plasmacytoma

Multiple
myeloma: X-ray with multiple osteolytic lesions in the forearm.
Wikipedia • CC BY-SA 3.0
Imaging of
skull vault tumors in adults. Myeloma and plasmacytoma. Upper row. Myeloma. X-ray (a) NECT (b, c) and T1WI (d). Multiple “punched-out” lytic lesions with variable soft tissue components (a–c). Mandibular lesion suggesting myeloma instead of metastases (arrow in d). Note also the clival lesion (dashed arrow in d). Lower row. Plasmacytoma. NECT (e), T1WI post-contrast (f), and DSC-PWI (g). Single purely lytic transdiploic lesion with narrow zone of transition (arrows in e), hyperdense, hyperenhancing, and hypervascular (arrowheads respectively in e–g)
insightsimaging.springeropen.com • CC-by-4.0
Atypical
multiple myeloma. T1W post-contrast axial image showing homogeneous enhancement of the lesion.
www.eurorad.org • CC by-nc-sa-4.0
Atypical
multiple myeloma. CT scan guided tru-cut biopsy from left para-vertebral soft tissue in dorsal region.
www.eurorad.org • CC by-nc-sa-4.0
Atypical
multiple myeloma. FDG PET image showing hypermetabolic lesions involving multiple bones (MAX SUV: 18)
www.eurorad.org • CC by-nc-sa-4.0
Spectrum of
lytic lesions of the skull: a pictorial essay. Multiple myeloma (MM). Axial CT images with bone window showing multiple osteolytic lesions varying in shape and size, involving the skull vault and base
insightsimaging.springeropen.com • CC-by-4.0
Bone up on
spinal osseous lesions: a case review series. Plasmacytoma. Sagittal and axial MR images demonstrate an expansile mass (orange arrows) arising from the posterior elements of C2 and C3. The mass demonstrates hypointense signal to normal marrow on T1 (a), and isointense to hyperintense signal on T2 (b). Post-contrast sagittal T1 (c) and axial T1 fat-suppressed (d) sequences demonstrate enhancement. A few areas of curvilinear low-signal intensity are seen at the remaining thickened bony cortex (white arrows), projecting into the lesion, resulting in a “mini-brain” appearance resembling cortical sulci
insightsimaging.springeropen.com • CC-by-4.0
Multiple
myeloma: X-ray with multiple osteolytic lesions in the forearm.
Wikipedia • CC BY-SA 3.0
Lucent/lytic
bone lesion - differential diagnosis (mnemonic) • Multiple myeloma - skeletal survey - Ganzer Fall bei Radiopaedia
Gaillard, F. Multiple myeloma - skeletal survey. Case study, Radiopaedia.org. (accessed on 13 Nov 2022) https://doi.org/10.53347/rID-7682 • CC by-nc-sa 3.0 (modified)
Multiple
myeloma, left proximal humerus. Plain x-ray.
Wikipedia • CC BY-SA 3.0
Young adult
with anemia. Lateral radiograph of the skull shows multiple well circumscribed lytic lesions throughout the skull.The diagnosis was multiple myeloma.
pediatricimaging.org • CC-by-nc-sa 4.0
Radiopaedia • CC-by-nc-sa 3.0 • de

Plasmacytomas are discrete, solitary tumors of neoplastic monoclonal plasma cells in either bone or soft tissue (extramedullary). It is a rare tumor that is associated with latent systemic disease in the majority of affected patients. In contradistinction to multiple myeloma, there is minimal or no systemic bone marrow involvement.

Solitary plasmacytomas can be divided into two groups according to location:

Epidemiology

  • overall, solitary plasmacytoma represent 3-6% of all plasma cell neoplasia (i.e. including multiple myeloma, plasma cell leukemia) 
  • usually occur in patients between 40 and 80 years of age
  • the median age is 55 years, that is 10 years younger than patients with multiple myeloma

Clinical presentation

The most common symptom of solitary bone plasmacytoma is pain at the site of the skeletal lesion due to bone destruction by the infiltrating plasma cell tumor.

Pathology

A plasmacytoma can arise in any part of the body. A solitary bone plasmacytoma arises from the plasma cells located in the bone marrow, whereas extramedullary plasmacytoma is thought to arise from plasma cells located in mucosal surfaces. Both represent a different group of neoplasms in terms of location, tumor progression, and overall survival rate. Both do, however, share many of the biologic features of other plasma cell disorders.

Radiographic features

Plasmacytoma (as with multiple myeloma) are typically seen as well-defined, “punched-out” lytic lesions with associated extraosseous soft-tissue masses, similar in appearance to most metastatic lesions. In advanced plasmacytoma, there is often marked erosion, expansion, and destruction of the bone cortex, sometimes with thick ridging around the periphery, creating a “soap bubble” appearance.

CT

CT may demonstrate subtle lytic lesions or small soft-tissue masses, particularly of the sternum, that are not visible at radiography.

MRI

Use of short-inversion-time inversion recovery and contrast-enhanced fat suppression techniques may improve the sensitivity of MR imaging.

Treatment and prognosis

Treatment may consist of radiotherapy alone, surgery alone, or a combination of the two depending on location and resectability of the plasmacytoma . Solitary bony plasmacytomas are highly radiosensitive with local control rates of greater than 80% .

Three patterns of failure indicating poorer prognosis include development of multiple myeloma, local recurrence, and development of new lesions . The progression rate to multiple myeloma is higher in solitary bone plasmacytoma (65-85% at 10 years) than extramedullary plasmacytoma .

Siehe auch:
und weiter:
Assoziationen und Differentialdiagnosen zu Multiples Myelom:
Osteoid-Osteom
 
Wikipedia • CC BY-SA 3.0
Aneurysmatische
Knochenzyste
www.eurorad.org • CC by-nc-sa-4.0
Osteolyse
 
Wikipedia • CC BY-SA 4.0
Riesenzelltumor
 
pediatricimaging.org • CC-by-nc-sa 4.0
extraossäres
Plasmozytom
insightsimaging.springeropen.com • CC-by-2.0
Ostitis
fibrosa cystica
Wikipedia • CC BY-SA 4.0
Knochenmetastasen
 
Wikipedia • CC BY-SA 3.0