Solitary Osseous Plasmacytoma of a Lumbar Vertebrae with Systemic Involvement in a Dog
Background: Myeloma-related disorders are characterized by proliferation of neoplastic plasma cell or immature immunoglobulin secreting B-lymphocytes, and include multiple myeloma, M-macroglobulinemia and extra-medullary plasmacytoma (cutaneous or extra-cutaneous). Solitary osseous plasmacytoma (SOP) is considered an unique entity among extra-medullary extra-cutaneous plasmacytoma. It is an unusual neoplasia in dogs, predominantly found in middle-aged to older animals, with a higher incidence in bones of axial skeleton. Dogs with vertebral SOP present neurological signs related to spinal cord compression, but progression to multiple myeloma is related to a poor outcome. As in humans, progression to multiple myeloma occurs in most cases, although it may take months or years from its initial presentation. SOP´s biological behaviour, incidence and prognostic are rarely documented. Chemotherapy with melphalan and prednisolone represent the most used protocol for multiple myeloma. However, in SOP, the combination of chemotherapy with local approaches is controversial before the evidence of systemic disease. This paper aims at reporting a case of SOP in a lumbar vertebrae of a dog, with systemic involvement.
Case: A 11-year old male mixed breed dog was attended presenting muscle weakness, lethargy, anorexia, adipsia and intense pain manifestation. The dog also presented multiple skin nodules, previously diagnosed as a plasmacytoma, through cytology. The dog´s poor clinical condition and aggressive temper, associated with suspicious of an advanced myeloma-related disorder, resulted in the decision for humanized euthanasia. At necropsy, a pale, friable and hemorrhagic mass was identified on the L3 lumbar vertebrae, associated with an osteolytic bone lesion and spinal cord compression. Histopathological analyses revealed proliferation of plasma cells, with pale perinuclear halo, moderate cellular pleomorphism, 10 binucleated cells and 10 mitotic figures per 10 high power fields, compatible with extramedullary plasmacytoma of the mature type, in the lumbar vertebrae (SOP). It was also seen myeloma-related lesions in the skin and subcutaneous, prostate, heart, superficial mandibular and axillary lymph nodes
Discussion: Solitary osseous plasmacytoma is a myeloma-related disorder rarely reported in dogs. Its biological behaviour is poorly characterized, however progression for multiple myeloma is common in humans and dogs, and it is related to a poor outcome. As the present report, systemic progression of SOP has been previously described and although an overt bone marrow infiltration was not detected, such possibility can not be excluded, once multiple myeloma distribution in the bone marrow is often multifocal. Although chemotherapy is the treatment of choice for multiple myeloma, its indication for SOP is conditioned to the evidence of systemic disease. It might delay tumour progression, but its early implementation may favor the selection of resistant neoplastic clones, making it ineffective when progression to multiple myeloma occurs. In humans radiotherapy is the treatment of choice for SOP, however it may be indicated in association to surgery. A retrospective study showed a higher survival rate in patients with SOP in the axial skeleton, which received surgical treatment combined with radiotherapy, if compared to those treated with surgery or radiotherapy alone. Decision for euthanasia was made based on the suspicious of advanced myeloma-related disorder, patient´s medical condition and aggressive temper, which limited diagnostic investigation and treatment.
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