Surgical resection of a solitary plasmacytoma originating in a rib

Rare Rib-Originating Solitary Plasmacytoma: Retrospective Analysis and Surgical Outcomes

INTRODUCTION

Solitary plasmacytomas are tumors characterized by a local increase of malignant plasma cells in soft tissue or bone and may occur anywhere without evidence of systemic disease. The aim was to focus on the main surgical techniques and outcomes for this rare chest wall tumor.

METHODS

Patients with solitary plasmacytoma involving a rib, who were operated for diagnostic or treatment purposes between 2018 and 2023 were retrospectively reviewed.

RESULTS

Of the six patients included, three were male and the median age was 55.6 (range: 32-74) ys. All patients had preoperative positron emission tomography-computed tomography. Two underwent Tru-cut biopsy before surgery, but only one was then diagnosed. Two patients underwent surgery for diagnosis and the remainder underwent resection and reconstruction. In one patient with both rib and sternum involvement, rib and partial sternum resection was performed and the defect was repaired with mesh. During the 24.1 mos average follow-up period, two patients died, both of whom had metastasis preoperatively. The median survival of all patients was 24.1 (range: 3-63) mos.

CONCLUSIONS

Solitary plasmacytoma is rarely seen among primary malign tumors of the chest wall. A multidisciplinary approach is important in these cases. Surgical treatment in solitary plasmacytoma has fewer local and systemic side effects compared to radiotherapy and chemotherapy. Therefore, the place of surgery in the treatment of solitary plasmacytoma should be revised. Our findings show that surgery should be considered as not only a palliative treatment, but also a curative one, in solitary plasmacytomas arising in the rib.

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.

Surgery combined with radiotherapy for the treatment of solitary plasmacytoma of the rib: a case report and review of the literature

Solitary plasmacytoma of the bone, especially of a single rib, is a rare disease. We present the case of a 44-year-old Han Chinese man who was diagnosed with a solitary plasmacytoma of the bone located in the right sixth rib. The patient presented with a 4-year history of continuous pain in the right chest area and moderate fever lasting 7 days. A chest roentgenogram showed a solitary expanding lesion in the right thorax, and chest computed tomography revealed an osteolytic tumor in the chest wall. The patient underwent complete en-bloc resection of the chest wall, including the ribs, muscle, and parietal pleura. Histologically, the resected mass was composed of abundant neoplastic plasma cells, and the diagnosis was confirmed to be a plasmacytoma of rib. The examination of marrow cells showed 9 % normal plasma cells among karyocytes without clonal disease. On postoperative day 14, the patient underwent thoracic radiotherapy with a total dose of 50 Gy. The patient remained asymptomatic during the 6-month follow-up period. Herein, we also review previous reports on solitary plasmacytomas of the rib. In summary, this report provides further insights for the diagnosis and effective treatment of this rare disease.