Skip to main content

Surgery combined with radiotherapy for the treatment of solitary plasmacytoma of the rib: a case report and review of the literature


Solitary plasmacytoma of the bone, especially of a single rib, is a rare disease. We present the case of a 44-year-old Han Chinese man who was diagnosed with a solitary plasmacytoma of the bone located in the right sixth rib. The patient presented with a 4-year history of continuous pain in the right chest area and moderate fever lasting 7 days. A chest roentgenogram showed a solitary expanding lesion in the right thorax, and chest computed tomography revealed an osteolytic tumor in the chest wall. The patient underwent complete en-bloc resection of the chest wall, including the ribs, muscle, and parietal pleura. Histologically, the resected mass was composed of abundant neoplastic plasma cells, and the diagnosis was confirmed to be a plasmacytoma of rib. The examination of marrow cells showed 9 % normal plasma cells among karyocytes without clonal disease. On postoperative day 14, the patient underwent thoracic radiotherapy with a total dose of 50 Gy. The patient remained asymptomatic during the 6-month follow-up period. Herein, we also review previous reports on solitary plasmacytomas of the rib. In summary, this report provides further insights for the diagnosis and effective treatment of this rare disease.

Peer Review reports


Solitary plasmacytoma of bone (SPB) is a rare localized neoplasm that accounts for only 5 % of malignant plasma cell tumors [1]. SPBs typically occur in the vertebrae or pelvic bones, with presentation in the rib being less common [2, 3]. SPBs are characterized by the presence of only one or two isolated bone lesions with no evidence of disease dissemination and are generally considered to be curable with surgical resection and radiotherapy [4]. In most cases, SPBs present as osteolytic lesions of the bone on chest X-ray [5]. Herein, we report a case of solitary plasmacytoma of the rib (SPR) with unique clinical features.

Case report

A 44-year-old man visited our clinic complaining of continuous pain in the right chest area for 4 years and moderate fever for 7 days. He had no history of trauma or tuberculosis. A chest roentgenogram (Fig. 1a) and chest computed tomography (CT) (Fig. 2a and b) revealed a 6.11 cm × 9.33 cm, oval opacity in the right side of the chest, which was highly suspected to be an intra-thoracic tumor originating from the pleura or rib. Spiral CT three-dimensional reconstruction showed an osteolytic lesion in the right sixth rib (Fig. 2c and d), and abnormally increased uptake of radioisotope around the right sixth rib was observed in a bone scan (Fig. 1b). The radiologic features suggested a focal lytic lesion in the right sixth rib and limited pleura thickening (Fig. 2a and b). Peripheral blood examination showed no abnormalities (Table 1). Therefore, we decided to remove the lesion via a surgical approach for the treatment and diagnosis of the tumor. A standard posterolateral thoracotomy was performed along the fifth intercostal space. We completely resected the tumor and the surrounding fifth and seventh ribs with a safety margin of at least 3 cm. Adherent parietal pleura at the tumor site was also resected. During the operation, no pleural dissemination was found. Reconstruction of the chest wall defect was accomplished using a tension-free dacron patch (Johnson & Johnson, New Brunswick, NJ, USA). The gross pathology of the resected specimen showed an irregular, pale, soft, and friable tumor (Fig. 3a). Histological analysis of the resected tumor revealed abundant neoplastic plasma cells in the lesion (Fig. 3b). Immunohistochemical staining of the specimen showed positive staining for CD38 and CD138 (Fig. 3c and d). No M-protein in the serum or urine was found by immunoelectrophoresis. A biopsy of the bone marrow along with aspiration revealed that normal plasma cells accounted for 9 % of karyocytes, and these cells expressed CD38, CD138, CD19, and CD45 (Table 1). These characteristics were consistent with a diagnosis of plasmacytoma, excluding the possibility of multiple myeloma (MM).

Fig. 1
figure 1

Preoperative chest roentgenogram and bone scanning examinations. Chest roentgenogram showing a solitary expanding lesion in the right sixth rib (arrow, a). Abnormally increased uptake of radioisotope in the right sixth rib on a bone scan (b)

Fig. 2
figure 2

Spiral computed tomography showing more detailed imagery and data. Three-dimensional computed tomographic image of the chest showing an irregular mass projecting into the thorax (arrow, a, b and c) and a focal lytic lesion in the sixth rib (black arrow, b). Spiral CT 3D reconstruction showing the absence of the right sixth rib (arrow, d)

Table 1 Summary of laboratory test results
Fig. 3
figure 3

Gross specimen and pathological findings. The tumor (arrow) was resected with the surrounding fifth to seventh ribs, with a safety margin of at least 3 cm (a). Microscopic view shows abundant neoplastic plasma cells (H&E, ×400) (b). Immunohistochemical staining showed that the specimen is positive for CD38 (c) and CD138 (d)

Starting in postoperative day 15, radiation therapy with a total target dose of 50 Gy (2 Gy/d, 25 days) was administered to tissue surrounding the area of the resected tumor. The patient was followed up at 6 months after surgery and was relapse-free with no recurrence according to a chest CT scan (Fig. 4).

Fig. 4
figure 4

Follow-up chest computed tomography scan. No residual tumor or recurrence was found in the lungs (a) or chest wall (b)


SPB accounts for about 5 % of plasmacytomas [1, 6]. SPBs occur more commonly in males than in females, at an estimated ratio of 2:1 [7], and the median age of patients is approximately 55 years, which is about 10 years younger than patients with MM [5]. Thus far, few studies have compared SPRs with SPBs in other bones. We conducted an English literature search using the search terms “solitary plasmacytoma” and “rib” on Pudmed and found 18 case reports published between 1992 and 2014 [825] (Table 2). Among these SPR patients, 14 were male and four were female (male to female ratio, 3.5:1), and their ages ranged from 26–75 years (median, 52 years). The ratio of tumor occurrence in right ribs to left ones was 1.6:1, and the majority of tumors occurred on the fourth and fifth ribs (56 %).

Table 2 Characteristics of solitary plasmacytoma of the rib

The clinical presentation of SPR varies significantly. The most common symptom is pain due to progression of osteoclasia or oncothlipsis [8, 9, 11, 12, 14, 15, 21, 23, 25], but some cases are asymptomatic and found based on a chest mass during physical examinations [13, 14, 17, 19, 20]. Other chief complaints include limb weakness [16, 22], Horner’s syndrome [24], and axillary lymphadenectasis [18]. All the reported cases showed osteolytic ribs on radiologic examination, including 12 cases with a chest mass [914, 17, 1921, 24, 25] and two with pleural effusion [8, 12]. In our case, CT showed an irregular intrathoracic mass with heterogeneous density in the right sixth osteolytic rib with adjacent pleural thickening.

The currently recommended diagnostic criteria [5] for SPB include the following: (i) clinical and radiological evidence of a single area of bone destruction on skeletal survey; (ii) histological confirmation of plasma cell histology; (iii) normal marrow without clonal disease; (iv) absence of anemia, hypercalcemia, or renal impairment attributable to myeloma; and (v) absent or low serum or urinary level of monoclonal protein (called Bence-Jones protein) and preserved levels of uninvolved immunoglobulins. Therefore, the diagnosis of our case was based on the following findings: osteolytic rib observed by imaging, histopathological evidence of plasmacytoma, and absence of MM features on bone marrow examination.

Surgical intervention is the first choice of treatment for SPB, and a complete resection is expected to be curative. Bataille et al. [1] reported 114 cases of solitary myeloma and showed that the lowest incidence of progressive disease was observed in patients with peripheral solitary plasmacytoma treated with surgery plus an adequate dose of radiation therapy. Aviles et al. [26] demonstrated that most patients treated with adequate radiation therapy alone will develop MM within 3 years. With respect to the radiation dose, Mendenhall et al. [27] reported that the local failure rates were 6 and 31 % in patients with a solitary plasmacytoma treated with doses of 40 Gy or greater and doses below 40 Gy, respectively. It is recommended that SPB be treated with radical radiotherapy, encompassing the tumor volume shown on magnetic resonance imaging with a margin of at least 2 cm and treated to a dose of 40 Gy in 20 fractions. For a SPB with a tumor size of >5 cm, a higher dose of up to 50 Gy in 25 fractions should be considered [7].

The role of adjuvant chemotherapy in preventing progression to MM remains unclear. Some reports suggest that adjuvant chemotherapy does not affect the incidence of conversion from SPB into MM but could delay its progression to MM [4]. Patients not responsive to radiotherapy could be treated with chemotherapy, with a similar approach to that used in the treatment of MM [7], but the effectiveness of chemotherapy for SPR remains to be determined. Our patient received a complete en-bloc resection and postoperative 50 Gy of radiotherapy, with no relapse at 6 months after surgery, indicating that our surgery plus radiation therapy was efficacious.

It is generally accepted that patients with SPB have an indolent course of disease, with a median survival time of 10.7 years and 5-, 10-, and 20-year survival rates of 75, 52, and 37 %, respectively [5]. However, Warsame et al. [28] reported that in a study of 127 SPB patients followed up for 7–28 months (median, 56 months), 85 patients (67 %) progressed to MM and 27 patients (21 %) died of progression.


In conclusion, SPRs show an earlier average age of onset and higher male to female incidence ratio than SPBs located in other bones, according to the literature review. SPRs should be considered when confronted with a lytic tumor of the rib. The treatment is based on surgery and radiotherapy. SPRs are often resectable, and the prognosis is generally good and dominated by the risk of progression to MM.


Written informed consent was obtained from the patient for publication of this case report and any accompanying images. A copy of the written consent is available for review by the Editor-in-Chief of this journal.



Solitary plasmacytoma of bone


Computed tomography


Solitary plasmacytoma of the rib


Multiple myeloma


  1. Bataille R, Sany J. Solitary myeloma: clinical and prognostic features of a review of 114 cases. Cancer. 1981;48:845–51.

    Article  CAS  PubMed  Google Scholar 

  2. Frassica DA, Frassica FJ, Schray MF, Sim FH, Kyle RA. Solitary plasmacytoma of bone: Mayo Clinic experience. In J Radiat Oncol Biol Phys. 1989;16:43–8.

    Article  CAS  Google Scholar 

  3. Woodruff RK, Malpas JS, White FE. Solitary plasmacytoma II: Solitary plasmacytoma of bone. Cancer. 1979;43:2344–7.

    Article  CAS  PubMed  Google Scholar 

  4. Jackson A, Scarffe JH. Prognostic significance of osteopenia and immunoparesis at presentation in patients with solitary myeloma of bone. Eur J Cancer. 1990;26:363–71.

    Article  CAS  PubMed  Google Scholar 

  5. Dimopoulos MA1, Moulopoulos LA, Maniatis A, Alexanian R. Solitary plasmacytoma of bone and asymptomatic multiple myeloma. Blood. 2000;96:2037–44.

    CAS  PubMed  Google Scholar 

  6. Wiltshaw E. The natural history of extramedullary plasmacytoma and its relation to solitary plasmacytoma of bone and myelomatosis. Medicine (Baltimore). 1976;55:217–38.

    Article  CAS  Google Scholar 

  7. Soutar R, Lucraft H, Jackson G, Reece A, Bird J, Low E, et al. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma. Br J Haematol. 2004;124:717–26.

    Article  PubMed  Google Scholar 

  8. Caffery T, Foy M. Plasmacytoma presenting as missing rib on chest film: a case report and review of the literature. J La State Med Soc. 2014;166:63–6.

    PubMed  Google Scholar 

  9. Tajima K, Uchida N, Azuma Y, Okada T, Sasamoto H, Yokoo H, et al. Surgical resection of a solitary plasmacytoma originating in a Rib. Ann Thorac Cardiovasc Surg. 2014;20:609–12.

    Article  PubMed  Google Scholar 

  10. Santos VM, Brito EF, Paz BC, Leal CT. Rib plasmacytoma and IgA multiple myeloma with hyperviscosity syndrome. Arch Iran Med. 2012;15:517–9.

    PubMed  Google Scholar 

  11. Lee HY, Kim JI, Kim KN. Solitary plasmacytoma of the rib. Korean J Thorac Cardiovasc Surg. 2012;45:269–71.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Singal R, Dalal U, Dalal AK, Attri AK, Gupta S, Raina R. Solitary plasmacytoma of the rib: A rare case. Lung India. 2011;28:309–11.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Kodate M, Takagishi T, Osaki T. Plasmacytoma of chest wall. Kyobu Geka. 2010;63:879–82.

    PubMed  Google Scholar 

  14. Pattanayak L, Samantaray S, Rout N. Solitary plasmacytoma of the rib: a rare cytological detection. Indian J Cancer. 2010;47:485–6.

    Article  CAS  PubMed  Google Scholar 

  15. Ketata W, Triki F, Msaad S, Ayadi L, Fouzi S, Ayadi H, et al. A rare localization of solitary plasmacytoma. Rev Pneumol Clin. 2009;65:165–8.

    Article  CAS  PubMed  Google Scholar 

  16. Palao S, Masjuan J, López J, Calleja P. Solitary costal plasmacytoma: a rare cause of subacute demyelinating polyradiculoneuropathy. Neurologia. 2006;21:265–8.

    CAS  PubMed  Google Scholar 

  17. Bousnina S, Zendah I, Marniche K, Yalaoui S, El Mezni F, Megdiche ML, et al. Solitary plasmacytoma of the rib: A rare tumor not to miss. Rev Pneumol Clin. 2006;62:243–6.

    Article  CAS  PubMed  Google Scholar 

  18. Wilkinson S, Forrester-Wood CP. Surgical resection of a solitary plasmacytoma originating in a rib of a patient with Castleman’s disease. Ann Thorac Surg. 2003;75:1018–9.

    Article  PubMed  Google Scholar 

  19. George SM, Ratnakar KS, Shome DK, Nair R, AI Ajmi A. Plasmacytoma of the rib in young male. Asian Cardiovasc Thorac Ann. 2002;10:282–4.

    Article  PubMed  Google Scholar 

  20. Sato Y, Hara M, Ogino H, Kaji M, Yamakawa Y, Wakita A, et al. CT-pathologic correlation in a case of solitary plasmacytoma of the rib. Radiat Med. 2001;19:303–5.

    CAS  PubMed  Google Scholar 

  21. Kadokura M, Tanio N, Nonaka M, Yamamoto S, Kataoka D, Kushima M, et al. A surgical case of solitary plasmacytoma of rib origin with biclonal gammopathy. Jpn J Clin Oncol. 2000;30:191–5.

    Article  CAS  PubMed  Google Scholar 

  22. Mankodi AK, Rao CV, Katrak SM. Solitary plasmacytoma presenting as peripheral neuropathy: a case report. Neurol India. 1999;47:234–7.

    CAS  PubMed  Google Scholar 

  23. Hirai T, Hamada Y, Kanou T, Kobayashi J, Endo K, Morishita Y. Solitary plasmacytoma of the rib-a case report and review of Japanese literatures. Nihon Kyobu Geka Gakkai Zasshi. 1995;43:205–9.

    CAS  PubMed  Google Scholar 

  24. Carvajal Balaguera JJ, Mallagray Casas S, Dancausa Monge A, Canto Romero JJ. Horner’s syndrome associated with a solitary bone plasmacytoma of the first rib. Arch Bronconeumol. 1994;30:410–3.

    Article  CAS  PubMed  Google Scholar 

  25. Ikeda T, Minakata Y, Inui H, Yukawa S, Nomoto H, Tsujimoto M. A case of plasmacytoma of the ribs with intrathoracic tumors. Nihon Kyobu Shikkan Gakkai Zasshi. 1992;30:133–7.

    CAS  PubMed  Google Scholar 

  26. Avilés A, Huerta-Guzmán J, Delgado S, Fernández A, Díaz-Maqueo JC. Improved outcome in solitary bone plasmacytomata with combined therapy. Hematol Oncol. 1996;14:111–7.

    Article  PubMed  Google Scholar 

  27. Mendenhall CM, Thar TL, Million RR. Solitary plasmacytoma of bone and soft tissue. Int J Radiat Oncol Biol Phys. 1980;6:1497–501.

    Article  CAS  PubMed  Google Scholar 

  28. Warsame R, Gertz MA, Lacy MQ, Kyle RA, Buadi F, Dingli D, et al. Trends and outcomes of modern staging of solitary plasmacytoma of bone. Am J Hematol. 2012;87:647–51.

    Article  PubMed  PubMed Central  Google Scholar 

Download references


We thank our colleagues in the Departments of Thoracic Surgery and Pathology of our hospital for helpful discussions.

Author information

Authors and Affiliations


Corresponding author

Correspondence to Zhefeng Zhang.

Additional information

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

ZFZ, study concept and design; RJ and LX, drafting and finalization of the manuscript, preparation of the figures, acquisition of data, and analysis and interpretation of data; KG, HGL and JL, critical revision of the manuscript for important intellectual content and material support; and all authors read and approved the final manuscript.

Authors’ information

Rui Jia, Master’s degree, attending surgeon; Lei Xue, Associate Chief Physician; Huagang Liang, PhD, Superintendent of the Institution, chief surgeon; Kun Gao, Master’s degree, associate chief surgeon; Jian LI, Master’s degree, resident surgeon; Zhefeng Zhang, PhD, attending surgeon,

Rui Jia and Lei Xue contributed equally to this work.

Rights and permissions

Open Access This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (, which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Jia, R., Xue, L., Liang, H. et al. Surgery combined with radiotherapy for the treatment of solitary plasmacytoma of the rib: a case report and review of the literature. J Cardiothorac Surg 10, 125 (2015).

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: