Preston Gordon, Anton Toomas
Department of Orthopedic Surgery, Western Reserve Hospital, Cuyahoga Falls, Ohio, USA.
Department of Neurosurgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Surg Neurol Int. 2017 Aug 9;8:173. doi: 10.4103/sni.sni_209_17. eCollection 2017.
Plasma cell neoplasmas are a heterogenous group of neoplastic tumor lesions occurring secondary to disordered proliferation of cells from a monocyte lineage. Plasmacytoma is a rare lesion that accounts for 5% of all plasma cell neoplasms. The current recommended treatment for solitary plasmacytoma is moderate dose radiation therapy. For patients who are suffering from axial back pain, spinal instability, radiculopathy, or bowel/bladder dysfunction secondary to spinal cord compression, surgical intervention with spinal decompression and stabilization can be used as an adjuvant to radiation therapy.
We report a patient who presented with worsening axial and bilateral upper extremity pain. He was found to have a locally aggressive tumor involving the vertebral body of T2. After a repeat magnetic resonance imaging (MRI) and a computed tomography (CT)-guided biopsy, the diagnosis of a solitary plasmacytoma was confirmed. It destroyed over 90% of the T2 vertebral body, resulted in 22° of local kyphosis, and caused spinal cord compression. The tumor was treated with a T2 vertebrectomy, posterior arthrodesis from C5-T4, and anterior arthrodesis from T1-3.
Solitary plasmacytomas of the vertebral bodies are difficult lesions to treat secondary to their location and risk of neurologic compromise. Surgical intervention with tumor resection and adjuvant chemotherapy or radiation is the recommended treatment option.
浆细胞肿瘤是一组异质性肿瘤病变，继发于单核细胞谱系细胞的无序增殖。浆细胞瘤是一种罕见病变，占所有浆细胞肿瘤的5%。目前推荐的孤立性浆细胞瘤治疗方法是中等剂量放射治疗。对于因脊髓受压而出现轴向背痛、脊柱不稳、神经根病或肠道/膀胱功能障碍的患者，可采用脊柱减压和稳定的手术干预作为放射治疗的辅助手段。
我们报告一名患者，其轴向及双侧上肢疼痛逐渐加重。发现他患有一个侵犯T2椎体的局部侵袭性肿瘤。经重复磁共振成像（MRI）及计算机断层扫描（CT）引导下活检后，确诊为孤立性浆细胞瘤。该肿瘤破坏了超过90%的T2椎体，导致22°的局部后凸，并引起脊髓受压。对该肿瘤进行了T2椎体切除术、C5至T4后路关节融合术以及T1至3前路关节融合术。
椎体孤立性浆细胞瘤因其位置及神经功能受损风险而难以治疗。推荐的治疗选择是手术切除肿瘤并辅助化疗或放疗。
