Proximal femur giant solitary plasmacytoma of bone: lessons learnt.

To cite: Matar HE, Mottram C, Gudena R. BMJ Case Rep Published online: [please include Day Month Year] doi:10.1136/bcr-2014204976 DESCRIPTION Solitary skeletal Plasmacytoma is a malignant plasma cell tumour that accounts for 3–5% of all monoclonal gammopathies. It presents as a single lytic lesion with clonal plasma cells in the vertebrae, ribs or pelvis, with low or no serum or urine M-protein. Bone marrow is not consistent with multiple myeloma, however, approximately 50% of cases progress to multiple myeloma over 4–5 years. Bone pain is the most common symptom; symptoms are usually of short duration because of the aggressive nature of the disease. Radiographically, solitary plasmacytoma appears as a sharply demarcated, purely lytic lesion without any surrounding reactive sclerosis. 2 Diagnosis is usually confirmed by serum immunoelectrophoresis, bone scans, MRI, skeletal survey, bone marrow and tissue biopsies. 2 The primary treatment is chemotherapy. Treatment of pathological fractures is often challenging including debulking the tumour and using internal fixation augmented with methacrylate cement. If this method does not allow immediate full weight bearing, segmental resection and joint reconstruction should be considered. We present a very interesting series of images, as the primary interest of this case, of a giant solitary proximal femur plasmacytoma in a 57-year-old man. He had a pacemaker, which contraindicated MRI scanning, but the patient was otherwise fit and well. He presented with a 3-month history of pain in his right groin with no other constitutional symptoms of malignancy. His plain radiographs (figure 1) revealed a giant lytic lesion of the