demonstrated a relationship between the pres- ence of myeloma proteins after radiation and progression of solitary plasmacytoma tomultiple myeloma. 26-28 In the emergency department, complaints of chest pain and coughing are typically representa- tive of more minor diagnoses, with suspicion of SPB being very low in the differential. A chest X-ray was ordered in this case due to the daily occurrence, constant nature, the duration of pain, and lack of findings on physical exam. The absence of the rib on plain chest X-ray prompted further radiological examinationwith CT, which ultimately revealed a tumor. Destructive pro- cesses of the bone should be given consideration in findings of bony lucency on plain radiographs. REFERENCES Jaffe ES, Harris NL, Stein H, et al. World Health Organization classification of tumours: Pathology and genetics of tumours of haematopoietic and lymphoid tissues . IARC Press; Lyons: 2001. 2. Dores GM, Landgren O, McGlynn KA, et al. Plasmacytoma of bone, extramedullary plasmacytoma, and multiple myeloma: Incidence and survival in the United states, 1992-2004. Br J Haematol 2009;144(1):86-94. 1.
Figure 3: CT-guided biopsy, magnified at 100x, with hematoxylin and eosin (H&E) stain demonstrating sheets of well-differentiated plasma cells infiltrating the bone.
articles or abstracts indicated spinal involvement; in which case, surgical resection would have been appropriate. In the current case, the patient was successfully treated with radiotherapy and remained in remission at 27 months from initial diagnosis. The degree of progression of SPB to multiple myeloma is debated in the literature, ranging from an estimated 36% 5 to 75% 3 of cases. Of the 15 cases identified in the literature review, one patient was reported to have recurrence of a tumor at five months and 14 months. 19 The other patients reportedly remained asymptomatic for durations ranging from eight months 18 to three years. 11 Patients with SBP, on average, have a median overall survival time of 10 years. 5 In their epidemiological study of patients in the United States, Dores and colleagues 2 reported the five-year survival of patients with SPB, who were under the age of 60, was 77%. For patients with SPB, who were more than 60 years old, the survival rate was 53%. These rates are higher than those found for multiple myeloma, where survival was 43% and 26% for patients who were less than andmore than 60 years old, respectively. Warsame et al. 25 examined rates of progression and survival in 127 patients treated at the Mayo Clinic for SPB. Patients were followed for 7 to 28 months (median = 56 months). Of the 127 patients, 85 patients progressed to multiple myeloma, and 27 patients died due to progression. Patients who receive treatment for SBP should be fol- lowed closely for recurrence or progression to multiple myeloma. Soutar et al. 3 recommends patients be followed every six weeks for six months and then followed regu- larly after six months. Follow-up should include physical examination and laboratory tests. In particular, physicians should measure myeloma protein, as multiple studies have
3. 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):717-726. 4. Frassica DA, Frassica FJ, Schray MF, et al. Solitary plasmacytoma of bone: Mayo Clinic experience. In J Radiat Oncol Biol Phys . 1989;16(1): 43-48. 5. Dimopoulos MA, Moulopoulos LA, Maniatis A, et al. Solitary plasmacytoma of bone and asymptomatic multiple myeloma. Blood . 2000;96(6):2037-2944. 6. George SM, Ratnakar KS, Shome, DK, et al. Plasmacytoma of the rib in youngmale. Asian Cardiovasc Thorac Ann . 2002;10(3):282-284. 7. KadokuraM, Tanio N, Nonaka, M, et al. A surgical case of solitary plasmacytoma of rib origin with biclonal gammopathy. Jpn J Clin Oncol . 2003;30(4):191-195. 8. Lee HY, Kin JI, Kin KN. Solitary plasmacytoma of the rib. Korean J Thorac Cardiovasc Surg . 2012;45:269-271. 9. Mankodi AK, Rao CV, Katrak SM. Soliatry plasmacytoma presenting a peripheral neuropathy: A case report. Neurol India . 1999;47(3):234-237. 10. Pattanayak L, Samantaray S, Rout, N. Solitary plasmacytoma of the rib: A rare cytological detection. Indian J of Cancer . 2010;47(4):485- 486. 11. RoccoG, RobustelliniM, Rossi G, et al. Solitary bone plasmacytoma of rib presenting as a superior sulcus tumor. J Thorac Cariovasc Surg . 1993;105(5);944-945. 12. Sato Y, HaraM, Ogino, H, et al. CT-pathologic correlation in a case of solitary plasmacytoma of the rib. Radiat Med . 2001;19(6):303-305. 13. Singal R, Dalal AK, Attri AK, et al. Solitary plasmacytoma of the rib: A rare case. Lung India . 2011;28(4):309-311. 14. Wilkinson, S, Forrester-Wood, CP. Surgical resection of a solitary plasmacytoma originating in a rib of a patient with Castlesman’s Disease. Ann Thorac Surg . 2003;75:1018-1019. 15. Bousnina S, Zendah I, Marniche K, et al. Solitary plasmacytoma of the rib: A rare tumor not to miss. Rev Pneumol Clin. 2006;
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