Plasmacytoma / multiple myeloma - spine

Case contributed by RMH Neuropathology

Presentation

Back pain

Patient Data

Age: 50 years
Gender: Female

Thoracic spine x-rays

Modality: X-ray

Angled thoracic kyphosis at the T8 level which is almost completely obliterated. Bones are diffusely osteopenic.

CT spine

Modality: CT

Axial imaging with multiplanar reformats of the lumbar spine have been obtained. There is an angled kyphosis centred at the T8 level, with a soft tissue destructive mass engulfing the T7, T8 and T9 vertebral bodies (near complete obliteration of the T8 vertebra). There is no definite thoracic spinal canal tumour extension and minimal paravertebral soft tissue involvement. No focal abnormality identified.

MRI spine

Modality: MRI

A large mass involves T7 , T8 and T9 vertebral bodies with a vertebra plana of T8. There is only minimal epidural extension without cord compression. 

Biopsy

Modality: Pathology

MICROSCOPIC DESCRIPTION:

Paraffin sections show fragments of a densely hypercellular tumour.  Tumour cells have plasmacytoid features with round and oval vesicular nuclei with a clock face arrangement of chromatin.  Many have conspicuous nucleoli.  There is a moderate amount of basophilic cytoplasm.  Frequent mitotic figures are identified.  Involvement of marrow spaces of bone is seen in specimen 3. Immunohistochemistry shows strong staining for CD138 and CD79a. There is also lambda light chain restriction.  The features are of plasmacytoma/myeloma.

FINAL DIAGNOSIS: Plasmacytoma/myeloma

Case Discussion

This patient had been diagnosed with multiple myeloma years earlier and had been in remission. 

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Case Information

rID: 24398
Case created: 13th Aug 2013
Last edited: 25th Apr 2017
Tag: spine
Inclusion in quiz mode: Included

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