Differentiated plasma cell myeloma presenting as a solitary spinal amyloidoma: a case report, possible pitfall and review to the literature.

OBJECTIVE

Solitary spinal amyloidoma is a rare entity. Amyloidomas consist of extracellular amyloid deposits with an insoluble beta-pleated proteinaceous material. Although amyloidomas are slow growing lesions, they may lead to a progressive spinal cord or nerve root compression. Moreover amyloidoma results in destruction of bone with consequence of progressive osteolysis.

METHODS

This study is a case presentation and review of the literature and should point out the need to explore any underlying diseases to guarantee the best therapy for the affected patient. In this case report we present a female patient with high-level paraparesis and lumbar stenosis in L2-L3 with combined spondylolisthesis (ASIA Impairemet Scale C). Paraparesis increased shortly after lumbar osteosynthesis. Contrast-enhanced MRI of the thoracic spine revealed medullary compression at the D5 level due to an epidural and paraspinal mass with concomitant bone infiltration. Operative decompression followed. Histopathological examination initially revealed amyloidoma. Finally the lesion was classified as a plasma cell myeloma.

RESULTS

Plasma cell myeloma may rarely present as a solitary amyloidoma in the initial pathological examination with the potential to cause spinal cord compression associated to osteolytic lesions of the spine.

CONCLUSIONS

A thorough pathological work-up is mandatory in order to rule out differential diagnosis and exclude possible underlying diseases.