Pathological cervical spine fracture
Awoke with right sided neck pain and stiffness. No recent trauma. Background of previous prostate cancer for which he received radium therapy 6 months ago. Also warfarinised for previous pulmonary embolism.
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Contrast CT of the neck shows multiple lucent lesions throughout the bones of the cervical spine, the largest of these involves the right lateral mass of C1 and there is a pathological fracture through this area with no displacement.
The CT images were most likely to be consistent with multiple myeloma however could also be consistent with lucent prostate metastasis given the patient's history.
Subsequent trephine biopsy results from the posterior superior iliac spine were consistent with plasma cell myeloma.
PLASMA CELLS: Increased, present in small random focal clusters and around vessels. Immature forms present.
IMMUNOHISTOCHEMISTRY: lambda restricted CD138+ plasma cells comprise 10-15% of total cells. They are present diffusely throughout the marrow as well as in small random focal cluster and around vessels.
TREPHINE BIOPSY SUMMARY: Lambda restricted plasmacytosis of 10-15% is consistent with plasma cell myeloma.