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Case Reports
. 2021 Apr 30;16(7):1622-1627.
doi: 10.1016/j.radcr.2021.04.024. eCollection 2021 Jul.

Spinal cord compression due to a solitary, bulky plasmacytoma of posterior mediastinum

Garrido David  1 , Posada Marianela  1 , Matosas Victoria  1 , Lorenzo Mariana  1 , Garagorry Francisco  2 , Di Matteo Carina  2 , Guillermo Cecilia  1 , Riva Eloisa  1
Affiliations
Case Reports

Spinal cord compression due to a solitary, bulky plasmacytoma of posterior mediastinum

Garrido David et al. Radiol Case Rep. .

Erratum in

Abstract

Solitary plasmacytoma is a rare clonal plasma cell tumor, representing 2-5% of plasma cell disorders. The standard treatment is local radiotherapy. However, in some cases, its use is limited by the size and/or location of the mass. Systemic chemotherapy may be a useful therapeutic alternative. We describe a case of a 27-year-old male with a bulky solitary plasmacytoma arising in the posterior mediastinum, causing spinal cord compression. Radiotherapy was considered risky as the mass was located in the heart and left lung fields. Systemic treatment was given. After the first cycle of cyclophosphamide, bortezomib, and dexamethasone (VCD), the patient attained full neurological recovery. After four VCD cycles, complete remission was achieved. Autologous stem cell transplantation was given as consolidation therapy. At 3 months post-transplantation, the patient is in full clinical recovery and complete metabolic remission on 18FDG PET-CT. Although infrequent, plasma cell disorders must be considered in adult patients with a bulky tumoral mass in the posterior mediastinum. PET-CT is the whole-body imaging technique of choice to detect SP, to evaluate response to treatment and during follow-up.

Keywords: Extramedullary solitary plasmacytoma; Multiple myeloma; Posterior mediastinal mass; Solitary plasmacytoma.

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Figures

Fig 1
Fig. 1
A and B, on MRI, a poly-lobulated expansive process (white arrow) is observed in posterior mediastinum at the level of the dorsal vertebral bodies from T5 to T8, involves the adjacent coastal arches and the transverse process of T 7 and is presented inside the T5-T6, T6-T7, and T7 -T8 neuroforamen channel. It occupies the spinal canal (48 mm); C and D; on CT, a voluminous (85mm x 85mm x 35mm) solid tumor is observed at the middle third of the posterior mediastinum (white arrow), which contacts and displaces the descending thoracic aorta and displaces the left inferior pulmonary vein, and the middle third of the esophagus, without signs of infiltration; E and F, 18FDG PET-CT imaging which demonstrates increased uptake in the posterior mediastinum mass. (white arrow).
Fig 2
Fig. 2
A, hematoxylin and eosin (HE) staining of the tumoral mass biopsy; B, immunohistochemistry directed to the detection of the antigens CD20, CD56, Kappa, CD138, and CD38 (40x Olympus BX51).
Fig 3
Fig. 3
A and B, MRI control after 6 cycles of VCD; C and D, 18FDG PET-TC after 6 cycles of VCD, E and F, 18FDG PET-CT at 3 months post-transplantation.
See this image and copyright information in PMC

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