Multidisciplinary Care of a Complex and Destructive Plasmacytoma of the Sternum: A Case Report
Chidinma S. Tiko-Okoye, Michael Karon, Ryan Hoffman, Michael J. Walker, Ned Carp
Lankenau Medical Center, Philadelphia, PA, USA
OBJECTIVE: Review the multidisciplinary approach to a rare form of a plasma cell malignancy, plasmacytoma of the sternum, that required the use of both radiation therapy and intervention by multiple surgical subspecialists.
METHODS: We present a case of a 45-year-old female with a large plasmacytoma of the sternum who was effectively treated with a multimodal approach of radiation therapy, resection, and chest wall reconstruction.
RESULTS: A 45-year-old female presented with an enlarging and painful chest wall mass, that had been present for two years. A core needle biopsy showed an infiltrating malignant neoplasm with plasmacytoid features and, for a more definitive diagnosis, she underwent an incisional biopsy. This was complicated by profuse bleeding due to increased vascularity of the mass. Subsequently, the patient underwent IMA embolization and radiotherapy to control further bleeding. After completion of her radiotherapy course, the patient returned to the operating room for resection of the mass, requiring complex chest wall reconstruction with rib plates and pectoralis muscle flaps.
CONCLUSION: Sternal involvement with solitary plasmacytoma of bone is a rare presentation of an already uncommon malignancy. There is a lack of consensus on the most effective treatment modality for SPB given its rarity. Each case warrants an individualized approach that will be most beneficial to the patient. Due to the complex nature of this patient’s plasmacytoma, her best results were achieved with a combination of radiation and surgical intervention.
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