A Surgical Case of Solitary Plasmacytoma of Rib Origin with Biclonal Gammopathy

Abstract

Localized solitary plasmacytoma of the bone (SPB) is a rare disease and is characterized by only one or two isolated bone lesions with no evidence of disease dissemination. A previously healthy 44-year-old male was admitted for evaluation of an abnormal radiographic shadow in the left middle lung field with symptoms of left back pain. Radiological evaluation revealed a peripheral opacity in the left chest wall, which was highly suspected to be a chest wall tumor. CT-guided transcutaneous needle biopsy of the tumor was performed and the specimens showed a monomorphous population of mature plasma cells. The bone marrow biopsy findings revealed no evidence of myeloma and bone scanning revealed only abnormal accumulation in the left seventh rib. He had mild M-proteins in a urine sample and Bence-Jones protein was detected. Immunoelectrophoresis revealed mild biclonal gammopathy of Bence-Jones protein of both the kappa and lambda light-chain types. Under a diagnosis of solitary bone plasmacytoma, preoperative radiation therapy with doses of 40 Gy for the tumor was performed. He underwent complete en bloc resection of the chest wall, including one-third of the left sixth and seventh ribs, the intercostal muscle and the parietal pleura. The protein abnormalities in the urine sample disappeared following surgical resection. Adjuvant chemotherapy using melphalan and prednisolone was performed. He is doing well without evidence of tumor recurrence 2 years following his initial diagnosis.

Solitary Plasmacytoma of the Chest Wall

“…An involvement of the chest wall and ribs in multiple myeloma is generally associated with other skeletal localizations. There are few reported cases of solitary plasmacytoma of the ribs [3]. Patients with solitary plasmacytoma of the chest wall are curable and have a higher survival rates with the combination of surgery and adjuvant therapies, as reported in this case.…”

Extramedullary Plasmacytoma Involving the Abdominal Vessels and Pancreas

“…SP has been reported to be highly radiosensitive and chemosensitive [5,6,8]. However, as seen in our case and in the other reports [4,9], the prognosis and the sensitivity of SP to radiochemotherapy may be poor, and the course of the disease may be very aggressive.…”

“…Solitary plasmacytoma (SP) is defined as a neoplastic proliferation of plasma cells which originate in almost any tissue throughout the body, without any sign of systemic spread [4,5]. Primary SPs are considered clinically distinct entities and approximately 2-10% of MM patients who present with SPs develop the generalized disease later [6]. SPs are rare occurrences and categorized into two groups: SPs of the bone (SPB), which account for 2-5% of all plasma cell neoplasms; and extramedullary plasmacytomas (EMPs) of the soft tissue, which account for 3% of all such neoplasms [5].…”

Solitary plasmacytoma of rib in a young adult – a rare case report

“…Plasmacytoma may be primary or secondary to the disseminated multiple myeloma and may arise from the osseous (medullary) or nonosseous (extramedullary) sites. Primary extramedullary plasmacytoma can be solitary or multiple [4] .SPB has been considered a genetic abnormality that can often change to multiple myeloma [5]. Solitary plasmacytoma is rare as compared with multiple myeloma.…”