Localized epidural and bone amyloidosis, rare cause of paraplegia in multiple myeloma

Abstract

We report two cases of spinal cord compression by AL amyloid deposits in the setting of multiple myeloma. The first patient, a 57 year old man, had a surgical procedure late in his course, when his neurological status worsened despite medical treatment. The second patient, a 61 year old man, had surgical treatment as soon as vertebral body collapse and epiduritis were diagnosed and spinal amyloidosis revealed a non secretory myeloma. Neurological recovery was significant in both cases and neither developed manifestations of systemic amyloidosis 4 years later.

Biochemical and Immunohistochemical Characterization of the Amyloid in Canine Amyloid-Producing Odontogenic Tumor

“…21,51 Localized amyloid deposits with or without association with neoplasia also have been described in the human mammary gland, 41,52 respiratory tract, 26,34 gastrointestinal tract, 5,38 genitourinary tract, 13,17 skin, 24,25 and bone. 23 In animals, localized amyloidosis has been associated with neoplastic conditions such as calcifying epithelial odontogenic tumor (CEOT), 2,29 pancreatic endocrine tumor, 28 medullary thyroid carcinoma, 15 ameloblastoma, 10 mammary carcinoma, 43 intestinal carcinoid, 40 extramedullary plasmacytoma, 31,36 and myeloma. 12 CEOT is a rare neoplasm of the tooth-forming apparatus that produces a mineralized substance and amyloid.…”

Solitary epidural amyloidoma of C2–4 without osteolysis of the spine in a multiple myeloma patient

“…The occurrence of an isolated amyloidoma in the spine is extremely rare, and only 13 cases of spine involvement have been reported [2][3][4][5][6][7][8][9][10][11][12][13][14]. Most cases are accompanied by vertebral collapse, and only one case associated with MM without bone connection had been previously reported [2], even though amyloidosis is commonly association with MM (Table 1).…”

“…However, a localized amyloid tumor, also known as an amyloidoma in the spine, is rare, and a few patients [2,3] had underlying multiple myeloma (MM). The present case was unique in the form without osteolysis or vertebral collapse, which did not originate from adjacent spinal vertebrae, in a patient with a known diagnosis of MM.…”

Intradural, extramedullary amyloidoma involving cervical and thoracic spine

“…Of these, 16 were cervical [5,10,11,[15][16][17][18]24,[27][28][29]31,33,35,37,41], 19 were thoracic [1,3,4,[7][8][9][19][20][21][22][23]26,30,32,34,36,[38][39][40], three were lumbar [2,13,25] and one was thoracolumbar [6]. Notably, all reported patients describe extradural amyloidomas making our patient, to our knowledge, the first with an intradural, extramedullary amyloidoma.…”