Objective

To explore the clinical manifestations，diagnosis，treatment，and prognosis of elderly female patients with multiple plasmacytoma of spine （MPS）.

Methods

A case of elderly female MPS （patient 1）diagnosed in the 72nd Group Army Hospital of the Chinese People's Liberation Army in July 2024 was selected as the research subject.A retrospective study was conducted to analyze the medical history，clinical manifestations，imaging，and pathological examination results of patient 1 after admission，as well as the diagnosis and treatment process.The literature review of MPS-related research in domestic and foreign databases was conducted using the search strategy set in this study.This study was approved by the Medical Ethics Committee of the 72nd Group Army Hospital of the Chinese People's Liberation Army （Approval No.2024-6）.

Results

The admission-related examinations，admission diagnosis and treatment results of patient 1 were as follows.①Medial history and orthopedic examination：Patient 1 was a 78-year-old female who had neck，back and left upper limb pain for more than 3 months without obvious cause.Orthopedic examination showed obvious neck and back tenderness，slightly limited stretching and rotational movements，and decreased sensation in the left neck，shoulder，and left fingers.②Laboratory examination after admission：The red blood cell count（RBC）was 3.12×10¹²/L，hemoglobin（Hb）was 79 g/L，and fibrinogen was 1.81 g/L，all of which were lower than normal，and the globulin was 50.6 g/L，which was higher than normal.③Post-admission imaging examination：Cervical spine CT showed lytic bone destruction of the C5 spinous process，C7 spinous process，vertebral arch，transverse process，and part of the vertebral body，and the local edge of bone cortex was hardened，and a soft tissue density shadow was shown in it.Cervical spine MRI showed T1-weighted iso intensity and T2-weighted iso intensity in C5 spinous process，C7 spinous process，vertebral arch，transverse process，and and part of the vertebral body.And fat suppression sequences had hyperintensity，slightly elevated intensity in diffusion-weighted imaging ^（DWI），and hypointensity in apparent diffusion coefficient（ADC）images.These areas showed homogeneous enhancement in the enhancement scan，with clear borders，and the spinal cord was markedly compressed.④Treatment and intraoperative resection histopathology and immunohistochemistry results：Patient 1 underwent posterior cervical incision，C7 vertebral lumpectomy，spinal cord release，and vertebral fixation under general anesthesia，and the C7 vertebra had cortical destruction.The tumor was cystic and encapsulated，with a jelly-like opening and a soft texture.The cyst wall of the mass was adherent to the dura mater.Histopathology of intraoperative resection tissue and immunohistochemistry revealed positive results for CD138（+），CD38（+），and Ki-67（+，approximately 30%）.The pathologic diagnosis was plasmacytoma.After the operation，neck pain and numbness，and pain in the left upper limb of patient 1 were significantly improved，her neurological function was significantly r estored.⑤Literature search results：Two pieces of MPS related literature were retrieved in domestic and foreign databases，involving 9 patients （patients 2-10），plus patient 1 in this study，a total of 10 MPS patients.Among these 10 patients，8 cases （patients 2-9）progressed from solitary plasmacytoma of spine（SPS）to MPS，and 1 case （patient 10）was clinically diagnosed as MPS after double lower limb paralysis.Two cases （patients 1 and 10）was treated with surgery alone，2 cases （patients 2 and 7）were treated with surgery combined with radiotherapy，1 case （patient 6）was treated with surgery combined with radiotherapy and chemotherapy，2 cases （patients 5 and 8）were treated with chemotherapy combined with radiotherapy，and 3 cases （patients 3，4，and 9）were treated with radiotherapy alone.Four patients （patients 1，2，7，and 8）had a good prognosis；2 patients （patients 3 and 9）progressed to multiple myeloma（MM），1 patient （patient 3）was still alive at the end of follow-up，and 1 patient （patient 9）died；3 patients （patients 5，6，and 8）progressed to leukemia，and 2 patients （patients 5 and 6）died，and 1 patient（ patient 8）was still alive at the end of follow-up；1 patient （patient 10）was discharged 14 d after surgery and was lost to follow-up，and 1 patient（patient 4）was lost to follow-up after discharge.

Conclusions

In this study，one elderly female patient with MPS who mainly had multiple appendages involved in the lower cervical segment was diagnosed by combining laboratory and imaging examinations and intraoperative resection histopathological examination.There are few reported MPS patients at home and abroad，and the treatment of patients with MPS is mainly radiotherapy and chemotherapy，appropriate surgery can improve the patient's neurological function and alleviate the corresponding pain symptoms in time.