Solitary bone plasmacytoma as posterior fossa cranial neoplasia, presentation of two clinical cases

Background: Solitary bone plasmacytoma is a plasmatic cell dyscrasia; its presentation in the posterior fossa is very rare. Case Description: We present two cases, a 59-year-old male and a 50-year-old female, both with heterogeneous clinical presentation. One had symptoms compatible with endocranial hypertension, and the other presented with a hemispheric cerebellar syndrome and ipsilateral trigeminal neuralgia. They were both related to an intraosseous tumor of the occipital region near the torcula with large extension to the posterior fossa. The diagnosis of a plasma cell neoplasm arising from the diploe of the squamous portion of the occipital bone was confirmed with immunohistochemistry. Conclusion: The treatment for a cranial tumor that is suspected to be a solitary bone plasmacytoma requires a multidisciplinary team to diagnose, plan a total resection, and after surgery continue with the follow-up of the patient. Solitary bone plasmacytoma should be considered as a differential diagnosis for a tumor that produces cancellous bone widening without sclerotic borders.

Exploring Solitary Bone Plasmacytoma: A Rare Case Report

The Solitary Bone Plasmacytoma (SBP) is a rare oncologic disease corresponding to less than 5% of the malignant neoplasms of the plasma cells. It is characterized as a localized aggressive tumor consequent to the accumulation of monoclonal plasma cell neoplasms and, due to the rarity of the disease, there are only few clinical studies reporting it especially regarding prognostic factors and treatment. Here, we report a fatal clinical case of SPB in Roraima, the northernmost state of Brazil. The study shows a case of solitary bone plasmacytoma on the femur, where the patient was submitted to the preconized radiotherapy cycles. However, over approximately four-years following the diagnose, the patient required multi-modal approach to guarantee quality of life during the survival time. Finally, this study explores SBP-related issues and examines the challenges physicians face when managing the care of patients with SBP.

The Analysis of Risk for Solitary Bone Plasmacytoma Rapidly Progressing to Multiple Myeloma

Background: Solitary bone plasmacytoma(SBP) is a very rare and heterogeneous disease. Some patients have rapid progress into multiple myeloma. But some patients stay stable for a long time. Different patients have different clinical processes and prognostic performance. At present, there is no inconclusive prognostic factors of SBP progressed into multiple myeloma，and different studies have great different results. and they did not ues modern detection technology and methods. Therefore, there is no easy reliability methods for the factors of SBP progressed into multiple myeloma. There could not screen the SBP that rapidly progressing to MM and give intervention treatment for them. Purpose: to analyze the clinical characteristics and lesion biological markers of SBP patients using body PET / CT, flow cytometry and immunocellularization to and screen out the high-risk SBP patients who rapid progress into MM. SBP patients divided into different stratification according with high risk factors. And we preliminary establish the prognostic risk assessment systems which could predict SBP progressed into multiple myeloma. Objects and methods: Case: This study retrospectively analyzed 41 patients who were hospitalized from January 2003 to January 2020.All these patients accorded with the diagnostic standard of 2018 European solitary plasmacytoma .Enrolled 41 patients in groups. Observation indicators: age, gender, hemoglobin, β2 microglobulin, lactic acid dehydrogenase, blood calcium, creatinine,uninvolved immunoglobulin inhibited, M protein,X-ray / computed tomography (CT) / Magnetic Resonance Imaging(MRI) or whole body PET / CT, bone marrow smear, flow cytometry of bone marrow, the immunohistochemical conditions of the puncture lesion include VCAM-1, MMP9, VEGF, TGFβ, IGF-1, Ki-67, p53, CXCR4, 67LR, MCP-1, CCR2, CCR7. Results: 1. General Characteristics: A total of 41 patients with SBP are enrolled in this study, The median age of onset is 53.02 years (20-73 years), and 22pts are males and 19pts females. The median follow-up time is 48 months, and during this time, 17 patients progressed into multiple myeloma.The median PFS is 84 months.For the significance of lesions, the lesions were in vertebral body of 16 cases (39.0%), 7 cases (17.1%), respectively in scapular, rib and clavicle. For treatment, 20 patients (48.8%) were received radiotherapy, 16 patients (39.0%) received surgery + radiotherapy, and 5 (12.2%) patients just only accepted surgery.Among 41 SBP, 17 patients(41.5%) progressed into MM during follow-up, including 8 cases (8/17)progressed within 1 year after diagnosis. 3 cases progressed between 1 to 2 years, and 3 cases between 2 to 4 years.Also 3 patients progressed above 4 years after diagnosis. 2. In single-factor and multi-factor analysis, the progress group and the disease stabilization group are independent adverse pre-factors affecting SBP progress into MM ,including the vertebral body (p =0.028), excition clone plasma cell in BM (p =0.010)and the proportion of ki67 positive cells> 12.5%(p =0.019). 3. Establish formula model to predict the prognosis of SBP progressed into MM.On the base of beta Predicting prognosis = lesion is located in vertebral body × 2 +excited clone plasma cell in bone marrow × 3 + ki67 > 12.5% × 4. According to the model, the score is between 0 points to 9 points, the scores <2 are divided into low-risk group, and scores between 2 ~ 5 are divided into middle-risk group.When scores≥5 are divided into high-risk group. Among the 41 patients in this study, 15 patients (36.6%), are the low-risk group that PFS has not been achieved.And 11 patients (26.8%) are the middle-risk group ,which PFS is 8.3% of 2-year. Verify the prediction prognostic model of SBP progressed into MM. There are six cases of SBP which include the prognosisi factors can be used to verify our model in Guidong People's Hospital, Guangxi. These 6 patients are identical with our prognosis model. Conclusions: SBP patients divided into different stratification according with high risk factors. The vertebral body, excition clone plasma cell in BM and the proportion of Ki67 positive cells> 12.5% are the independent adverse pre-factors for SBP progressed into MM. According the score of our model,SBP can be divided into low-risk, middle-risk groups and high-risk groups. It may require early intervention for high-risk patients that progressed into multiple myeloma within 2 years. Disclosures No relevant conflicts of interest to declare.

Recurrent solitary bone plasmacytoma: A case report

Background: Plasmacytoma is an hematological malignancy that originates in bone. It may involve a single skeletal location. Notably, these lesions can progress to involve multiple segments in 50% of cases, at which point they are classified as having multiple myeloma (MM). Case Description: One year ago, this patient had undergone a D6 laminectomy and biopsy for plasmacytoma. Now at age 73, she newly presented with the onset of a progressive paraparesis of 4 weeks’ duration. On examination, she had 3/5 strength in both lower extremities accompanied by diffuse hyperreflexia, and bilateral Babinski signs. She underwent a D5-D7 decompression, D6 corpectomy with anterior mesh cage reconstruction, and a D3-D9 posterior fusion. Conclusion: Patients originally treated for plasmacytoma present 50% of the time with the new onset of neurological symptoms and signs due to the subsequent evolution of MM. As these lesions may be refractory to radiation and/or chemotherapy, surgery is often warranted.

Safety and Feasibility Analysis of a Prospective Trial on Stereotactic Body Radiotherapy for Solitary Bone Plasmacytoma

<b><i>Background:</i></b> There have been reports on the use of hypofractionated stereotactic body radiotherapy (SBRT) for bone plasmacytomas, but no prospective data are available. We present the initial analysis of an ongoing prospective protocol on SBRT addressing the feasibility and safety of this treatment for solitary bone plasmacytomas. <b><i>Patients and Methods:</i></b> A prospective cohort of SBRT for solitary bone plasmacytoma was developed. Patients could receive different doses depending on the index bone, from single fraction for skull base lesions, 24 Gy in 3 fractions for spine lesions, and 30 Gy in 5 fractions for other bones. Overall survival, bone events, local control, and progression to multiple myeloma (MM) were measured and compared to our retrospective cohort of patients treated with conformal standard-dose radiotherapy. Quality of life was assessed via the EORTC QLQ-C30 questionnaire, and toxicities were assessed by the CTCAE v5.0 criteria. After 1 year or the inclusion of 5–10 patients, a feasibility and safety analysis was programmed. <b><i>Results:</i></b> Between April 2018 and April 2019, 5 patients were included. All were male, with a median age of 53.1 years. The median follow-up was 21.8 months. No patient had local progression, bone event, or died. Two patients had progressions to MM. The mean survival free of progression to MM was 18.6 months, compared to 19 months in the retrospective cohort; median values were not reached. There were no grade 3 toxicities. <b><i>Conclusion:</i></b> SBRT for plasmacytoma is safe and feasible. More robust data are awaited.