胸椎孤立性浆细胞瘤1例及文献复习

Solitary bone plasmacytoma in thoracic vertebrae: case report and literature review

目的探讨胸椎孤立性浆细胞瘤(SPB)的临床表现、影像特征及鉴别诊断。方法分析1例脊柱SPB病人的CT及MRI表现,并复习相关文献。结果 CT示T10椎体呈楔形,轻度膨胀性、溶骨性骨质破坏,边缘骨硬化,内部见残存骨嵴,未见典型"微脑征"。瘤体均质,未见钙化及肿瘤骨。MRI平扫示病变于T1WI呈低信号,T2WI呈稍高信号,T2WI脂肪抑制序列呈高信号,MRI增强示瘤体呈均匀强化,未见椎旁肿块及脓疡,相邻椎间盘信号无异常。手术病理提示浆细胞来源肿瘤,结合ECT及本周蛋白、血钙及肌酸水平,临床诊断为SPB。结论 SPB好发于椎体前部,溶骨性破坏,瘤体均质,常伴有骨嵴及硬化边。"微脑征"有助于诊断,但敏感性较低。SPB的确诊有赖于影像检查、临床实验室及病理结果的综合分析。

Objective To illustrate the clinical manifestations, image features, and differential of solitary bone plasmacytoma （SBP）in thoracic vertebrae. Methods CT and MRI images of a case with SBP in thoracic vertebrae were analyzed, and literatures were reviewed. Results Precontrast CT scan revealed moderately anterior wedging and osteolytic bone destruction at T10 vertebral body. The focus was homogeneous with residual bone crest located on the edge, without typical ＂mini brain＂ sign, calcification and tumor bone. No typical ＂mini brain＂ sign, calcification and tumor bone were observed. MRI showed that T10 vertebral body presented hypointensity on T1WI, mild hyperintensity on T2WI and FLAIR. The lesion was markedly enhanced on enhanced MRI scan. No paraspinal mass and abscess were detected. The intervertebral disc signal and shape were normal. A plasma cell neoplasm was suspected in surgical pathology exam. The lesion was ultimately diagnosed as SBP by combining imaging features, laboratory M protein, blood calcium and creatine level. Conclusions SBP in thoracic vertebrae occurs more frequently in the anterior part of vertebral body. Imaging features includes homogeneous, expansive and osteolytic destruction, with bone crest. The＂mini brain＂sign is valuable , but lack of sensitivity in diagnosis. The diagnosis of SBP should combine with imaging features, clinical laboratory and pathological exam results.