Cervical Epidural Plasmacytoma Presenting As Ascending Paraparesis

Background Context: Spinal epidural plasmacytomas are very rare and are usually localized in the cervicothoracic and lumbar spines.

Purpose: To present the first case of cervical dural plasmacytoma and discuss the treatment options for this entity.

Study Design: Case report and review of the literature.

Methods: A 45-year-old man presented with gradually progressive legs to arms numbness preceded by upper respiratory tract infection and followed by rapid flaccid quadriparesis over 1 week. Because of the above symptoms, he was initially thought to have Guillain-Barré syndrome, but this diagnosis was ruled out by an emergency normal nerve conduction studies and needle electromyography. Cervical magnetic resonance imaging revealed an enhancing epidural mass at the C4-C7 level on T1-weighted images and increased signal on T2, causing spinal cord compression. Complete surgical evacuation was performed. Subsequent histology revealed plasmacytoma associated with anaplastic multiple myeloma, and the patient was referred to the hematology department for further treatment.

Results: Follow-up at 9 and 13 months after surgery revealed complete remission of the primary disease (multiple myeloma). The patient was neurologically improved and ambulatory with unilateral support.

Conclusion: The reported case describes the first epidural extramedullary plasmacytoma isolated in the cervical spine in the English literature. Emergent neuroimaging and surgery can dramatically affect prognosis of this rare spinal neoplasm.