Mohammadi Afshin, Ilkhanizadeh Behrooz, Ghasemi-Rad Mohammad
Department of Radiology, Urmia University of Medical Sciences, Urmia, West-Azerbaijan, Iran.
Int J Surg Case Rep. 2012;3(7):296-8. doi: 10.1016/j.ijscr.2012.02.009. Epub 2012 Apr 3.
Solitary plasmocytoma is a rare plasmacytic cell tumor, which occurs in the head and neck region and rarely involves the mandible.
We present a unique radiographic presentation of solitary bone plasmocytoma (SBP) occurring in the Jaw. A 63-year-old male presented with the left mandibular swelling and on the conventional radiograph we noticed a lytic lesion with a sunray periosteal reaction. Clinical diagnosis was osteosarcoma but histopathology revealed sheets of plasma cells with cartwheel appearance and expansile bony trabecula suggestive for solitary bone plasmocytoma. 5years after complentary treatment by local radiotherapy he developed malaise, weakness and generalized bone pain and bone marrow aspiration revealed more than 90% plasma cell in the marrow and diagnosis of Multiple Myeloma was confirmed.
SBP is radiographically seen as a well-defined radiolucent expansile lytic lesion with cortical thinning and no periosteal reaction. The imaging appearance of periosteal reaction is determined by the intensity, aggressiveness, and duration of the underlying pathology. Osteosarcoma, Metastasis (especially from sigmoid colon and rectum), Ewing s sarcoma, Haemangioma, meningioma and Tuberculosis are the main differential diagnosis of Sunburst periosteal reaction.
Sunray periosteal reaction should be included in the differential diagnosis of lytic bone lesion in the mandible.
孤立性浆细胞瘤是一种罕见的浆细胞肿瘤，发生于头颈部，很少累及下颌骨。
我们展示了一例发生于颌骨的孤立性骨浆细胞瘤（SBP）独特的影像学表现。一名63岁男性因左侧下颌肿胀就诊，在传统X线片上我们发现一个伴有日光放射状骨膜反应的溶骨性病变。临床诊断为骨肉瘤，但组织病理学显示成片的呈车轮状外观的浆细胞以及膨胀性骨小梁，提示为孤立性骨浆细胞瘤。在接受局部放疗辅助治疗5年后，他出现不适、乏力和全身骨痛，骨髓穿刺显示骨髓中浆细胞超过90%，确诊为多发性骨髓瘤。
SBP在影像学上表现为边界清晰的透光性膨胀性溶骨性病变，伴有皮质变薄且无骨膜反应。骨膜反应的影像学表现取决于潜在病变的强度、侵袭性和持续时间。骨肉瘤、转移瘤（尤其是来自乙状结肠和直肠的）、尤因肉瘤、血管瘤、脑膜瘤和结核是日光放射状骨膜反应的主要鉴别诊断。
日光放射状骨膜反应应纳入下颌骨溶骨性病变的鉴别诊断中。
