PMC8666231_01
Imaging, pathological findings, and a schematic illustration of the prognosis during the admission of the patient. (A) Abdominal computed tomography (CT) showing hepatomegaly (white arrow). (B) Thoracic vertebral CT (axial view) showing osteolysis in the thoracic vertebrae T2-T4. (C) Thoracic vertebral CT (coronal view) showing multiple osteosclerotic nodules in the thoracic vertebrae. (D) Magnetic resonance imaging (MRI) of the spine (sagittal view) showing an extramedullary tumor at T2-T4. (E) MRI of the spine (axial view) showed that it was surrounded by the tumor (white arrow), and (F) positron emission tomography-CT did not show any metastases in other organs.
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Abdominal computed tomography (CT) revealed hepatomegaly (Fig. 1A). Thoracic CT of the bone showed osteolysis at the T2-T4 level (Fig. 1B) and multiple osteosclerotic nodules in the thoracic vertebrae (Fig. 1C). Magnetic resonance imaging of the thoracic spine showed a solid extramedullary tumor at the T2-T4 level (Fig. 1D) that surrounded the spinal canal and was compressing the spinal parenchyma (Fig. 1E). Positron emission tomography-CT showed no metastases to other organs (Fig. 1F).
Histology of the excised tumor. (A) Hematoxylin and Eosin staining section showing neoplastic proliferation of atypical plasmacytes, consistent with a plasmacytoma. (B) Immuno-stained section strongly positive for lambda light chains. (C) Immuno-stained section weakly positive for kappa light chains. The length of each bar is 100 mum.
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Histological findings revealed the tumor to be a plasmacytoma positive for lambda protein on staining (Fig. 2).
A schematic illustration of the clinical course of our patient. The bar graph shows the vascular endothelial growth factor levels on Days 1 and 26. The Modified Rankin Scale shows the favorable outcome after comprehensive treatment including surgery, radiation, and steroid therapy.
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His serum level of VEGF decreased from 3,350 pg/mL to 558 pg/mL (Fig. 3). His modified Rankin Scale on discharge had decreased from 5 to 2 (Fig. 3).