Chen Zheng, Lin Shengrong, Zhu Hongwei
Department of Neurosurgery, The First Affiliated Hospital of Xiamen University, Xiamen, China.
Department of Orthopedics, The First Affiliated Hospital of Xiamen University, Xiamen, China.
Int J Surg Case Rep. 2022 Mar;92:106816. doi: 10.1016/j.ijscr.2022.106816. Epub 2022 Feb 8.
Solitary bone plasmacytoma (SBP) is a hematopoietic malignancy occurring in bone tissue, which often causes bone destruction at the site of the lesion. When the lesion occurs in the spine and causes spinal stenosis and compression of the spinal cord, surgery is performed as an adjuvant treatment before radiotherapy.
A 36-year-old patient suffered from neck, shoulder and upper limbs pain for 3 weeks and the symptom worsened for 3 days after exercise. CT and MRI examination of the neck after emergency admission revealed C5 vertebral pathological fracture with associated spinal stenosis and spinal cord compression. PET-CT indicated a hypermetabolic soft tissue mass in the C5-6 vertebral body. Granulomatous lesions (tuberculosis) were considered, but neoplastic lesions were not ruled out. The primary diagnosis was cervical fracture caused by tuberculosis. Finally, a needle biopsy was performed at the lesion site and a diagnosis of SBP was made. Radiotherapy was immediately followed and the spinal cord compression was relieved a month later. After 6 months of follow-up, she is now in stable condition with no neck pain or neurological impairment.
For patients with SPB resulting in pathological fracture of the cervical vertebra with spinal stenosis and compression of the spinal cord, forgoing surgery and undergoing radiation therapy alone may be an option.
孤立性骨浆细胞瘤（SBP）是一种发生于骨组织的造血系统恶性肿瘤，常导致病变部位的骨质破坏。当病变发生于脊柱并引起椎管狭窄和脊髓受压时，手术作为放疗前的辅助治疗手段。
一名36岁患者颈部、肩部及上肢疼痛3周，运动后症状加重3天。急诊入院后颈部CT和MRI检查显示C5椎体病理性骨折伴椎管狭窄和脊髓受压。PET-CT显示C5-6椎体有高代谢软组织肿块。考虑为肉芽肿性病变（结核），但未排除肿瘤性病变。初步诊断为结核所致颈椎骨折。最后在病变部位进行穿刺活检，确诊为SBP。随即进行放疗，1个月后脊髓压迫症状缓解。随访6个月后，患者目前病情稳定，无颈部疼痛及神经功能障碍。
对于因SBP导致颈椎病理性骨折伴椎管狭窄和脊髓受压的患者，放弃手术仅行放疗可能是一种选择。
