Plasmacytoma to the Axis Mimicking Metastatic Paraganglioma: Circumferential Reconstruction via Posterior Approach

Abstract

Plasmacytoma is a malignant plasma cell tumor growing within soft tissue or the axial skeleton. Here, we present the case of a patient with plasmacytoma of the axis vertebra who underwent decompressive surgery with reconstruction via a posterior approach. The patient was referred because of quadriparesis with severe neck pain. Magnetic resonance imaging revealed a relatively demarcated, highly enhanced mass lesion in a destructed axis, with spinal cord compression. Computed tomography revealed a 5.6×4.3 cm adrenal mass at the left retroperitoneal space. We suspected the axis lesion to be a metastatic paraganglioma from the adrenal mass. The patient underwent total excision of the tumor under an operative microscope with occipitocervical fixation. Histopathologically, the tumor was shown to be a plasmacytoma. Following the operation, the patient recovered without significant complications. This was a rare case of plasmacytoma in the axis, mimicking metastatic paraganglioma.

Keywords: Axis; Fusion; Paraganglioma; Plasmacytoma; Posterior surgery.

Fig. 1. Plain radiograph showing osteolysis of the axis with malaligment. (A) A lateral cervical plain radiograph, (B) An open mouth radiograph.

Fig. 2. A mass lesion extending along the anterior epidural space with cord compression at preoperative MRI. (A) Contrast-enhanced sagittal MRI, (B) Contrast-enhanced axial MRI, (C) T2 sagittal MRI.

Fig. 3. An abdominal PET/CT image showing a 5.6×4.3 cm size mass at the left retroperitoneum.

Fig. 4. Postoperative 12 months later, a CT image showing bony bridge formation through the implanted mesh. (A) Sagittal CT image, (B) Postoperative CT 3D reconstruction image.