Plasmacytoma / multiple myeloma - spine

Case contributed by RMH Neuropathology

Presentation

Back pain

Patient Data

Age: 50 years
Gender: Female

Thoracic spine x-rays

X-ray

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

CT spine

CT

Axial imaging with multiplanar reformats of the lumbar spine have been obtained. There is an angled kyphosis centered 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 tumor extension and minimal paravertebral soft tissue involvement. No focal abnormality identified.

MRI spine

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

Pathology

MICROSCOPIC DESCRIPTION:

Paraffin sections show fragments of a densely hypercellular tumor.  Tumor 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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