CTICasesExtraosseous (Extramedullary) Myeloma / Plasmacytoma
Imaging findings
PET/CT showed large, bilateral paraspinal soft-tissue masses in the upper thoracic spine along with anterior chest wall soft-tissue masses indenting the lungs on both sides. The extraosseous soft-tissue components were not clearly associated with destroyed bone, and PET showed only modest, non-intense FDG uptake within the masses, distinct from the more avid uptake typically seen with osteolytic bone metastases.
Key takeaways
Bulky paraspinal soft-tissue masses without obvious associated bone destruction, particularly at the upper thoracic spine, should prompt consideration of extraosseous (extramedullary) plasmacytoma or myeloma in a patient with known or suspected multiple myeloma, since disease can extend extensively beyond bone through an intact or only subtly porous cortex without frank cortical destruction, and typically shows only modest, low-grade FDG avidity rather than the intense uptake of an aggressive osteolytic metastasis.
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