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Is A Plasmacytoma Painful And Where Is Pubic Rams Inferior Located ?

Posted on Wed, 11 Apr 2012

Question: Hello Dr, I had a MRI of My pelvic area and lumbar spine after having some pain in my left hip. The MRI results showed a labrum tear in my left hip and it also showed a 1.7 cm lesion in My right inferior pubic ramus, Radiologist stated this could represent a hemangioma enchodroma but metestic disease could not be ruled out on exam alone recommend bone scan if clinically indicated. The lesion was deemed "non specific". I went for a bone scan which was normal "no lesion detected" I also had an xray 4 weeks before MRI which was negative AP of pelvis normal. I was sent for a complete blood work and spep both where completely normal no elevation hemoglubin is 16.7 hemocrit 48.9 ...My albium was on the high side 5.1 dr said that is nothing and actually rules against any myeloma. I have seen 3 Dr 2 say no further test it's a benign lesion one says get a ct scan with XXXXXXX just to make sure. I do get a llitte discomfort in the groin area maybe a 1 or 2 on a scale of 10 I do excercise and lift wieghts. I was told that a plasmacytoma is very painful and there would be some indicstion in my blood,,,also My x XXXXXXX was negative can u give me your opinion and would a plasmacytom be painful, also is the pubic ramus inferior a load bearing bone where is this ??? behind my penis...ty

Answered by Dr. Robert Galamaga (2 hours later)

Hello and thanks for the query.

Your question is a good one and I'll try to provide you with some information and recommendations regarding what is going on.

Regarding the findings on the imaging study which you had performed I agree that this is somewhat non-specific and actually not very worrisome in context of the other laboratory test which you have had performed.

I agree that there is no real concern for multiple myeloma in your case. Your oncologists and physicians have performed the appropriate laboratory workup.

I don't believe the CT scan is absolutely indicated but it may help provide you with some peace of mind related to what is going on. The risk of performing the scan is quite long and actually if I were you I would want to have this performed again to lend more peace of mind to what is going on. The area of the interior pubic ramus is a loadbearing bone and it is located in the center of the pelvis right behind the base of the bladder.

My feeling is that ultimately this will turn out to be a benign finding and it can be reevaluated on a yearly basis to document stability. I am not worried on your behalf and really think this is a completely benign process. Again I thank you for submitting your question. If you have any additional questions regarding this particular concern I would be happy to address them.

Sincerely,

Dr. Galamaga

Above answer was peer-reviewed by : Dr. Raju A.T

Follow up: Dr. Robert Galamaga (4 hours later)

would the SPEP blood test also make a plasmacytoma less likely... I read some stuff which says not all plasmacytoma show up in the blood and would a plasmacytoma in the bone be a painful lesion ...ty

Answered by Dr. Robert Galamaga (9 hours later)

Thanks for the followup.

The SPEP would likely be abnormal in a case of plasmacytoma which makes this less likely. A plasmacytoma would be painful as it does invade into bone and tissue and this can be excruciatingly painful actually.

Interval followup imaging is a fine idea for you. If the area in question changes or progresses, possibly a biopsy could be done but I think now it is premature to consider that.

Thanks again for the query. I hope this exchange has been helpful for you and as always I remain available for followups.

Regards,

Dr. Galamaga

Note: For further queries, consult a joint and bone specialist, an Orthopaedic surgeon. Book a Call now.

Above answer was peer-reviewed by : Dr. Raju A.T