title: An intramedullary capillary hemangioma of the spine with an underlying plasmocytoma.
abstract: BACKGROUND
  In contrast to vertebral hemangiomas, which are very common within the general population, only 3% to 5% of patients with plasma cell dyscrasia show a single osteolytic bone lesion due to plasma cell infiltration without the evidence of generalized myeloma. The vast majority of these hemangiomas are completely asymptomatic and only discovered incidentally. In rare occasions, representing only 1% to 2% of the known lesions, a locally aggressive subtype can cause problems analogous to the ones triggered by a plasmocytoma, ranging from back pain to vertebral compression fractures to neurologic deficit, resulting from nerve root or spinal cord compression. Both entities are extensively discussed in the literature, but finding both lesions in one is rare if not described for the first time.
  
  
  OBJECTIVE
  To advise colleagues that the differential diagnosis between benign and malignant vertebral tumors can be harder than expected and has to be definitely made to avoid severe consequences for the patient.
  
  
  METHODS
  A 46-year-old healthy man presented to the emergency department with an acute onset of thoracic back pain after a trivial incident. Although his medical history included no known diseases and no history of back pain, plain X-rays raised the clear suspicion of a fracture of T6 that was verified in computed tomography scans.
  
  
  METHODS
  Visual analog scale; neurologic status; tumor recurrence.
  
  
  METHODS
  The case of the patient was evaluated retrospectively according to standard procedures, clinical outcome, and in review of the literature.
  
  
  RESULTS
  Because there is still controversy about the best treatment (local radiation vs. operation vs. combination) of a solitary skeletal plasmocytoma, no gold standard has been established until now. Especially if a patient needs an emergency operation before all test results are obtained, each surgeon has to decide individually.
  
  
  CONCLUSIONS
  Capillary hemangiomas can hide underlying plasmocytomas, which might demand totally different treatment strategies. Although our patient did not match the common criteria for a solitary plasmocytoma, one has to discuss whether a stand-alone decompression and biopsy would have been the emergency treatment of choice. Such a strategy would have reduced the risk of tumor spreading and would have made radiotherapy easier, whereas on the other hand requiring a secondary stabilization procedure later on.
authors.affiliation: Department of Orthopaedic Surgery, University Hospital Munich, Ludwig-Maximilians University, Campus Grosshadern, Marchioninistr.15, 81377 Munich, Germany. carolin.melcher@med.uni-muenchen.de
authors.forename: Carolin
authors.initials: C
authors.lastname: Melcher
authors.forename: Bernd
authors.initials: B
authors.lastname: Wegener
authors.forename: Manuel
authors.initials: M
authors.lastname: Niederhagen
authors.forename: Volkmar
authors.initials: V
authors.lastname: Jansson
authors.forename: Christof
authors.initials: C
authors.lastname: Birkenmaier
mesh_terms: D001416:Back Pain / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D018324:Hemangioma, Capillary / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009378:Neoplasms, Multiple Primary / Q000000981:diagnostic imaging* / Q000601:surgery; D010147:Pain Measurement; D010954:Plasmacytoma / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D011859:Radiography; D013125:Spinal Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
keywords: Back pain; Hemangioma; Plasmocytoma; Treatment strategies; Vertebral