PMC9386064_01
MRI showed abnormal signal shadows in the 7th thoracic (T7) and adnexa vertebrae [(A) T1WI; (B) T2WI fat suppression sequence; white arrows] and the 3rd lumbar vertebrae [(C) T1WI; (D) T2WI fat suppression sequence; black arrows]. Besides, The T7 vertebrae became wedge-shaped, suggesting a pathological compression fracture. T1WI contrast enhancement showed obvious homogeneous enhancement of the lesions (E). T7, the white arrow; L3, the black arrow.
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F1
CT showed that the patient's 7th thoracic vertebral body, right vertebral arch, and 3rd lumbar vertebral body had low-density bone destruction, showing "fence-like" or "honeycombing" changes (as shown in Supplementary Figure 1), which presented as uneven low T1 and high T2 signals on magnetic resonance imaging (MRI), and a contrast-enhanced scan showed marked enhancement of the lesions (as shown in Figure 1). 18F-FDG PET/CT showed a mild FDG concentration in the 7th thoracic and 3rd lumbar vertebrae, with a maximum standard uptake value (SUVmax) of 4 and 4.5, respectively, as shown in Figure 2.
18F-FDG PET/CT was then performed to assess the nature of the lesion and the patient's systemic condition. The MIP (A) showed mild radiation uptake in the T7 area (the black arrow) and increased FDG uptake in the L3 lesion area (the white arrow). In addition, there is radioactive uptake of lymph nodes in the mediastinum (the asterisk arrow), which are pathologically confirmed as inflammatory. The axial figures at the T7 level [(B) PET; (C) CT; (D) PET/CT fusion] showed the destruction of bone density in the vertebral body and adnexa, presenting a "fence-like" change, with a slight increase in FDG uptake and an SUVmax of 3.0 (black arrows). An axial map at the L3 level [(E) PET; (F) CT; (G) PET/CT fusion] showed destruction of bone density in the right portion of the vertebral body with increased FDG uptake and SUVmax of 4.5 (white arrows). Based on these imaging findings, the patient was considered to have hemangiomas. Based on pathological and immunohistochemical findings, the patient was confirmed to have plasma cell myeloma.
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F2
CT showed that the patient's 7th thoracic vertebral body, right vertebral arch, and 3rd lumbar vertebral body had low-density bone destruction, showing "fence-like" or "honeycombing" changes (as shown in Supplementary Figure 1), which presented as uneven low T1 and high T2 signals on magnetic resonance imaging (MRI), and a contrast-enhanced scan showed marked enhancement of the lesions (as shown in Figure 1). 18F-FDG PET/CT showed a mild FDG concentration in the 7th thoracic and 3rd lumbar vertebrae, with a maximum standard uptake value (SUVmax) of 4 and 4.5, respectively, as shown in Figure 2. A recent X-ray examination is shown in Supplementary Figure 2.
HE staining showed the diffuse distribution of round or oval plasma cells in the tumor (A). Immunohistochemistry showed positive expression of tumor cells CD56 (B), CD79a (C), CD138 (D), Kappa (E), and MUM1 (F).
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F3
Immunohistochemistry showed positive expression of tumor cells CD56, CD79a, CD138, Kappa, MUM1, CD38, Vimentin, and Lambda was weakly positive, but CD20, CD3, CK, EMA, LCA, and ALK were negative (as shown in Figure 3).