Plasmacytoma

· In bone, the plasmacytoma may cause pain or broken bones. · In soft tissue, the tumor may press on nearby areas, causing pain or other problems. A plasmacytoma in the [|throat], for example, can make it difficult to swallow. 
 * Epidemiology: || Solitary plasmacytoma of bone accounts for about 5 percent of all patients with plasma cell disorders. Males are more commonly involved than females. The median age at diagnosis is a decade younger than that for MM, at approximately 55 years. However, solitary plasmacytoma of bone has been reported in patients as young as 15. 8 ||
 * Etiology: || The cause is unknown but plasmacytoma is a proliferation and accumulation of plasma cells that secrete immunoglobulin. These cells are derived from B cell lymphocytes. 1 Almost all patients diagnosed with plasmacytoma of the bone progress to develop multiple myeloma. 2 ||
 * Signs & Symptoms: || [|Symptoms] depend on where the tumor is

__Patients with paraimmunoglobulinopathy and must have at least one of the following also:__ Marrow plasmacytosis > 5% Tissue biopsy which demonstrates replacement and distortion of normal tissue with plasma cells >500 plasma cell per mm 3 in the blood. Osteolytic lesions that have other causes ruled out. __Patients without paraimmunoglobulinopathy have to have radiographic evidence of osteolytic lesions OR palpable tumors and at least one or more of the following:__ Marrow plasmacytosis > 20% in the absence of any other causes Tissue biopsy which demonstrates replacement and distortion of normal tissue with plasma cells Radiographic skeletal survey should be performed Beta 2 -microglobulin serum level. Plasmacytoma can be extra-medullary, therefore imaging modalities such as computed tomography can help determine extension into soft tissue. 3 || With radiation alone, local tumor control is 85%. There is a high risk of recurrence when tumors are treated to doses below 30 Gy. The risk drops to negligible with doses above 40 Gy.¹² || Solitary plasmacyctomas should be treated to 50 - 60 Gy in 2 Gy fractions. The treatment borders should be the same with the same fields as other primary tumors, based on their location (e.g. nasopharynx, tonsil, paranasal sinuses) Radiation is indicated in the following circumstances: (a) as primary treatment in localized disease, (b) as palliative treatment for disseminated disease when chemotherapy was not successful, (c) for prevention of pathologic fractures in weight bearing bones, and (d) relief of spinal cord or nerve root compression. The treatment volumes for plasmacytoma of bone should include the entire involved bone plus a 2-3 cm margin of surrounding tissue. Care must be taken to determine the true extent of the tumor as they frequently extent to adjacent soft tissue. The treatment volumes should also include the primary draining lymph nodes and be treated to 50 Gy in 5 weeks.¹² || TD 5/5 for Plasmactoma Sites 9 || Figure 1 Simulation of Forearm Treatment 10 Figure 2 Photograph of External Treatment Marks for Treatment of Distal Leg 10
 * Loss of appetite
 * Nausea
 * Thirst
 * Fatigue
 * Weakness⁵ ||
 * Diagnostic Procedures: || The diagnostic criteria were developed by the Chronic Leukemia-Myeloma Task Force:
 * Histology: || Monoclonal immunoglobulin secreting cells that are derived from B cell lymphocytes. 4 ||
 * Lymph Node Drainage: || A search of the literature does not demonstrate lymph node drainage playing a role in this disease. ||
 * Metastatic Spread: || Solitary plasmacytomas frequently extend into the adjacent soft tissues. ⁶ ||
 * Grading: || Histologically, extramedullary plasmacytoma (EMP) may be classified as low, intermediate, or high grade⁷ ||
 * Staging: || There are two stages of plasmacytoma: isolated plasmacytoma of the bone (or plasmacytoma of the skeletal system, SBP) and extramedullary plasmacytoma (EMP). In the former, only one tumor is found; less than five percent of the bone marrow is made up of plasma cells; and no other signs of cancer are found. Isolated plasmacytoma of the bone often develops into multiple myeloma. In the latter, one plasmacytoma is found in the soft tissue only.⁵
 * Wiltshaw classified soft-tissue plasmacytoma into 3 clinical stages, as follows
 * Stage I – Limited to an extramedullary site
 * Stage II – Involvement of regional lymph nodes
 * Stage III – Multiple metastasis (although it is no longer a solitary plasmacytoma⁵ ||
 * Radiation Side Effects: || Combination therapy may result in fever, neutropenia, mucositis, nausea, vomiting, and diarrhea. In addition to erythema in the radiatin field. Rare late effects include firbrosis, contractures, and growth arrest. Doses of 6000 cGy have been known to produce osteosarcoma in previously treated areas. Leukemia is also a possible, rare late effect. ¹¹ ||
 * Prognosis: || Overall 40% survival after 10 years.
 * Treatments: || For pedunculated extramedullary plasmacytoma, surgery is the treatment of choice due to low recurrence. All others should be treated with radiation.
 * TD5/5: || [[image:TD5-5_Plasma_&_Multiple.JPG width="393" height="134"]]
 * [[image:Forearm.JPG]]

__References__** 1. Sorenson SM, Gentili A, Masih S, et. al. //Multiple myeloma//. Available at: [|//http://emedicine.medscape.com/article/391742-overview//]//.// Accessed February 15, 2010. 2. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002:601-602. 3. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002:601-603. 4. Sorenson SM, Gentili A, Masih S, et. al. //Multiple myeloma//. Available at: [|//http://emedicine.medscape.com/article/391742-overview//]//.// Accessed February 15, 2010. 5. [] Accessed Febuary 18, 2010 6.Chao KS, Perez CA, Brady LW. Radiation Oncology-Management Decisions. 2nd edition. Philadelphia, PA: Lippincott, Williams & Wilkins. 2002. pg 603 7. [] Accessed Febuary 18, 2010 8. [] Accessed February 18, 2010 9. Wikibooks en.wikibooks.org TD5/5 adapted from Emami 1991 10. Faiz M. Khan. //Treatment Planning in Radiation Oncology//. 2nd ed. Philadelphia, PA Lippincott Williams & Wilkins. 2007  11. Washington CM, Leaver D. // Principles and Practice of Radiation Therapy //. 2nd ed. St. Louis, MO: Mosby. 2004 12. Chao KS, Perez CA., Brady LW. //Radiation Oncology - Management Decisions//. 2nd ed. Philadelphia, PA: Lippincott, Williams & Wilkins; 2002