Q J Med 2014; 107:675–676 doi:10.1093/qjmed/hct259 Advance Access Publication 24 December 2013
Clinical picture Plasmacytoma—a rare sternal tumor The osseous solitary plasmacytoma, or SBP, has a 40% higher incidence as compared with the extraosseous plasmacytoma, but overall it represents 5 cm for which reason a multi-disciplinary approach to treatment of SBP comprising of a hematologist, radiation therapist and surgeon is recommended. Photographs and text from: A. Aron, Veterans Affairs Medical Center, 4101 S 4th Street Trafficway, Leavenworth, KS 66048, USA; R.K. Jain, Amgen, Inc., 1 Amgen Center Drive, MS 38-2-B, Thousand Oaks, CA 91320, USA; A. Brateanu, Internal Medicine Residency Program, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH 44195, USA. email: [email protected] Conflict of interest: None declared.
References Figure 1. CT scan of the chest showing the tumor arising from the sternum.
1. Knowling MA, Harwood AR, Bergsagel DE. Comparison of extramedullary Plasmacytomas with solitary and
Published by Oxford University Press on behalf of the Association of Physicians 2013. This work is written by US Government employees and is in the public domain in the US.
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A 78-year-old male presented with a progressively growing, painless chest mass. It was firm, lobulated and fixed to the underlying xiphoid process. Chest computed tomography (CT) revealed an 8.6 8.4 6.3 cm subcutaneous soft tissue mass involving the lower sternum and xiphoid process (Figure 1). The patient underwent hemisternectomy and resection of the tumor and during surgery, the tumor was found to invade the anterior wall of the right ventricle. Histology showed sheets of plasma cells, many with prominent nucleoli and frequent bi or multinucleation. The tumor eroded the sternal bone into the marrow space. Further work-up revealed elevated lambda free light chains, 2.67 g/l (0.05–0.26 g/l) by serum immunoassay, normal levels of serum immunoglobulins, 3% plasma cells on bone marrow biopsy, no other lytic lesions on skeletal survey and absence of anemia, hypercalcemia or impaired renal function. The patient was diagnosed with a solitary bone plasmacytoma (SBP) and referred to a hematologist.
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Clinical picture
multiple plasma cell tumors of bone. J Clin Oncol 1983; 1:255–62. 2. Hughes M, Soutar R, Lucraft H, Owen R, Bird J. Guidelines on the Diagnosis and Management of Solitary Plasmacytoma of Bone, Extramedullary Plasmacytoma and Multiple Solitary Plasmacytomas: 2009 Update. London, UK: British committee for standards in haematology. http://www.
bcshguidelines.com/documents/solitary_plamacytoma_ bcsh_FINAL_190109.pdf (23 December 2013, date last accessed). 3. Dimopoulos MA, Moulopoulos LA, Maniatis A, Alexanian R. Solitary plasmacytoma of bone and asymptomatic multiple myeloma. Blood 2000; 96:2037–44 (Review).
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Clinical picture Plasmacytoma—a rare sternal tumor The osseous solitary plasmacytoma, or SBP, has a 40% higher incidence as compared with the extraosseous plasmacytoma, but overall it represents 5 cm for which reason a multi-disciplinary approach to treatment of SBP comprising of a hematologist, radiation therapist and surgeon is recommended. Photographs and text from: A. Aron, Veterans Affairs Medical Center, 4101 S 4th Street Trafficway, Leavenworth, KS 66048, USA; R.K. Jain, Amgen, Inc., 1 Amgen Center Drive, MS 38-2-B, Thousand Oaks, CA 91320, USA; A. Brateanu, Internal Medicine Residency Program, Cleveland Clinic Main Campus, 9500 Euclid Avenue, Cleveland, OH 44195, USA. email: [email protected] Conflict of interest: None declared.
References Figure 1. CT scan of the chest showing the tumor arising from the sternum.
1. Knowling MA, Harwood AR, Bergsagel DE. Comparison of extramedullary Plasmacytomas with solitary and
Published by Oxford University Press on behalf of the Association of Physicians 2013. This work is written by US Government employees and is in the public domain in the US.
Downloaded from by guest on November 13, 2015
A 78-year-old male presented with a progressively growing, painless chest mass. It was firm, lobulated and fixed to the underlying xiphoid process. Chest computed tomography (CT) revealed an 8.6 8.4 6.3 cm subcutaneous soft tissue mass involving the lower sternum and xiphoid process (Figure 1). The patient underwent hemisternectomy and resection of the tumor and during surgery, the tumor was found to invade the anterior wall of the right ventricle. Histology showed sheets of plasma cells, many with prominent nucleoli and frequent bi or multinucleation. The tumor eroded the sternal bone into the marrow space. Further work-up revealed elevated lambda free light chains, 2.67 g/l (0.05–0.26 g/l) by serum immunoassay, normal levels of serum immunoglobulins, 3% plasma cells on bone marrow biopsy, no other lytic lesions on skeletal survey and absence of anemia, hypercalcemia or impaired renal function. The patient was diagnosed with a solitary bone plasmacytoma (SBP) and referred to a hematologist.
676
Clinical picture
multiple plasma cell tumors of bone. J Clin Oncol 1983; 1:255–62. 2. Hughes M, Soutar R, Lucraft H, Owen R, Bird J. Guidelines on the Diagnosis and Management of Solitary Plasmacytoma of Bone, Extramedullary Plasmacytoma and Multiple Solitary Plasmacytomas: 2009 Update. London, UK: British committee for standards in haematology. http://www.
bcshguidelines.com/documents/solitary_plamacytoma_ bcsh_FINAL_190109.pdf (23 December 2013, date last accessed). 3. Dimopoulos MA, Moulopoulos LA, Maniatis A, Alexanian R. Solitary plasmacytoma of bone and asymptomatic multiple myeloma. Blood 2000; 96:2037–44 (Review).
Downloaded from by guest on November 13, 2015
