Flores MMA, Arroyo ZOJ, Vázquez NJR

Language: Spanish
References: 20
Page: 58-63
PDF size: 861.46 Kb.

ABSTRACT

Introduction: extraosseous epidural plasmacytoma associated with multiple myeloma arises from lymphoid tissue in the epidural space, and this location is rare. The five-year survival rate is still just under 50%. Case presentation: a 52-year-old male presents with oppressive pain in the dorsal region accompanied by decreased strength of the lower extremities 1/5 and hypoesthesia below T4. Condition with a month of evolution. Magnetic resonance imaging showed a heterogeneous lesion in the epidural space at T2 that caused spinal cord compression. A T4-T5 hemilaminectomy was performed plus tumor excision, and was reported as a plasmacytoma; adjuvant management with radiotherapy was decided. Results: after surgery, the patient presented improvement in pelvic limb strength 4/5 and sensitivity. In MRI control one-year post-treatment, there is no evidence of tumor recurrence. Conclusions: epidural plasmacytoma associated with multiple myeloma represents a rare clinical entity, but of great relevance due to its potential to generate acute neurological deterioration. This case highlights the importance of timely evaluation by advanced imaging, histological confirmation, and multimodal therapeutic approach. Surgical intervention, followed by radiation therapy, allowed for significant functional recovery and sustained local control of the disease. Early identification and comprehensive treatment are decisive in optimizing the prognosis in patients with this condition.

REFERENCES

1. Cui JF, Sun LL, Liu H, Gao CP. Extraosseous spinalepidural plasmocytoma associated with multiplemyeloma: Two case reports. World J Clin Cases. 2021;9: 2555-2561. doi: 10.12998/wjcc.v9.i11.2555.

2. Encarnacion D, Chmutin GE, Bozkurt I, Wellington J,Geraldino EB, Chaurasia B. Lesions of the spinal cordcaused by multiple myeloma: A systematic review andmeta-analysis regarding the neurosurgical aspects ofpatient management. J Craniovertebr Junction Spine.2023; 14: 313-318. doi: 10.4103/jcvjs.jcvjs_111_23.

3. Terpos E, Christoulas D, Gavriatopoulou M. Biology andtreatment of myeloma related bone disease. Metabolism.2018; 80: 80-90. doi: 10.1016/j.metabol.2017.11.012.

4. Lasocki A, Gaillard F, Harrison SJ. Multiple myelomaof the spine. Neuroradiol J. 2017; 30: 259-268. doi:10.1177/1971400917699426.

5. Zadnik PL, Goodwin CR, Karami KJ, Mehta AI, Amin AG,Groves ML, et al. Outcomes following surgical interventionfor impending and gross instability caused by multiplemyeloma in the spinal column. J Neurosurg Spine. 2015;22: 301-309. doi: 10.3171/2014.9.SPINE14554.

6. Xie L, Wang H, Jiang J. Does radiotherapy with surgeryimprove survival and decrease progression to multiplemyeloma in patients with solitary plasmacytoma of boneof the spine? World Neurosurg. 2020; 134: e790-e798.doi: 10.1016/j.wneu.2019.11.002.

7. Tan H, Gu J, Xu L, Sun G. Solitary bone plasmacytomaof spine with involvement of adjacent disc space: A casereport. Medicine (Baltimore). 2021; 100: e27288. doi:10.1097/MD.0000000000027288.

8. Ariyaratne S, Jenko N, Iyengar KP, James S, Mehta J,Botchu R. Primary osseous malignancies of the spine.Diagnostics (Basel). 2023; 13: 1801. doi: 10.3390/diagnostics13101801.

9. Aloui A, Kacem MS, Bahroun S, Jhimi A, Bouaziz A,Daghfous MS. Solitary plasmocytoma of the thoracicspine: A case report. Int J Surg Case Rep. 2023; 111:108799. doi: 10.1016/j.ijscr.2023.108799.

10. Mendoza S, Urrutia J, Fuentes D. Surgical treatment ofsolitary plasmocytoma of the spine: case series. IowaOrthop J. 2004; 24: 86-94.

11. Zehri AH, Calafiore RL, Peterson KA, Kittel CA, OseiJA, Wilson JL, et al. Surgical management of spinalmultiple myeloma: insights from the National InpatientSample database. J Spine Surg. 2024; 10: 428-437. doi:10.21037/jss-24-54.

12. Denaro V, Denaro L, Albo E, Papapietro N, Piccioli A,Di Martino A. Surgical management of spinal fracturesand neurological involvement in patients with myeloma.Injury. 2016; 47 Suppl 4: S49-S53. doi: 10.1016/j.injury.2016.07.047.

13. Milavec H, Ravikumar N, Syn NL, Yentia Soekojo C,Chng WJ, Kumar N. Surgical management of multiplemyeloma with symptomatic involvement of the spine. IntJ Spine Surg. 2020; 14: 785-794. doi: 10.14444/7112.

14. Surgeon’s Committee of the Chinese Myeloma WorkingGroup of the International Myeloma Foundation. Consensuson surgical management of myeloma bone disease. OrthopSurg. 2016; 8: 263-269. doi: 10.1111/os.12267.

15. Gokaraju K, Butler JS, Benton A, Suarez-HuertaML, Selvadurai S, Molloy S. Multiple myelomapresenting with acute bony spinal cord compressionand mechanical instability successfully managednonoperatively. Spine J. 2016; 16: e567-e570. doi:10.1016/j.spinee.2016.03.011.

16. Xiang QQ, Chu B, Lu MQ, Shi L, Gao S, Wang YT, etal. Risk-benefit ratio of percutaneous kyphoplasty andpercutaneous vertebroplasty in patients with newlydiagnosed multiple myeloma with vertebral fracture: asingle-center retrospective study. Ann Hematol. 2023;102: 1513-1522. doi: 10.1007/s00277-023-05202-9.

17. Zhang F, Liu S, Zhou X, Wang W, Jia C, Wang Q, et al.Percutaneous vertebroplasty/kyphoplasty contributes tothe improved outcome in patients with newly diagnosedmultiple myeloma: A single center cohort study. J BoneOncol. 2024; 47: 100615. doi: 10.1016/j.jbo.2024.100615.

18. Cai W, Yan W, Huang Q, Huang W, Yin H, Xiao J.Surgery for plasma cell neoplasia patients with spinalinstability or neurological impairment caused by spinallesions as the first clinical manifestation. Eur Spine J.2015; 24: 1761-1767. doi: 10.1007/s00586-014-3679-y.

19. Miller JA, Balagamwala EH, Chao ST, Emch T, SuhJH, Djemil T, et al. Spine stereotactic radiosurgery forthe treatment of multiple myeloma. J Neurosurg Spine. 2017; 26: 282-290. doi: 10.3171/2016.8.spine16412.

20. Cawley DT, Butler JS, Benton A, Altaf F, Rezajooi K,Kyriakou C, et al. Managing the cervical spine in multiplemyeloma patients. Hematol Oncol. 2019; 37: 129-135.doi: 10.1002/hon.2564.