CASE 3028 Published on 19.02.2008
0

Paravertebral extramedullary plasmacytoma

Section

Chest imaging

Case Type

Clinical Cases

Authors

Serrano C, Reus M, León AD, Morales MD, Vázquez V

Connected authors
Patient

56 years, female

Categories
No Area of Interest ; Imaging Technique CT, MR
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Clinical History
A 56-year-old female patient with dorsal pain irradiated to the right thoracic area. On doing a clinical examination, it was diagnosed as being due to the presence of a soft tissue mass on the right scapular area.
Imaging Findings
A 56-year-old female patient, with no clinical history of interest, came to our hospital with dorsal pain that irradiated to the right costal area. She also complained of asthenia and a palpable mass on the right scapular area. The physical examination revealed a soft tissue mass on the right subscapular region. A PA thoracic X-ray scan was performed, ando showed an extrapulmonary masson the right hemithorax, with an approximate size of 10–20 cm. The thoracic CT with intravenous contrast revealed a significant mass with no marked enhancement, localized on the right hemithorax that got through the thoracic wall and penetrated the vertebral foramen. No bone destruction was noted. Subsequently, an MRI of the dorsal spine was performed, showing a voluminous pre and paravertebral neoformation, affecting fundamentally paravertebral soft tissues, with no fat suppression and no medullary component being clearly observed. Immunohistochemistry studies that were done detected a monoclonal Ig G chain (Lambda subtype), and a Lambda light chain. After performing a surgical biopsy, the definitive diagnosis was an immature extramedullary plasmacytoma.
Discussion
The extramedullary plasmacytoma is known to be a rare tumor and it is characterized by plasmatic cell proliferation. It is included in the entity known as Monoclonal Gammopathies, with the multiple myeloma and the solitary plasmacytoma of the bone. They represent 5%–10% of all plasmatic cell illnesses, and the extramedullary plasmacytoma is different from the other two entities, because it is settled in the soft tissues and it does not affect the bone. The extramedullary plasmacytoma is known to be a very infrequently encountered condition, and it is localized most commonly in the upper respiratory tract, where it represents only 0–16% of all the malignant neoplasies of this localization. Also, in all the literature that we had referred to, we have not found any case reports that deal with extramedullary plasmacytomas in the paravertebral soft tissues, and this is the reason for our interest in this case. When immunohistochemistry techniques are performed, it is characterized by an elevation of the Ig G, lambda subtype, and it indicates the malignancy of the tumor. The imaging techniques allow the localization of the tumor, its characterization as a solid mass, and confirms that there is no bone affection. The definite diagnosis of these lesions is anatomopathological.
Differential Diagnosis List
Paravertebral soft tissue solitary plasmacytoma.
Final Diagnosis
Paravertebral soft tissue solitary plasmacytoma.
Case information
URL: https://www.eurorad.org/case/3028
DOI: 10.1594/EURORAD/CASE.3028
ISSN: 1563-4086
Figure 1

Figura 1

Figura 1
A PA thoracic X-ray image that shows a high-density mass located on the right hemithorax with an approximate size of 10--12 cm.
Figura 1
A lateral X-ray image showing the extrapulmonary origin of the mass.
Figure 2

Figura 2

Figura 2
Thoracic CT image: soft tissue mass with no significant enhancement located on the right hemithorax, penetrating the thoracic wall. No bone destruction is seen.
Figura 2
Thoracic CT image: The mass goes through the vertebral foramen.
Figure 3

Figura 3

Figura 3
An axial T2 image showing a hiperintense voluminous pre and paravertebral neoformation that goes through the vertebral foramen.
Figura 3
A sagittal T2 image: The hiperintense mass goes through several vertebral foramens.
Figura 3
An axial T2 image: The mass fundamentally affects the paravertebral soft tissues. There is no medullary component clearly seen.