neurologic deficit and with Frankel D received surgery，of these，10 were still alive with neurologic function improved significantly，while 8 of them progressed to Frankel E.The other 2 cases received radiotherapy，of these，1 case with Frankel B progressed to Frankel D，and 1 Frankel D had neurofunction improved despite Frankel score remained unchanged.No local recurrence was observed in the 6 cases undergoing radiotherapy，and recalcification was seen in 3 of them，and 1 case progressed to MM and died.No local recurrence was found in 10 patients undergoing radiotherapy immediately after surgery，while recurrence was noted in 4 cases undergoing operation and no radiotherapy.3 of the 10 patients experiencing adjuvant chemotherapy progressed to MM，while of the other 10 patients，40% progressed MM.Conclusion：CT guided needle biopsy is valuable for determination of SBP.Pain relief and neurological resolution can be achieved by both surgery and radiotherapy.Recalcification is evidenced in some cases after radiotherapy.The mechanism of adjuvant chemotherapy remains unclear before progression to MM.