Plasmocytome osseux solitaire de la mandibule : un cas clinique et revue de la littérature
01 Jul 2015-Vol. 21, Iss: 3, pp 137-140
TL;DR: La localisation mandibulaire du plasmocytome osseux est exceptionnelle, le diagnostic est avant tout histologique, anders de cette pathologie rare sont discutes.
Abstract: Introduction : Le plasmocytome osseux solitaire est une tumeur maligne qui se caracterise par une proliferation de cellules plasmatiques monoclonales. Il atteint preferentiellement le squelette axial notamment le rachis et le pelvis. Sa localisation mandibulaire est exceptionnelle. Observation : Un homme de 49 ans venait consulter pour une tumeur mandibulaire droite evoluant depuis six mois de facon asymptomatique. Apres une exerese chirurgicale a visee diagnostique realisee sous anesthesie generale, l'examen histologique montrait qu’il s’agissait d’un plasmocytome. Le bilan d’extension realise permettait de confirmer le diagnostic de plasmocytome osseux solitaire de la mandibule. Le patient beneficiait d’une radiotherapie externe adjuvante et l’evolution etait favorable. Discussion : A partir de cette observation clinique et d’une revue de la litterature, les aspects cliniques, radiologiques, therapeutiques et evolutifs de cette pathologie rare sont discutes. La localisation mandibulaire du plasmocytome osseux est exceptionnelle et le diagnostic est avant tout histologique.
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TL;DR: Results supported the importance of precise staging that includes MRI of the spine for optimum patient selection and the application of definitive radiotherapy and showed those patients with myeloma protein that disappears following radiotherapy represent a category with a high likelihood of cure.
Abstract: Purpose: To clarify the natural history of solitary plasmacytoma of bone (SBP) after radiation treatment. Methods and Materials: Between 1965–1996, we identified 57 previously untreated patients with a SBP. A serum myeloma protein was present in 33 patients (58%) and Bence Jones proteinuria was present in an additional eight patients (14%). The median radiotherapy dose was 50 Gy (range, 30–70 Gy). Overall survival, cause-specific survival, and freedom from progression to multiple myeloma were calculated actuarially. Results: Local control was achieved in 55 of 57 patients (96%). For those 29 patients (51%) who subsequently developed multiple myeloma, the median time to progression was 1.8 years. There was a direct correlation between persistence of abnormal protein following radiotherapy and the likelihood of developing multiple myeloma. Among 11 patients with disappearance of myeloma protein, only two developed multiple myeloma after 4 and 12 years, in contrast to progression in 57% of patients with a persistent protein peak and 63% of those with nonsecretory disease ( p = 0.02). Among 23 patients with thoracolumbar spine disease, 7 of 8 patients staged with plain radiographs alone developed multiple myeloma in comparison with 1 of 7 patients who also had magnetic resonance imaging (MRI) ( p = 0.08). For all patients, the median survival from radiotherapy was 11.0 years. The median cause-specific survival of patients with disappearance of myeloma protein was significantly longer than that of the remaining patients ( p = 0.004). Conclusion: Results supported the importance of precise staging that includes MRI of the spine for optimum patient selection and the application of definitive radiotherapy. Those patients with myeloma protein that disappears following radiotherapy represent a category with a high likelihood of cure.
158 citations
"Plasmocytome osseux solitaire de la..." refers background in this paper
...Le principal risque évolutif du POS est la survenue d’un myélome multiple avec des délais variables allant de quelques mois à dix ans [13]....
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TL;DR: Patients with EMP have a relatively low risk of progressing to multiple myeloma and have improved survival compared with those who present with SPB, and the optimal treatment is moderate-dose radiotherapy and occasionally surgery.
89 citations
"Plasmocytome osseux solitaire de la..." refers background in this paper
...Un certain nombre de critères sont nécessaires pour affirmer le caractère solitaire du POS et éliminer un myélome multiple [11, 12] : – absence d’anémie ; – bilan phosphocalcique normal ; – fonction rénale normale ; – cytologie médullaire normale dans au moins deux sites différents ; – absence d’autres lésions sur les radiographies du squelette ou sur la scintigraphie osseuse....
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TL;DR: Local control of EMP in the HN seems to be improved when the dose to the CTV is > or = [DOSAGE ERROR CORRECTED] 45 Gy, and a minimum dose of 45 Gy should be recommended to theCTV.
Abstract: Purpose: Our aim was to determine the dose to the clinical target volume (CTV) required for solitary extramedullary plasmacytoma (EMP) in the head and neck (HN). Methods and Materials: Seventeen patients (15 Stage I and 2 Stage II) were treated for HN EMP at our institution between 1979 and 2003. The mean International Commission on Radiation Units (ICRU) dose prescribed to the CTV was 52.6 Gy (range, 40–65 Gy) over 24 fractions (range: 20–30). The Stage II patients received neck irradiation doses of 40 and 60 Gy. A mean dose of 36.4 Gy was used for 5 Stage I patients who received elective neck irradiation. Dose administrated to the CTV was evaluated from dosimetric data or from planning films when dosimetric data were not available. Two groups of patients were distinguished: CTV covered with a dose greater than 40 Gy and CTV covered with a dose greater than 45 Gy. Results: The 5-year local control was 72.8%. It was 100% for patients who received dose to the CTV ≤ 45 Gy vs. 50% for dose to the CTV p = 0.034). The prognostic factor for 5-year disease-specific survival (81.6%) was local control ( p = 0.058). The prognostic factors for disease-free survival (64.1%) were monoclonal immunoglobulin secretion ( p = 0.008) and a CTV dose ≤ 45 Gy ( p = 0.056) Conclusions: Local control of EMP in the HN seems to be improved when the dose to the CTV is ≤ 45 Gy. A minimum dose of 45 Gy should be recommended to the CTV.
84 citations
"Plasmocytome osseux solitaire de la..." refers background in this paper
...Les hémopathies plasmocytaires représentent 1 à 2 % de l’ensemble des néoplasies humaines [1]....
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...La radiothérapie, utilisée à des doses de 40 à 50 Gy (1,8 à 2 Gy/j), permet d’obtenir un taux de contrôle local de plus de 90 % avec également un effet antalgique [1, 15]....
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TL;DR: It was felt that the use of adjuvant chemotherapy after adequate doses of radiotherapy in patients with SBP improved duration of remission and survival without severe side‐effects, but as with other studies in SBP, the group was too small to draw definitive conclusions.
Abstract: Solitary bone plasmacytoma (SBP) is a rare presentation of plasma cell dyscrasias. Radiotherapy has been considered the treatment of choice, however, most patients will develop multiple myeloma, 3 to 10 years after initial diagnosis and treatment. No innovations have been introduced in the treatment of SBP in the last 30 years. We began a prospective clinical trial to assess the efficacy and toxicity of adjuvant chemotherapy with low doses of melphalan and prednisone administered to patients with SBP after radiation therapy in an attempt to improve the disease-free survival and overall survival. Between 1982 and 1989, 53 patients with SBP were randomly assigned to be treated with either local radiotherapy with doses ranged from 4000 to 5000 cGy to achieve local control of disease (28 patients) or the same radiotherapy schedule followed by melphalan and prednisone given every 6 weeks for 3 years (25 patients). After a median follow-up of 8.9 years, disease-free survival and overall survival were improved in patients who were treated with combined therapy, 22 patients remain alive and free of disease in the combined treatment group compared to only 13 patients in the radiotherapy group (p < 0.01). Treatment was well tolerated; planned doses were administered in all cases; no delays in treatment or acute side-effects were observed during treatment. Long-term secondary toxicities including secondary neoplasms and acute leukaemia, have not been observed. We felt that the use of adjuvant chemotherapy after adequate doses of radiotherapy in patients with SBP improved duration of remission and survival without severe side-effects. However, as with other studies in SBP, the group was too small to draw definitive conclusions and more controlled clinical trials are necessary to define the role of this therapeutic approach in patients with SBP.
80 citations
"Plasmocytome osseux solitaire de la..." refers background in this paper
...Cependant, les auteurs de cette étude avouent que le groupe d’essai était trop petit pour tirer des conclusions définitives [16]....
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...Une seule étude prospective a rapporté un bénéfice avec l’association chimiothérapie et radiothérapie par rapport à la radiothérapie seule [16]....
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60 citations