Solitary plasmacytoma of the axis vertebra presenting as severe neck pain.

function test was normal. albumin was 3.7 g% and globulin was 3 gm%. Serum calcium was 9.5 mg% and phosphate was 4 mg%. X-Ray of the cervical vertebrae showed small multiple lytic lesions in second cervical vertebra involving spinous process and pedicle (Fig. 1). In CT scan there was also soft tissue swelling around the second cervical vertebra (Fig. 2). A CT guided FNAC from the lytic lesions showed multiple plasma cells with binucleate plasma cells—suggestive of plasmacytoma (Fig. 3). Electrophoresis and immunofixation of the patient’s blood and urine were normal. Bone marrow aspirate and biopsy were done which showed less than 5% plasma cells. X-Ray of other skeletal areas was normal. A metastatic bone survey by isotope scan showed no other lesion with increased uptake except the solitary lesion at second cervical vertebra. Thus this was finally diagnosed as a case of solitary plasmacytoma of axis vertebra with no other systemic features. The patient refused surgery and was treated with radiotherapy with decrease in pain after three weeks. The term solitary plasmacytoma is applied to tumor growth with no other evidence of multiple myeloma1. It is a rare entity, occurring in 2-5% of cases of plasma cell dyscrasia1. medullary Plasmacytomas present mainly in vertebra in 50% of cases. Solitary plasmacytoma of cervical spine often presents late. A case similar to ours was reported by Voulgaris et al from Greece2. That case also presented with cervical pain as the only complaint. Although radiotherapy is effective in early stage, definite surgical interventions like instrumented spinal fusion or decompression is needed to prevent future risks. This is necessary because these patients have a good chance of survival and so limitation of disabilities is a major concern3. malignant tumors like plasmacytoma can present with apparently no other systemic features. This case shows that any spinal pain should not be neglected. This is especially true for pain in older patients that do not heal with regular therapy.