Topics in diagnostic imaging
Plasmacytoma of the Cervical Spine: A Case Study

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Abstract

Objective

The purpose of this case study is to describe the presentation of a patient with plasmacytoma.

Clinical Features

A 49-year-old man presented with progressive neck pain, stiffness, and dysphagia to a chiropractic office. A radiograph indicated a plasmacytoma at C3 vertebral body. The lesion was expansile and caused a mass effect anteriorly on the esophagus and posteriorly on the spinal cord. Neurologic compromise was noted with fasciculations and hypesthesia in the right forearm. The patient was referred to a neurosurgeon.

Intervention and Outcome

Surgical resection of the tumor was performed with a vertebral body spacer and surrounding titanium cage. Bony fusion was initiated by inserting bone grafts from the iliac crests into the titanium cage. Additional laboratory analysis and advanced imaging confirmed that the plasmacytoma had progressed to multiple myeloma and radiation and chemotherapy were also necessary.

Conclusion

A chiropractor recognized a large, expansile plasmacytoma in the C3 vertebral body and referred the patient for surgical care. This case suggests that all practitioners of manual medicine should provide a careful analysis of the patient’s clinical presentation and, if clinically warranted, radiographic examination to determine neck or back pain is due to an underlying malignant condition.

Introduction

Multiple myeloma is a malignant disease usually originating in the bone marrow, although other tissues may be involved. The age of onset for the average multiple myeloma patient is 60 to 70 years,1 although it can manifest in younger patients on rare occasions. It is characterized by an idiopathic and uncontrolled proliferation of plasma cells that replace normal healthy tissue. Laboratory evaluation of blood samples in such patients may reveal a number of characteristic findings, such as an increase in the number of serum plasma cells, reversal of the ratio of albumin to globulin in the blood (albumin normally accounts for greater than 50% of total serum proteins), a spike in immunoglobulin M gammaglobulins, and an excessive number of polypeptide subunits of the immunoglobulin M proteins (specifically, Bence Jones proteins, which can be most easily detected in a urinalysis). In 75% of cases of multiple myeloma, skeletal lesions present with osteolysis in the form of discrete “punched-out” lesions.2 The axial skeleton is affected more often than the extremities. Multiple lesions are most commonly apparent in the vertebrae, ribs, skull, pelvis, and femur, in descending order of frequency.

This malignancy, while common in regard to tumor incidence, is not frequently reported in the chiropractic literature. The purpose of this case study is to describe the clinical presentation and imaging characteristics of a patient with plasmacytoma who presented to a chiropractic clinic.

Section snippets

Case Report

A 49-year-old man presented to his chiropractor with the complaint of neck stiffness of 4 months’ duration followed by severe progressive radiating neck pain of 2 months’ duration. The patient also experienced fasciculations in his right forearm, which started 3 weeks before presentation. He also complained of progressive dysphagia that started at the same time as his fasciculations. His neck pain was reported on a verbal pain scale as an 8 out of 10. He rated his neck stiffness at an 8 to a 10

Discussion

A plasmacytoma is considered to be a solitary form of multiple myeloma.1 These lesions are typically found in the vertebral bodies of the thoracic and lumbar spine in patients with an average onset age of 50 years. This is in contrast to the average onset age for multiple myeloma, which is 60 to 70 years. Men are slightly more likely than women to develop both plasmacytoma and multiple myeloma.3 Cervical spine involvement is found in only 8% of cases,4 and pedicle involvement occurs in

Conclusion

This case suggests that all practitioners of manual medicine provide a careful analysis of the patient’s clinical presentation and, if clinically warranted, radiographic examination to determine if neck or back pain is due to an underlying malignant condition. A cursory examination of this patient may not have revealed the more serious cause of his neck pain.

Funding Sources and Conflicts of Interest

No funding sources or conflicts of interest were reported for this study.

Contributorship Information

  • Concept development (provided idea for the research): R.P., W.M.C., C.D.W., D.R.P.

  • Design (planned the methods to generate the results): R.P., W.M.C., C.D.W., D.R.P.

  • Supervision (provided oversight, responsible for organization and implementation, writing of the manuscript): R.P., W.M.C., C.D.W., D.R.P.

  • Data collection/processing (responsible for experiments, patient management, organization, or reporting data): R.P., W.M.C., C.D.W., D.R.P.

  • Analysis/interpretation (responsible for statistical

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