Richard Pashayan1, Wesley M Cavanaugh2, Chad D Warshel2, David R Payne3. 1. Private Practice, Flushing, NY. 2. Department of Chiropractic Clinical Sciences, New York Chiropractic College, Seneca, Falls, NY. 3. Private Practice, Garden City, NY.
Abstract
OBJECTIVE: The purpose of this case study is to describe the presentation of a patient with plasmacytoma. CLINICAL FEATURES: A 49-year-old man presented with progressive neck pain, stiffness, and dysphagia to a chiropractic office. A radiograph indicated a plasmacytoma at C3 vertebral body. The lesion was expansile and caused a mass effect anteriorly on the esophagus and posteriorly on the spinal cord. Neurologic compromise was noted with fasciculations and hypesthesia in the right forearm. The patient was referred to a neurosurgeon. INTERVENTION AND OUTCOME: Surgical resection of the tumor was performed with a vertebral body spacer and surrounding titanium cage. Bony fusion was initiated by inserting bone grafts from the iliac crests into the titanium cage. Additional laboratory analysis and advanced imaging confirmed that the plasmacytoma had progressed to multiple myeloma and radiation and chemotherapy were also necessary. CONCLUSION: A chiropractor recognized a large, expansile plasmacytoma in the C3 vertebral body and referred the patient for surgical care. This case suggests that all practitioners of manual medicine should provide a careful analysis of the patient's clinical presentation and, if clinically warranted, radiographic examination to determine neck or back pain is due to an underlying malignant condition.
OBJECTIVE: The purpose of this case study is to describe the presentation of a patient with plasmacytoma. CLINICAL FEATURES: A 49-year-old man presented with progressive neck pain, stiffness, and dysphagia to a chiropractic office. A radiograph indicated a plasmacytoma at C3 vertebral body. The lesion was expansile and caused a mass effect anteriorly on the esophagus and posteriorly on the spinal cord. Neurologic compromise was noted with fasciculations and hypesthesia in the right forearm. The patient was referred to a neurosurgeon. INTERVENTION AND OUTCOME: Surgical resection of the tumor was performed with a vertebral body spacer and surrounding titanium cage. Bony fusion was initiated by inserting bone grafts from the iliac crests into the titanium cage. Additional laboratory analysis and advanced imaging confirmed that the plasmacytoma had progressed to multiple myeloma and radiation and chemotherapy were also necessary. CONCLUSION: A chiropractor recognized a large, expansile plasmacytoma in the C3 vertebral body and referred the patient for surgical care. This case suggests that all practitioners of manual medicine should provide a careful analysis of the patient's clinical presentation and, if clinically warranted, radiographic examination to determine neck or back pain is due to an underlying malignant condition.
Entities:
Keywords:
Bone Neoplasms; Multiple Myeloma; Neoplasms, Plasma Cell; Plasmacytoma
Authors: Rahma Warsame; Morie A Gertz; Martha Q Lacy; Robert A Kyle; Francis Buadi; David Dingli; Philip R Greipp; Suzanne R Hayman; Shaji K Kumar; John A Lust; Stephen J Russell; Thomas E Witzig; Joseph Mikhael; Nelson Leung; Steven R Zeldenrust; S Vincent Rajkumar; Angela Dispenzieri Journal: Am J Hematol Date: 2012-05-02 Impact factor: 10.047