Senol Selcen, Ampomah Kwasi, Montes-Chinea Nataly
Physical Medicine and Rehabilitation, Eastern Virginia Medical School, Norfolk, USA.
Cureus. 2023 Sep 21;15(9):e45673. doi: 10.7759/cureus.45673. eCollection 2023 Sep.
Solitary plasmacytoma (SP) can be classified into two groups: a solid mass of neoplastic monoclonal plasma cells in bone, also called a solitary bone plasmacytoma (SBP), or less likely solitary extramedullary plasmacytoma (SEP) without any evidence of systemic disease of multiple myeloma. The diagnosis should be made by biopsy confirmation, revealing monoclonal plasma cell infiltration from the mass. The SBP usually affects the axial skeleton. Males have a higher incidence than females, as the ratio is 2/1, and the average age is 55. SP incidence usually increases with age. SBP has a significantly higher risk for progression to myeloma, usually within two years, and radiotherapy (RT) is the treatment of choice. Patients with acute declining neurologic dysfunction require urgent surgery before radiation therapy. We report a middle-aged man who presented with bilateral lower extremity weakness. Thoracic MRI with and without contrast revealed a large soft tissue and osseous mass centered at the T8 vertebral body with a large paravertebral extension, causing spinal cord compression at the T8-T9 level. The patient's clinical presentation, assessment, and rehabilitation management are discussed. Patients with this diagnosis are not properly diagnosed for approximately six months.
孤立性浆细胞瘤(SP)可分为两组:一种是骨骼中肿瘤性单克隆浆细胞的实体肿块,也称为孤立性骨浆细胞瘤(SBP),或者较少见的孤立性髓外浆细胞瘤(SEP),且无任何多发性骨髓瘤系统性疾病的证据。诊断应通过活检确认,显示肿块中有单克隆浆细胞浸润。SBP通常累及中轴骨骼。男性发病率高于女性,比例为2:1,平均年龄为55岁。SP发病率通常随年龄增长而增加。SBP进展为骨髓瘤的风险显著更高,通常在两年内,放射治疗(RT)是首选治疗方法。急性神经功能障碍下降的患者在放疗前需要紧急手术。我们报告一名中年男性,表现为双侧下肢无力。增强和未增强的胸椎磁共振成像显示一个以T8椎体为中心的巨大软组织和骨质肿块,伴有巨大的椎旁延伸,导致T8 - T9水平脊髓受压。讨论了该患者的临床表现、评估和康复管理。患有这种诊断的患者大约有六个月不能得到正确诊断。