Solitary Plasmacytoma Of Bone

Solitary plasmacytoma of bone occurs in 3-5% of myeloma patients. It is more common in men (male-to-female ratio 2:1) and at a younger age (50 vs 65 years). It involves mainly the axial bones, particularly vertebrae. Local bone pain and occasionally pathologic fracture may be the presenting feature. Anemia, hypercalcemia, and renal impairment are absent. A serum monoclonal immunoglobulin, usually of low concentration, is detected in about 50% of patients. The bone marrow is not involved, by definition. A bone survey should be done to exclude more extensive disease.

The diagnostic criteria for solitary plasmacytoma of the bone and solitary extramedullary plasmacytoma are not well defined. Because a fraction of these patients, presumably those with truly localized disease, appear curable with radical radiotherapy,107 stringent criteria that allow precise diagnosis of a potentially curable disease are needed. Questions have been raised as to the need for using sensitive molecular techniques to assess marrow involvement and for advanced imaging methods, such as MRI or PET, to exclude disseminated diseases. Guidelines on the diagnosis and treatment have recently been proposed.107

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