None of the 27 nonplasmacytoma lesions revealed the mini brain appearance on mr imaging, but had low signal intensity on t1weighted mr images and high signal intensity on the t2weighted mr images. Treatment may consist of radiotherapy alone, surgery alone, or a combination of the two depending on location and resectability of the plasmacytoma 6. Radiographic evaluation of lesions within the vertebrae. Some tumors are known to metastasize spread via arteries, veins and the lymphatic system.
We describe a case of oncogenic osteomalacia secondary to solitary plasmacytoma of the vertebral body of t3. Part 1, techniques and normal agerelated appearances. This book with credit will address practical, real life clinical scenarios, and will provide tips and tricks to optimize. Solitary vertebral plasmacytoma causing compression fracture in a patient with multiple vertebral hemangiomas.
Health, general multiple myeloma case studies diagnosis plasmacytoma. Buy introduction to systematic analysis of the spinal mri spinal mri for musculoskeletal clinicians book 1. In approximately 20% of the cases involvement of other bones like rib, sternum, scapula, or clavicle have also been reported 10. At the spine hospital at the neurological institute of new york, we specialize in spinal plasmacytomas. Plasmacytoma is a plasma cell dyscrasia in which a plasma cell tumour grows within soft tissue or within the axial skeleton. The patient presented with symptoms of hypophosphataemia.
These findings suggest the diagnosis of plasmacytoma. Radiation therapy for solitary plasmacytoma and multiple. Periodic evaluation for progression and development of multiple myeloma is recommended every 6 months for solitary bone plasmacytoma and soft tissue plasmacytoma. Emp generally presents as a bulky soft tissue mass, isointense to muscle on t1weighted mr images, isointense to slightly hyperintense to muscle on t2weighted. Whole body mr wbmr has emerged as the most sensitive imaging modality to date at detecting diffuse and focal multiple myeloma in the spine, as well as the extraaxial skeleton 1921. Lateral radiograph showing mild collapse of vertebral body height at t10 a. Multiple other vertebral body lesions are seen consistent with multiple myeloma. After a repeat magnetic resonance imaging mri and a computed tomography ctguided biopsy, the diagnosis of a solitary plasmacytoma was confirmed. Extramedullary plasmacytoma of the orbit request pdf. Which radiography findings are characteristic of multiple. Use of shortinversiontime inversion recovery and contrastenhanced fat suppression techniques may improve the sensitivity of mr imaging. Solitary bone plasmacytoma sp is a rare diagnosis for which the primary treatment is local radiotherapy.
Due to its ability to visualise large volumes of bone marrow without inducing radiation exposure and in an acceptable amount of time, mr imaging has become a favoured imaging method for. Books radiology libguides at university of north carolina at. Solitary vertebral plasmacytoma causing compression. Calvarial plasmacytoma, an unusual manifestation of. Solitary plasmacytoma of bone spb, also called osseous plasmacytoma is a localized tumor in the bone comprised of a single clone of plasma cells in the absence of other features of mm ie, anemia, hypercalcemia, renal insufficiency, or multiple lytic bone lesions. Though multiple myeloma can cause problems throughout the body, this article will focus on how one of its most common symptomsbone damagethat can impact your spine. Magnetic resonance t1weighted image showing the tumor to be isointense compared with normal vertebra b, but enhanced with contrast c. What is the cause and treatment of plasmacytoma in the. Guidelines for acquisition, interpretation, and reporting of whole body mri in myeloma 6 radiology. Radiographic examination included ct that showed an osteolytic lesion with soft tissue component involving c7 and d1 vertebral bodies.
T2 vertebrectomy with combined anterior and posterior. It is most commonly found in the thoracic vertebrae but can also be seen in following order in other vertebrae lumbar, sacral, and cervical vertebrae 9. When people discuss plasmacytomas, they discuss three of the body s systems. Guidelines for acquisition, interpretation, and reporting. Mri can also provide important information for prognosis. Softtissue or nonosseous extramedullary plasmacytoma emp solitary bone plasmacytoma sbp multifocal form of multiple myeloma multiple myeloma plasmablastic sarcoma t. Purchase ct and mri of the whole body, 2volume set 6th edition. The rate of progression of soft tissue plasmacytoma to multiple myeloma is lower than in solitary bone plasmacytoma, ranging from 1% at 10 years. To make a diagnosis of solitary plasmacytoma of bone or extramedullary site, other plasma cell tumours or multiple myeloma must be excluded. Following the initial diagnosis, the lesion was surgically resected with good results, although several followup procedures, including bone grafting, were necessary to stabilize the thoracic spine. Mri of the lumbar spine revealed the presence of an l4 vertebral body lesion extending into the pedicles, transverse process, and inferior articular facet on the right. Malignant tumors of the breast, prostate, lung and kidney can spread into the spine.
This book is distributed under the terms of the creative commons attribution 4. There is no established consensus suggesting a total spondylectomy in spinal sp. Comput ed tomography scan showing lytic bone destruction of the vertebral body b. Total spondylectomy for solitary bone plasmacytoma of the. Ct and mri of the whole body, 2volume set 6th edition elsevier. Vertebral hemangiomas are a common etiology estimated to be found in 1012% of humans at autopsy. Fast whole body techniques are available on some magnet systems. The tumor arises in the posterior elements 79% with partial vertebral body involvement and is confined to the vertebral body in 21% of patients. Radiographs, ct scan and mri showed a single osteolytic lesion of. Spinal tumors rarely occur and are either benign or malignant. Mri is also highly sensitive for evaluating tumors and metastasis. A plasmacytoma is a discrete, solitary mass of neoplastic monoclonal plasma cells in either bone or soft tissue extramedullary. An adjacent soft tissue mass extends into the spinal canal and retrocrural space causing spinal stenosis and displacing the aorta anteriorly.
Introduction to systematic analysis of the spinal mri spinal mri for. Search for print and electronic books at the uf libraries. Solitary bone plasmacytoma is one of the two subgroups of plasmacytoma, the other being the extramedullary plasmacytoma. What is the role of mri in the diagnosis of multiple myeloma. There is pathologic fracture through the l2 vertebral body with approximately 30% loss of vertebral body height. Solitary bone plasmacytoma radiology reference article. So patients suffering from this type of plasmacytoma, need to be monitored regularly with xrays, blood tests and mri scans. Clinical report by the journal of the louisiana state medical society. The lumbar spine consists of 5 lumbar vertebral bodies. Solitary plasmacytoma is an infrequent form of plasma cell dyscrasia that presents as a single mass of monoclonal plasma cells, located either extramedullary or intraosseous.
Calvarial plasmacytoma, an unusual manifestation of multiple myeloma. This shows invasion of the bone or tissue by monoclonal identical plasma cells see cutaneous plasmacytoma pathology. A spine mri figure 1 disclosed involvement of the t12 vertebral body. Number 1april 2019 whole body mri as currently used includes dw mri sequences that are sensitive to cellular density and viability and are important for disease detection, monitoring, and therapy. A wide variety of lesions can be found in the osseous spine. Diagnosis, treatment, and response assessment in solitary. Peak prevalence occurs during the fourth decade of life equally in both sexes. To report a case of extramedullary plasmacytoma of the orbit. The cpt book states to not use 62267 in conjunction with 20225. In a clear clinical context, the diagnosis can be easily made. Magnetic resonance imaging mri was performed to rule out cord compression.
They occur most frequently in the vertebral column 3050% and skull 20%, whereas involvement of other sites including the. Biopsy confirmation of a monoclonal plasma cell infiltration from a single site is required for diagnosis. Solitary bone plasmacytoma is a bone tumor that arises from plasma cells. Solitary plasmacytoma of the spine associated with. They are benign in nature and frequently asymptomatic. These lesions can be solitary or multiple with a benign or malignant aetiology. Solitary plasmacytoma sp is characterized by a mass of neoplastic monoclonal plasma cells in either bone sbp or soft tissue without evidence of systemic disease attributing to myeloma. The l5 vertebral body and sacrum are uniformly high in signal because of prior radiation treatment to this area. Sagittal t1weighted spin echo image shows normal marrow signal intensity of lumbar vertebral bodies, which. Plasmacytomas can occur in any bone, but they are most common in the spine. Solitary plasmacytoma of bone with oncogenic osteomalacia. In some patients, a bone marrow aspiration can detect a low monoclonal plasma cell infiltration which indicates a high risk of early progression to an overt myeloma disease. Patients with solitary plasmacytoma in the spine frequently require a biopsy for diagnosis of their. Mri showed a lytic lesion in c7 and d1 vertebral body appearing mildly isointense on t 1 weighted t1w images and hyperintense on t 2 weighted t2w images compared to adjacent normal vertebral bodies signal.
Ct is the modality of choice to assess the bony lesion while mri provides a better assessment of soft tissue lesions. They are found in the bone marrow of the axial skeleton or long bones of limbs. There are some patients 5070% with solitary bone plasmacytoma who can develop multiple myeloma in the future, like in about 10 years or so. Solitary plasmacytoma of the spine associated with neurological.
Fundamentals of body mri fundamentals of radiology. Imaging appearance of primary bony tumors and pseudo. Malignant bone tumours of the spine are extremely rare plasmacytoma. One study of 611 myeloma patients showed that the presence of more. Mri raised concern for vertebral osteomyelitis and discitis at the l4l5 levels.
Spinal tumors can be dangerous when they cause spinal canal compression, which may lead to neurologic dysfunction, e. Cpt 62267 vs 20225 medical billing and coding forum aapc. A vertebral hemangioma vh is a vascular lesion within a vertebral body. The international myeloma working group lists three types. The classic radiologic appearance of osseous plasmacytoma, an area of bone destruction with discrete marginsthe socalled punchedout lesionmay be absent in sternal plasmacytomas. The common presentation of sbp is in the axial skeleton, whereas the extramedullary plasmacytoma. Commonly, these are benign lesions that are found incidentally during radiology studies for other indications. Features such as low signal intensity band on t1 and t2 with maintained marrow signal intensity of the vertebral body. Metastatic bone disease usually presents as multiple vertebral body lesions and is the most common vertebral tumour.
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