Plasmacytomas (Bsh 2004)

 

Epidemiology & Clinical Features

 

Male:Female 2:1, median age 55

Occur in spine twice as often as other sites

Presents as pain or cord/nerve root compression

Base of skull lesions can cause cranial nerve palsies

Solitary Bone Plasmacytoma (SBP)

  

Majority with apparent SBP develop myeloma after 2-4 years

  • i.e. undetected myeloma at diagnosis (MRI spine may increase pick-up rate)

Increased likelihood of progression to myeloma with:

  • Low uninvolved Ig, Axial disease, Older age, Size >5cm, monoclonal band post-Rx

Diagnostic criteria

  • Single area of bone destruction due to clonal plasma cells + normal BM biopsy + normal skeletal survey + no myeloma ROTI + absent or low monoclonal Ig

Treatment

  • Radical radiotherapy of approx. 40 Gy with a 2cm margin

  • Post-treatment regular review and monitoring for myeloma development

 

Solitary Extramedullary Plasmacytoma (SEP)

 

Less common than SBP but better prognosis

90% occur in head and neck but can be anywhere in body

Diagnostic criteria

  • Single extramedullary mass of clonal plasma cells + normal BM biopsy + normal skeletal survey + no myeloma ROTI + absent or low monoclonal Ig

  • Due to soft tissue mass and rarity, can be confused with Non-hodgkin lymphomas

Treatment

  • High cure rates with radiotherapy of approx. 40 Gy with 2cm margin

  • Surgery may be considered if not ‘mutilating’