Presentation
Paraparesis and incontinence.
Patient Data
There is marked osteolysis of the spinous process of T1. There is also mild irregular periosteal proliferation associated with the spinous process of T1 and osteolysis of the lamina and right pedicle of the vertebra. There is a pathologic fracture of the spinous process of T1. The dorsal aspect of T2 spinous process is also lytic. The right caudal pedicle of C7 is indistinct. There are multiple sites of spondylosis deformans with smoothly marginated osseous proliferation and sclerosis of the end plates at L1-2 and L2-3. An alveolar pattern is present in the right lung lobe with shift of the mediastinum to the right compatible with atelectasis secondary to anesthesia and right lateral recumbency.
Case Discussion
Differential diagnosis
Progressive, primarily destructive lesion of T1 and T2 with possible involvement of C7 compatible with neoplasia. Differential diagnoses include soft tissue neoplasia invading bone, primary bone or round cell neoplasia, or metastatic neoplasia.
Diagnosis
Multiple myeloma
Discussion
Bloodwork revealed hyperglobulinemia. This along with the cytologic diagnosis of plasma cells, and vertebral location of the mass, is consistent with myeloma.
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