Plasmacytoma

**Isolated plasmacytoma of bone**: one plasma cell tumor is found in the bone, less than 5% of the bone marrow is made up of plasma cells, there are no other signs of cancer. **Extramedullary plasmacytoma**: one plasma cell tumor is found in the soft tissue but not in the bone or the bone marrow. [1] || • Extramedullary plasmacytoma (EMP) progresses to multiple myeloma in 11- 30% of patients at 10 years. Overall survival rate at 10 years is 70%. [2] Factors that decrease survival and time before a relapse are:
 * **Epidemiolgy:** || 2-3 cases per 100,000 per year. [2] ||
 * **Etiology:** || caused by proliferation and accumulation of immunoglobulin-secreting cells [2] ||
 * **Signs & Symptoms:** || bone pain, infection, bleeding, fatigue, anemia, thrombocytopenia, granulocytopenia, hypercalcemia. [2] ||
 * **Diagnostic Procedures:** || The initial diagnostic workup includes a complete medical history, a comprehensive physical examination followed by laboratory studies. There are two types of plasmacytomas, solitary plasmacytoma and extramedullary plasmacytoma. Solitary plasmacytoma is typically detected by electrophoresis and medical imaging studies. It usually involves the axial skeleton and is accompanied by bone pain. Extramedullary plasmacytoma is a rare plasma cell tumor that arises from outside of the bone marrow. Diagnosis is done by bone marrow biopsy. Also, computed tomography (CT) and magnetic resonance imaging (MRI), and complete endoscopic examination of the respiratory and gastrointestinal tract are used to determine the extent of the disease. [3] ||
 * **Histology:** || Both solitary plasmacytoma and extramedullary plasmacytoma involve monoclonal plasma cells. Solitary plasmacytoma lesions involve infiltration of the bone by monoclonal plasma cells where extramedullary plasmacytoma involves infiltration of soft-tissue by monoclonal plasma cells. [3] ||
 * **Lymph node drainage:** || There is no specific lymph node drainage information on plasmacytoma. ||
 * **Metastatic spread:** || Metastasis may spread to other soft tissues or lymph nodes. ||
 * **Grading:** || Plasmacytoma can be classified as low, intermediate or high grade. ||
 * **Staging:** || There are two stages of plasmacytoma: isolated plasmacytoma of bone and extramedullary plasmacytoma.
 * **Radiation side effects:** || Patients may feel tired and lose their appetite. The skin above the treated area are more sensitive and irritated. Side effects include peripheral neuropathy, clinical thrombocytopenia and diarrhea. Fibrosis, contractures and growth arrest may also be presented. ||
 * **Prognosis:** || Solitary bone plasmacytoma (SBP) develops into multiple myeloma in 50-60% of patients. Median overall survival time is 10 years.
 * Over the age of 65 median time of 20 months
 * Severe anemia
 * Hypercalcemia
 * Blood urea nitrogen greater the 40 mg per dL
 * Elevated M protein
 * Hypoalbuminemia
 * High tumor cell burden

Overall 10 year survival is 40% [2] Overall 10 year survival for solitary bone plasmacytoma is 76% Overall 10 year survival for extramedullary plasmacytoma is 36% || • Indicated for (a) primary treatment in localized presentations; (b) palliation of pain not controlled by chemotherapy from bone lesions of disseminated disease; <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">(c) prevention of pathologic fractures in weight-bearing bones; and (d) relief of spinal cord compression and nerve root compression.[1] <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">• Portals should include the entire involved bone and 2-3 cm margin of surrounding bone (10-20 Gy in 10 fractions)[2] <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">• Portals for extramedullary plasmacytomas should include the primary draining lymph nodes; 50 Gy in 5 weeks is required.[2]
 * **Treatments:** || <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Radiation therapy is the standard treatment

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Surgery <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">• Surgery alone without radiation therapy leads to an unacceptably high local recurrence rate[1] ||
 * **TD 5/5:** ||= || <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Organ of Interest

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">SOLITARY <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Bone marrow

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Bone

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Spinal cord

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">EXTRAMEDULLARY <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Liver

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Mucosa

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Lung

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Colon

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Esophagus

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Small intestine

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Stomach || <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">TD 5/5 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">1/3

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">250 cGy

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">-

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">-

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5,000 cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5cm

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5,000 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">-- <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">4,500 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5,500 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">6,000 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5,000 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">6,000 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy || <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">TD 5/5 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">2/3

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">250 cGy 250 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">-

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">-

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5,000 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">10cm <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">3,500 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">- <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">3,000 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">- <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5,800 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">- <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">- <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5,500 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">cGy || <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">TD 3/3

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">250 cGy

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">2,000 cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">10 cm3 <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">4,700 cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">20 cm

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">3,000 cGy

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">6,000 cGy <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">50cm3

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">1,750 cGy

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">4,500 cGy

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5,500 cGy

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">4,000 cGy

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">5,500 cGy || <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Complication

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Aplasia

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Growth arrest

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Myelitis/Necrosis

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Liver failure/Hepatitis

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Ulceration/Fibrosis

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Pneumonitis

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Obstruction/Perforation <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Ulceration/Fistula <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Stricture/Perforation

<span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Obstruction/Perforation <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Fistula <span style="color: #7030a0; font-family: "Times New Roman","serif"; font-size: 16px;">Ulceration/Perforation || || [2] Chao KS, Perez C, Brady L. //Radiation Oncology Management Decisions.// 2nd ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2002. <span style="color: #e62e25; font-family: "Arial","sans-serif"; font-size: 13px;">[3] Hoppe TR, Phillips LT, Roach M. //<span style="font-family: "Arial","sans-serif";">Leibel and Phillips Textbook of Radiation Oncology //. 3rd Ed. Philadelphia, PA: Saunders, Elsevier; 2010. || Back to Week 7
 * **References:** || [1] Plasmacytoma. MEDTV. http://cancer.emedtv.com/plasmacytoma/plasmacytoma-p3.html. Accessed July 3, 2012.