Solitary plasmacytoma

Bone
Hematologic neoplasms
Solitary plasmacytoma

Author: Sheren Younes, M.D. (see Authors page)

Revised: 28 October 2016, last major update April 2014

Copyright: (c) 2003-2016, PathologyOutlines.com, Inc.

PubMed search: solitary plasmacytoma [title] bone

Table of Contents

Cite this page: Solitary plasmacytoma. PathologyOutlines.com website. http://www.pathologyoutlines.com/topic/bonesolitaryplasmacytoma.html. Accessed July 14th, 2017.

Definition / general

Defined by WHO 2008 as a localized bone tumor consisting of monoclonal plasma cells, with no other bone lesions, no bone marrow involvement and no clinical features of myelomas

Epidemiology

Rare; < 5% of myeloma patients
Majority are males
Median age is 50 - 55 years

Sites

Sites of active bone marrow hematopoiesis
40% - 60% in axial spine; also vertebrae, thoracic more than lumbar and cervical
Followed by ribs, skull, pelvis, femur, clavicle, scapula
Long bone involvement below elbow and knee are rare
Rarely involves lymph nodes or peripheral blood

Clinical features

Incidental finding
May have bone pain and pathologic fracture
May cause soft tissue mass

Diagnosis

Diagnostic criteria:
Single bony lesion consisting of monoclonal plasma cells; MRI may be needed to exclude involvement of other sites
No bone marrow involvement
No clinical features of myeloma, such as anemia, hypercalcemia and renal failure
Absence or low levels of M protein in urine
Normal levels of uninvolved polyclonal immunoglobulins (Br J Haematol 2004;124:717)

Laboratory

CBC, renal function tests, serum calcium (to exclude myeloma)
Immunofixation studies in serum and urine (M protein detection)

Radiology description

Osteolytic lesions, similar to myeloma
May show soft tissue extension
Vertebral involvement may be associated with spinal cord or nerve root compression

Radiology images

Images hosted on PathOut server:

Pelvis xray, by Dr. Mark R. Wick

Skull xray, by Dr. Mark R. Wick

Images hosted on other servers:

Lobulated osteolytic sternal lesion

Prognostic factors

Median survival is 10 years
50% eventually develop myeloma, 1 / 3 remain disease free > 10 years after radiotherapy
Poor prognostic factors are large size and M protein persistence after radiotherapy

Case reports

36 year old man with anaplastic tumor (Arch Pathol Lab Med 2004;128:237)
43 year old woman with solitary bone plasmacytoma of lumbar spine (Eur Spine J 2014;23:35)
52 year old patient with maxillary solitary recurrent plasmacytoma (Chirurgia (Bucur) 2013;108:732)
64 year old woman with solitary bone plasmacytoma (Can Respir J 2013;20:11)
Extended resection of a plasmocytoma of bone and an amyloidoma of the chest wall (Ann Thorac Surg 2013;96:2223)
Solitary plasmacytoma of the medial clavicle (Am J Orthop (Belle Mead NJ) 2013;42:230)

Treatment