David Garrido, Marianela Posada, Victoria Matosas, Mariana Lorenzo, Francisco Garagorry, Carina Di Matteo, Cecilia Guillermo, Eloisa Riva
Hematology Department, Hospital de Clinicas "Dr. Manuel Quintela". Av Italia sn,11600. Montevideo, Uruguay.
Pathology Department, Hospital de Clinicas "Dr. Manuel Quintela". Av Italia sn,11600. Montevideo, Uruguay.
Radiol Case Rep. 2021 Apr 30;16(7):1622-1627. doi: 10.1016/j.radcr.2021.04.024. eCollection 2021 Jul.
Solitary plasmacytoma is a rare clonal plasma cell tumor, representing 2-5% of plasma cell disorders. The standard treatment is local radiotherapy. However, in some cases, its use is limited by the size and/or location of the mass. Systemic chemotherapy may be a useful therapeutic alternative. We describe a case of a 27-year-old male with a bulky solitary plasmacytoma arising in the posterior mediastinum, causing spinal cord compression. Radiotherapy was considered risky as the mass was located in the heart and left lung fields. Systemic treatment was given. After the first cycle of cyclophosphamide, bortezomib, and dexamethasone (VCD), the patient attained full neurological recovery. After four VCD cycles, complete remission was achieved. Autologous stem cell transplantation was given as consolidation therapy. At 3 months post-transplantation, the patient is in full clinical recovery and complete metabolic remission on 18FDG PET-CT. Although infrequent, plasma cell disorders must be considered in adult patients with a bulky tumoral mass in the posterior mediastinum. PET-CT is the whole-body imaging technique of choice to detect SP, to evaluate response to treatment and during follow-up.
孤立性浆细胞瘤是一种罕见的克隆性浆细胞肿瘤，占浆细胞疾病的2% - 5%。标准治疗方法是局部放疗。然而，在某些情况下，其应用受到肿块大小和/或位置的限制。全身化疗可能是一种有效的治疗选择。我们描述了一例27岁男性患者，后纵隔出现巨大孤立性浆细胞瘤，导致脊髓受压。由于肿块位于心脏和左肺野，放疗被认为具有风险。于是给予了全身治疗。在接受环磷酰胺、硼替佐米和地塞米松（VCD）的第一个周期后，患者实现了完全神经功能恢复。经过四个VCD周期后，达到了完全缓解。给予自体干细胞移植作为巩固治疗。移植后3个月，患者临床完全康复，18FDG PET-CT显示完全代谢缓解。尽管罕见，但对于后纵隔有巨大肿瘤肿块的成年患者，必须考虑浆细胞疾病。PET-CT是检测孤立性浆细胞瘤、评估治疗反应及随访期间的首选全身成像技术。
