Cáceres’ Corner Case 248 – SOLVED

Dear Friends,

today I am showing preop radiographs for knee surgery of a 71-year-old man.
What do you see?

More images will be shown on Wednesday.

Click here to see new images

Dear friends, showing additional images of the sternum taken six years earlier, in 2014.
What do you think?

Click here to see the answer

Findings: PA chest is unremarkable (A). The lateral radiograph shows an expanding lytic lesion in the sternal manubrium (B, circle).

Cone down view shows the lesion better (C, arrows). Sagittal, coronal and axial unenhanced CT taken six years earlier (2014) demonstrate that the cortical bone is broken in several places, suggesting an aggressive process (D-F, arrows). A soft-tissue mass is not visible.

No other skeletal lesions were found. Biopsy of the sternum confirmed the diagnosis of solitary myeloma (plasmocytoma), that was subsequently treated. The patient remained asymptomatic.
 
Final diagnosis: Plasmocytoma of the sternum
 
Congratulations to Priyanka Chhabra and Olena, who made the correct diagnosis. And kudos to all of you who saw the lesion in the lateral chest radiograph.
 
Teaching point: Remember that a lytic lesion of the sternum in an adult is malignant until proven otherwise. Main etiologies are primary tumors (chondrosarcoma) and metastases.

Reviewing the literature, I found a case report with similar findings: Solitary plasmacytoma of the sternum with a spiculated periosteal reaction: A case report. ONCOLOGY LETTERS 9: 191-194, 2015

13 thoughts on “Cáceres’ Corner Case 248 – SOLVED

  1. I think there is also some cystic changes of medial end of the right clavicula – compare with the opposite side, sure could be because of age or just shadow and lucencies summation.

    1. This end of right clavicula could look like near “normal” size, but could be expanded forward and backward.

  2. In sternum there is expansive lytic lesion with preserved cortex (needs further investigation in CT). Vertebral column degenerative changes with anterior longitunal ligament calcification (disc spaces not preserved which excludes DISH). Possible old fracture in the right 7th rib.

  3. Good morning!!

    There are osseous findings: calcificaction of the anterior longitudinal ligament and an insufflant lytic sternal lesion.

    There is an increased density proyected over Riader´s trinagle but I think about arms soft tissue.

    No relevant pulmonary findings.

  4. …i valori del PSA?…clavicola dx e prima costa a sx, presentano alterazioni strutturali ossee come da metastasi..

  5. The radiological features of that lesion are not pathognomonical – DDx between mts, solitary plasmocytoma (according to age).
    If mts – needs to check medical history (prostate cancer, stable disease)
    Plasmocytoma – usually are cured with radiation therapy – should be seen some fibrous changes in adjacent tissue, lungs. It seems there is no.

  6. Expansile bony lesion is seen in the manubrium sterni region.
    Syndesmophytes are seen in the anterior vertebral margins with decreased disc spaces and disc calcinosis (ankylosis).
    I see no lung abnormality. Normal mediastinal structures.

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