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BACKGROUND: Plasma cell neoplasmas are a heterogenous group of neoplastic tumor lesions occurring secondary to disordered proliferation of cells from a monocyte lineage. Plasmacytoma is a rare lesion that accounts for 5% of all plasma cell neoplasms. The current recommended treatment for solitary plasmacytoma is moderate dose radiation therapy. For patients who are suffering from axial back pain, spinal instability, radiculopathy, or bowel/bladder dysfunction secondary to spinal cord compression, surgical intervention with spinal decompression and stabilization can be used as an adjuvant to radiation therapy. CASE DESCRIPTION: We report a patient who presented with worsening axial and bilateral upper extremity pain. He was found to have a locally aggressive tumor involving the vertebral body of T2. After a repeat magnetic resonance imaging (MRI) and a computed tomography (CT)-guided biopsy, the diagnosis of a solitary plasmacytoma was confirmed. It destroyed over 90% of the T2 vertebral body, resulted in 22° of local kyphosis, and caused spinal cord compression. The tumor was treated with a T2 vertebrectomy, posterior arthrodesis from C5-T4, and anterior arthrodesis from T1-3. CONCLUSIONS: Solitary plasmacytomas of the vertebral bodies are difficult lesions to treat secondary to their location and risk of neurologic compromise. Surgical intervention with tumor resection and adjuvant chemotherapy or radiation is the recommended treatment option.

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BACKGROUND: Clinically significant spontaneous bilateral iliopsoas hematoma is a rare complication of anticoagulation therapy. Definitive treatment of spontaneous iliopsoas hematomas is not well-established and varies between observation and surgical intervention. The intramuscular hematoma causes severe pain, muscle dysfunction, and occasionally nerve palsy with the femoral nerve most commonly affected. Most patients are neurologically normal but when a significant neurological deficit is associated with iliopsoas hematoma, optimal treatment recommendations vary. We report a case of spontaneous bilateral iliopsoas hematomas causing significant bilateral femoral nerve dysfunction. CASE DESCRIPTION: The authors present the case of a 63-year-old female who developed bilateral femoral nerve palsy due to anticoagulation bleeding complication. Magnetic resonance imaging demonstrated large bilateral intramuscular psoas hematomas causing femoral nerve compression. Surgical evacuation and decompression of the femoral nerves was performed with rapid neurological improvement. CONCLUSION: Management recommendations depend on the volume and cause of the hematoma, timing of diagnosis, and the degree of neurological impairment. A conservative approach with bed rest and correction of bleeding abnormalities to allow the hematoma to spontaneously resorb has been utilized for patients with small hematomas and little to no neurological symptoms. In contrast, more aggressive recommendations have been made for patients with large hematomas, severe motor function deficits, or hemodynamic instability.

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STUDY DESIGN: Case report. OBJECTIVE: To examine the management of abdominal lymphoceles after anterior spine surgery and to review the existing literature on lymphoceles after access to the spine. SUMMARY OF BACKGROUND DATA: Abdominal lymphoceles are a rare complication of anterior spinal approaches. METHODS: Case report and review of the literature. RESULTS: In this article, we describe the management of 2 lymphoceles. In the first case, immediate operative drainage was required because of worsening abdominal pain and distention. In the second patient, conservative management was attempted, but the lymphocele ultimately persisted and required surgical intervention. CONCLUSION: Lymphoceles are often difficult to distinguish from ureteral injury, cerebrospinal fluid-leaks and hematomas using conventional imaging techniques. Although surgery remains the gold standard for the treatment of lymphoceles, expectant observation may be reasonable in some situations.

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INTRODUCTION: Schwannomas are most often found in association with the eighth cranial nerve, but may also arise from any other cranial nerve. They are rarely found in an intra-parenchymal location. Unusual locations for intracranial schwannomas have also been reported in association with neurofibromatosis. CLINICAL PRESENTATION: A 23-year-old male without von Recklinghausen's disease presented with intermittent dizziness and difficulty swallowing. Past medical history was significant for a motor vehicle accident (MVA) without loss of consciousness 6 months prior. Magnetic resonance imaging revealed a large tentorial-based tumor. At surgery the origin of the tumor was clearly the tentorium, and while the trigeminal nerve was displaced, it easily separated from the mass. There was no attachment to any other cranial nerve in the immediate vicinity and postoperative cranial nerve examination was unremarkable. Pathological review was consistent with schwannoma. CONCLUSION: While there are few reported cases of tentorial-based schwannoma, these tumors have been noted in unusual locations within the intracranial vault, and clinicians should be aware of this diversity of origin.

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