初診時単純X線で異常なく, 急速進行した頚椎多発性骨髄腫の1例

抄録

  Metastases of malignant cervical spine tumors often cause posterior cervical pain. We report a case of rapidly progressive multiple myeloma of the third cervical vertebra in a patient who presented with cervical pain but without any abnormal findings on plain radiography in the early stages of diagnosis.

  A 72-year-old man with a 1-month history of posterior cervical pain visited our outpatient clinic. We did not identify any abnormal findings on plain radiography except for a degenerative change in the C5-C6 disk space. The patient was treated using conservative measures. Six weeks later, the patient returned with gradual development of the cervical and mandibular pains during swallowing. Plain radiography revealed destruction of the C3 vertebral body. Computed tomography revealed osteolytic changes and a C3 compression fracture. The magnetic resonance imaging scan demonstrated a tumor extending from the C3 vertebral body to the retropharyngeal space. Fludeoxyglucose positron-emission tomography revealed abnormal accumulation only in C3. Moreover, Bence-Jones protein expression was detected in the patient’s urine. We performed laminectomy of C3, biopsy of the tumor, and posterior fixation.

  The tumor was diagnosed as a myeloma. Stereotactic radiotherapy (Cyberknife 25 Gy/5 fractions) and chemotherapy (lenalidomide, bortezomib, and dexamethasone) were administered and resulted in the regression of the C3 tumor.

  In cases of cervical pain without any abnormal findings on plain radiography, magnetic resonance imaging or computed tomography should not be performed on the basis of suspicion of a malignant spinal tumor. However, in cases of malignancy, rapid destruction of bone may occur. Therefore, in patients with chronic cervical pain and worsening of this pain while resting or at night, complete examination should be repeatedly performed.