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Hindi Research Article, J Spine Neurosurg Vol: 6 Issue: 2
Solitary Plasmacytoma of the Axial Spine and Dorsal Spine: Treatment Dilemmas and Review of Literature
| Kongwad LI1, Nair RP1*, Nayal B2 and Nagaraj A2 | |
| 1Department of Neurosurgery, KMC, Manipal University, Manipal, India | |
| 2Department of Pathology, KMC, Manipal University, Manipal, India | |
| Corresponding author : Dr. Rajesh P Nair, MS, MCh
Senior Registrar, Department of Neurosurgery, Kasturba Medical College, Manipal University, India E-mail: rajeshnair39@yahoo.com |
|
| Received: December 12, 2016 Accepted: January 20, 2017 Published: April 20, 2017 | |
| Citation: Kongwad LI, Nair RP, Nayal B, Nagaraj A (2017) Solitary Plasmacytoma of the Axial Spine and Dorsal Spine: Treatment Dilemmas and Review of Literature. J Spine Neurosurg 6:2. doi:10.4172/2325-9701.1000263 |
Abstract
Abstract
Background: Solitary plasmacytoma of the spine accounts
for 5% of plasmacytomas and is a rare entity [1]. More than 25-
60% of these lesions are localized in the dorsal spine and cause
myelopathy in 42-71% of the patients. Diagnosis and treatment
protocols have been established, however the final decision of
whether to stabilize and irradiate locally versus direct irradiation is
controversial. Many centers advocate different treatment protocols
based on their institutional experience and patient outcomes.
Clinical presentation: We present, herewith, our experience with a
63 year-old patient with upper dorsal solitary lesion, who presented
with upper back pain and was diagnosed to have a D3-4 solitary
plasmacytoma and another 44 year old patient who presented with
spastic quadriparesis progressing to quadriplegia over the last 6
months, who had a C2 lytic lesion with instability.
Conclusion: In the presence of solitary spinal lesions, despite
the location, solitary plasmacytoma of the bone should be
considered as one of the differential diagnosis. Abnormal
proteinemia or proteinuria may often be absent, yet this entity is
commonly encountered in clinical practice. Patients show clinical
and neurological improvement with surgical decompression with/
without stabilization. Postoperatively, radiotherapy is advocated
since it reduces the recurrence rates. Often confused with spinal
tuberculosis, starting ATT can be detrimental to the patient since it
delays the standard line of treatment.
