Plasmacytoma of the Cervical Spine: A Case Study
Richard Pashayan, DC, DABCO, CCSP,
Wesley M. Cavanaugh, DC,
Chad D. Warshel, DC, DACBR, and
David R. Payne, MD
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.
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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.
KEYWORDS: Bone Neoplasms; Multiple Myeloma; Neoplasms, Plasma Cell; Plasmacytoma
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Multiple myeloma is a malignant disease usually originating in the bone marrow, although other tissues may be involved. The age of onset for the average multiple myeloma patient is 60 to 70 years,  although it can manifest in younger patients on rare occasions. It is characterized by an idiopathic and uncontrolled proliferation of plasma cells that replace normal healthy tissue. Laboratory evaluation of blood samples in such patients may reveal a number of characteristic findings, such as an increase in the number of serum plasma cells, reversal of the ratio of albumin to globulin in the blood (albumin normally accounts for greater than 50% of total serum proteins), a spike in immunoglobulin M gammaglobulins, and an excessive number of polypeptide subunits of the immunoglobulin M proteins (specifically, Bence Jones proteins, which can be most easily detected in a urinalysis). In 75% of cases of multiple myeloma, skeletal lesions present with osteolysis in the form of discrete “punched-out” lesions.  The axial skeleton is affected more often than the extremities. Multiple lesions are most commonly apparent in the vertebrae, ribs, skull, pelvis, and femur, in descending order of frequency.
This malignancy, while common in regard to tumor incidence, is not frequently reported in the chiropractic literature. The purpose of this case study is to describe the clinical presentation and imaging characteristics of a patient with plasmacytoma who presented to a chiropractic clinic.