Plasmacytoma/Multiple myeloma with severe spine cord compression: case reports

Resumo

Introdução: o mieloma múltiplo (MM) geralmente se localiza na medula óssea (MO) e está associado a um amplo espectro de achados clínicos, laboratoriais e radiológicos. Por outro lado, o plasmocitoma solitário (SP) é caracterizado por uma única massa de células plasmáticas clonais, com nenhuma ou mínima plasmacitose de BM e sem outros sintomas além daqueles derivados da lesão primária. Os casos com envolvimento da coluna vertebral e medula com compressão sempre foram muito complicados e desafiadores. Relato de casos: descrevemos dois casos de SP e MM com compressão medular grave tratados cirurgicamente com indicação de abordar a compressão e estabilização dos segmentos acometidos com posterior tratamento em hematologia e oncologia. Resultados: em ambos os casos a cirurgia foi um sucesso, o paciente com SP sobreviveu 3 anos e um mês e o paciente com MM-1 ano e 3 meses. Conclusão: os resultados das intervenções cirúrgicas para esses pacientes com compressão da medula espinhal e instabilidade da coluna vertebral devido a mieloma múltiplo e plasmocitoma da coluna vertebral foram com melhora da função neurológica após a cirurgia e sem falha de instrumentação.

Palavras-chave

Medula óssea; Mieloma múltiplo; Plasmacitoma

Abstract

Introduction: multiple myeloma (MM) is generally located in the bone marrow (BM) and associated with a wide spectrum of clinical, laboratory, and radiological findings. Conversely, solitary plasmacytoma (SP) is characterized by a single mass of clonal plasma cells, with no or minimal BM plasmacytosis and with no other symptoms than those derived from the primary lesion. Cases with spine involvement and spine cord suffering from compression have always been very complicated and challenging. Case presentation: we describe two cases of SP and MM with severe spine cord compression treated surgically with indication to address the compression and stabilization of the affected segments with subsequent treatment in hematology and oncology. Results: in both cases, the surgery was a success: the patient with SP survived 3 years and one month and the patient with MM, 1 year and 3 months. Conclusion: outcomes of surgical interventions for these patients with spine cord compression and spinal instability due to multiple myeloma and plasmacytoma of the spine were improved neurological function following surgery and no instrumentation failure.

Keywords

Bone marrow; Multiple myeloma; Plasmacytoma

References

1. Moulopoulos LA, Granfield CA, Dimopoulos MA, Kim EE, Alexanian R, Libshitz HI. Extraosseous multiple myeloma: imaging features. AJR Am J Roentgenol. 1993;161(5):1083-7. http://doi.org/10.2214/ ajr.161.5.8273615. PMid:8273615.

2. Soutar R, Lucraft H, Jackson G, et al. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Br J Haematol. 2004;124(6):717-26. http://doi.org/10.1111/j.1365-2141.2004.04834.x. PMid:15009059.

3. Dimopoulos MA, Moulopoulos LA, Maniatis A, Alexanian R. Solitary plasmacytoma of bone and asymptomatic multiple myeloma. Blood. 2000;96(6):2037-44. http://doi.org/10.1182/blood.V96.6.2037. PMid:10979944.

4. Usmani SZ, Hoering A, Cavo M, et al. Clinical predictors of long-term survival in newly diagnosed transplant eligible multiple myeloma IMWG Research Project. Blood Cancer J. 2018;8(12):123. http://doi. org/10.1038/s41408-018-0155-7. PMid:30470751.

5. Walker RC, Brown TL, Jones-Jackson LB, De Blanche L, Bartel T. Imaging of multiple myeloma and related plasma cell dyscrasias. J Nucl Med. 2012;53(7):1091-101. http://doi.org/10.2967/jnumed.111.098830. PMid:22693310.

6. Rajkumar SV, Dimopoulos MA, Palumbo A, et al. International Myeloma Working Group updated criteria for the diagnosis of multiple myeloma. Lancet Oncol. 2014;15(12):e538-48. http://doi.org/10.1016/ S1470-2045(14)70442-5. PMid:25439696.

7. Du X, Chen WM, Chen S. The surgical treatment of multiple myeloma bone disease. Beijing: People Health Press; 2013. p. 50-9

8. International Myeloma Foundation. Consensus on surgical management of myeloma bone disease. Orthop Surg. 2016;8(3):263-9. http://doi.org/10.1111/os.12267. PMid:27627707.

9. Molloy S, Kyriakou C. Expert’s comment concerning Grand Rounds case entitled “total spondylectomy for solitary bone plasmacytoma of the lumbar spine in a young woman: a case report and review of the literature” (by N. von der Hoeh, S.K. Tschoeke, J. Gulow, A. Voelker, U. Siebolts and C.-E. Heyde). Eur Spine J. 2014;23(1):40-2. http://doi. org/10.1007/s00586-013-2957-4. PMid:24037464.

10. Mulligan M, Chirindel A, Karchevsky M. Characterizing and predicting pathologic spine fractures in myeloma patients with FDG PET/CT and MR imaging. Cancer Invest. 2011;29(5):370-6. http://doi. org/10.3109/07357907.2011.584589. PMid:21599514.

Plasmacytoma/Multiple myeloma with severe spine cord compression: case reports

Plasmacitoma/Mieloma múltiplo com compressão severa da medula espinhal: relato de casos

Resumo

Palavras-chave

Abstract

Keywords

References

JBNC Brazilian Journal of Neurosurgery

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ABNc Academia Brasileira de Neurocirurgia

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