Indian Journal of Cancer
Home  ICS  Feedback Subscribe Top cited articles Login 
Users Online :458
Small font sizeDefault font sizeIncrease font size
Navigate here
  Search
 
  
   
  Table of Contents
  
Resource links
   Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
   Article in PDF (785 KB)
   Citation Manager
   Access Statistics
   Reader Comments
   Email Alert *
   Add to My List *
* Registration required (free)  

 
  In this article
   References
   Article Figures

 Article Access Statistics
    Viewed2511    
    Printed179    
    Emailed1    
    PDF Downloaded194    
    Comments [Add]    
    Cited by others 1    

Recommend this journal

 


 
Table of Contents
LETTER TO EDITOR
Year : 2010  |  Volume : 47  |  Issue : 4  |  Page : 485-486
 

Solitary plasmacytoma of the rib: A rare cytological detection


1 Department of Radiation Oncology, A. H. Regional Cancer Centre, Cuttack, India
2 Department of Oncopathology, A. H. Regional Cancer Centre, Cuttack, India

Date of Web Publication4-Dec-2010

Correspondence Address:
L Pattanayak
Department of Radiation Oncology, A. H. Regional Cancer Centre, Cuttack
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0019-509X.73566

Rights and Permissions



How to cite this article:
Pattanayak L, Samantaray S, Rout N. Solitary plasmacytoma of the rib: A rare cytological detection. Indian J Cancer 2010;47:485-6

How to cite this URL:
Pattanayak L, Samantaray S, Rout N. Solitary plasmacytoma of the rib: A rare cytological detection. Indian J Cancer [serial online] 2010 [cited 2019 Oct 18];47:485-6. Available from: http://www.indianjcancer.com/text.asp?2010/47/4/485/73566


Sir,

Plasma cell neoplasms are disorders arising from the proliferation of a single clone of B-cell lymphocytes, 3% of which present as solitary lesions of bone or soft tissue. [1] Solitary plasmacytoma most frequently involves the vertebrae or pelvic bones. [2] Fine-needle aspiration cytology (FNAC) has been used as a first line investigation. We report a rare case of solitary plasmacytoma of the rib where a diagnosis was distinctly made on cytology.

A 60-year-old man presented with a history of increasing pain over the right side of the chest since 6 months. There was no history of trauma or tuberculosis. Physical examination revealed an oval swelling on the right side of the chest over the fourth rib, about 3 Χ 3 cm, firm and tender. A radiograph of the chest revealed a single, well-defined osteolytic lesion of 2 Χ 2 cm over the fourth right rib. Laboratory evaluation showed Hb 8.0 gm%, erythrocyte sedimentation rate 60 mm at the end of the first hour, and serum Ca +2 6.0 mg%. FNAC from the rib was done and cytologic smears stained with Papanicolaou revealed multiple plasma cells both typical and atypical, arranged in sheets. Binucleated plasma cells with eccentric nucleus, characteristic cartwheel appearance along with prominent nucleoli, perinuclear halo, and abundant cytoplasm were also seen. The cytologic picture was highly suggestive of plasmacytoma [Figure 1] and [Figure 2]. Bone marrow aspiration revealed normocellular marrow, no systemic myelomatosis with myeloid:erythroid ratio (M:E) of 2:1. Serum electrophoresis showed a distinct M-band suggestive of multiple myeloma. Urinary Bence Jones protein was negative and a skeletal survey inclusive of radiograph of the skull, spine, and pelvis revealed no abnormality confirming the diagnosis of solitary plasmacytoma of the rib. The only two differential diagnoses on cytology include metastatic carcinoma and osteoblasts in case of bony lesions. In metastatic carcinoma, clusters of cells in acinar or glandular pattern with features of malignancy are seen, whereas osteoblasts can be differentiated by the absence of typical clear cytoplasm or perinuclear halo as seen in plasmacytomas. Knowing the radiosensitivity of the tumor, the patient was treated with radiation, 30 Gy in 10#(fractions), 3 Gy/#(fraction) over a period of 5 weeks. Eight months posttreatment, he was locoregionally controlled.
Figure 1 :Low magnification view (×100, Pap) of fine-needle aspiration cytology showing hypercellular smear with discretely present plasma cells.

Click here to view
Figure 2 :High magnification view (×400, Pap) of fine-needle aspiration cytology showing plasma cells with eccentric cartwheel-like nucleus and abundant cytoplasm.

Click here to view


Woodruff et al, [2] defined solitary plasmacytoma of bone as a solitary osteolytic lesion without any evidence of myelomatosis on bone marrow examination. Most frequently it affects the vertebral bodies, ribs, pelvis, skull, and sternum. The characteristic findings on X-ray are a single, well-defined osteolytic lesion with sharp borders, lack of bony sclerosis, and periosteal reaction.[3] Histopathology shows multiple plasma cells as a thick sheet with scant intercellular stroma, extensive basophilic cytoplasm, round eccentric nucleus with cartwheel appearance, and perinuclear halo as seen in our case. The diagnosis is based on the solitary lesion in radiograph, plasma cells in biopsy, less than 5% plasma cells in bone marrow, and a negative urine test for Bence Jones protein. [4] Here the cytology revealed a distinct picture of plasma cells with eccentric cartwheel-like nucleus, whereby a diagnosis of plasmacytoma was easily made, and further investigations ruled out multiple myeloma. Being highly radiosensitive, the local recurrence is less than 5% with conventional radiotherapy.

The present case of solitary plasmacytoma diagnosed on FNAC highlights the utility of FNAC and stresses that cytology can not only be used as an investigation tool, but also as a diagnostic modality.

 
  References Top

1.Wiltshaw E. The natural history of extramedullary plasmacytoma and its relation to solitary plasmacytoma of bone and myelomatosis. Medicine (Baltimore) 1976;55:217-38.  Back to cited text no. 1
[PUBMED]    
2.Woodruff RK, Malpas JS, White FE. Solitary plasmacytoma II: Solitary plasmacytoma of bone. Cancer 1979;43:2344-7.  Back to cited text no. 2
[PUBMED]    
3.Du Preez JH, Branca EP. Plasmacytoma of the skull: Case reports. Neurosurgery 1991;29:902-6.  Back to cited text no. 3
[PUBMED]    
4.Lasker JC, Bishop JO, Wilbanks JH. Solitary myeloma of the talus bone. Cancer 1991;68:202-5.  Back to cited text no. 4
    


    Figures

  [Figure 1], [Figure 2]

This article has been cited by
1 Surgery combined with radiotherapy for the treatment of solitary plasmacytoma of the rib: a case report and review of the literature
Rui Jia,Lei Xue,Huagang Liang,Kun Gao,Jian Li,Zhefeng Zhang
Journal of Cardiothoracic Surgery. 2015; 10(1)
[Pubmed] | [DOI]



 

Top
Print this article  Email this article

    

  Site Map | What's new | Copyright and Disclaimer
  Online since 1st April '07
  2007 - Indian Journal of Cancer | Published by Wolters Kluwer - Medknow