Solitary bone plasmacytoma

Case contributed by Yaïr Glick

Presentation

Low back pain. History of well-controlled hypertension and prostatectomy.

Patient Data

Age: 70 years
Gender: Male
ct

Homogeneous lytic lesion isodense to muscle in the T12 vertebral body measuring 30 x 29 x 20 mm (laterolateral x AP x CC) with thickening of the surrounding trabeculae (mini brain sign). The lesion breaches the posterior wall of the vertebral body and bulges into the spinal canal at its left paramedian aspect, narrowing the lateral recess and displacing the thecal sac to the right. Both upper and lower T12 endplates are fractured where they border on the lesion. Radiographic appearance suggestive of solitary bone plasmacytoma.

Lumbosacral transitional vertebra (LSTV) - lumbarization of S1.

ct

Contrast-enhanced CT chest-abdomen was done to rule out additional lesions/metastases, which were not found. Radiographs (not shown) were taken of the appendicular skeleton: no evidence of disease.

The lesion in T12 shows homogeneous enhancement.

mri

Enhancing soft-tissue lesion in T12 vertebral body, with mild loss of vertebral height. The lesion exerts mild pressure on the dural sac and narrows the left lateral recess.
No additional lesions are seen.

Core needle biopsy

Fluoroscopy

Core needle biopsy obtained from the lesion.

Case Discussion

The appearance on non-contrast CT was already suggestive of a solitary bone plasmacytoma.

Histopathology: compatible with plasmacytoma.

The patient also underwent PET, which ruled out additional lesions.

NB: it is important to mention a lumbosacral transitional vertebra in the radiology report, as this has bearing on the level of tumor; in this case, for obtaining a biopsy and centering the radiation beam on the tumor.

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