Solitary plasmacytoma of the left rib misdiagnosed as angina pectoris:A case report

BACKGROUND Solitary plasmacytoma in the left rib is rare and can cause chest discomfort such as chest pain and tightness,and its clinical manifestations are not typical,so it is often misdiagnosed.We report a case of left costal plasmacytoma misdiagnosed as angina pectoris.We also review the literature and provide suggestions as to how to avoid misdiagnosis.CASE SUMMARY A 77-year-old man with a history of intermittent chest tightness for 3 years presented with pain in the left chest for 1 wk and was admitted to hospital.The cardiologists initially diagnosed angina pectoris but the findings of coronary angiography were not consistent with the symptoms.Computed tomography showed that the left eighth rib mass was accompanied by bone destruction.The patient was transferred to our department for further treatment.Preoperative biopsy indicated that the lesion was possibly malignant,and elective surgery was performed to remove the lesion.The size of the tumor was about 4 cm.The tumor was spindle-shaped and protruded into the pleural cavity,without invading the lungs.Postoperative pathology confirmed that the left rib lesion was plasmacytoma.After 14 mo follow-up,the patient died of systemic metastasis.CONCLUSION Left rib solitary plasmacytoma is a rare disease confined to a specific rib and can cause local pain.Attention should be paid to the differential diagnosis of angina pectoris to avoid misdiagnosis.

Solitary bone plasmacytoma of the upper cervical spine: A case report

BACKGROUND Solitary bone plasmacytoma(SBP)of the upper cervical spine is a rare diagnosis.The exact role of surgery for SBP remains unclear.CASE SUMMARY We present the first case of SBP of the C2.A 69-year-old Chinese woman presented with severe neck pain and limitation of rotative activity for 2 mo.She underwent anterior one-stage debridement combined with cement augmentation in the C2 to reconstruct stability of the spine.The patient did not receive postoperative radiotherapy.She now remains disease free with no neck pain or neurological deficit after follow-up of 3 years.CONCLUSION Anterior one-stage debridement combined with cement augmentation of the upper cervical spine may be an alternative treatment for SBP.

Therapy-related acute promyelocytic leukemia with FMS-like tyrosine kinase 3-internal tandem duplication mutation in solitary bone plasmacytoma: A case report

BACKGROUND Therapy-related acute promyelocytic leukemia(t-APL)is a rare complication observed in solitary bone plasmacytoma(SBP),and SBP after radiotherapy evolving to APL harboring the FMS-like tyrosine kinase 3-internal tandem duplication(FLT3-ITD)mutation has never been reported.Here,we present the first case reported until now.CASE SUMMARY We describe a 64-year-old woman who presented with lumbar pain and was initially diagnosed with SBP.However,after one year of radiotherapy treatment,this patient experienced a long-standing bone-marrow-suppressive period and finally developed APL harboring the FLT3-ITD mutation,as confirmed by analyses of clinical features,bone marrow morphology,flow cytometry,cytogenetic examination,and molecular biology.On admission,the patient had disseminated intravascular coagulation and intracranial hemorrhage,and the peripheral blood and bone marrow smear displayed abundant abnormal promyelocytes.Unfortunately,she died when the definite diagnosis was made.CONCLUSION The patient with t-APL harboring FLT3-ITD mutation evolving from SBP after radiotherapy had not been reported and had poor clinical outcomes.FLT3-ITD mutation in t-APL may be a potential pathogenesis of leukemogenesis.We should consider the potential risk of secondary neoplasms in SBP patients after radiotherapy.