{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,29]],"date-time":"2026-01-29T22:30:27Z","timestamp":1769725827923,"version":"3.49.0"},"reference-count":46,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"25","license":[{"start":{"date-parts":[[2025,12,22]],"date-time":"2025-12-22T00:00:00Z","timestamp":1766361600000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J Neurosurg Case Lessons"],"published-print":{"date-parts":[[2025,12,22]]},"abstract":"<jats:sec>\n                    <jats:title>BACKGROUND<\/jats:title>\n                    <jats:p>Extramedullary plasmacytomas (EMPs) are rare plasma cell tumors forming outside the bone marrow. EMPs spread to soft tissues with a predilection for the head and neck region. Therefore, EMPs are rarely included in the differential for peripheral nerve sheath tumors (PNSTs). The authors discuss a case of tibial nerve sheath invasion by an EMP in the context of multiple myeloma (MM).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>OBSERVATIONS<\/jats:title>\n                    <jats:p>A 70-year-old female with MM presented with right leg pain and a suspected PNST of the tibial nerve. Imaging revealed a T1-hypointense lesion in the popliteal fossa. Resection was attempted, but frozen pathology revealed a plasma cell neoplasm with a high Ki-67 proliferation rate. The resection was halted due to the tumor\u2019s infiltrative and hemorrhagic nature and its extensive encasement of the tibial nerve. Postoperatively, the patient received 5 fractions of radiation therapy and three courses of teclistamab, which she continued as an outpatient without complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>LESSONS<\/jats:title>\n                    <jats:p>This case highlights a rare occurrence of peripheral nerve invasion by an EMP with the first documented involvement of the tibial nerve. This report suggests that EMPs should be considered in the differential diagnosis of PNSTs, particularly in MM patients. The present case underscores the need for intraoperative biopsies in PNST resection, as imaging features alone may not be fully diagnostic.<\/jats:p>\n                    <jats:p>\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/thejns.org\/doi\/10.3171\/CASE25104\">https:\/\/thejns.org\/doi\/10.3171\/CASE25104<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/case25104","type":"journal-article","created":{"date-parts":[[2026,1,22]],"date-time":"2026-01-22T11:59:57Z","timestamp":1769083197000},"source":"Crossref","is-referenced-by-count":0,"title":["Extramedullary plasmacytoma of the tibial nerve: illustrative case"],"prefix":"10.3171","volume":"10","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1460-5946","authenticated-orcid":true,"given":"Parsa","family":"Nilchian","sequence":"first","affiliation":[{"name":"Department of Neurological Surgery, NewYork-Presbyterian Hospital\/Weill Cornell Medicine, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0009-0005-1044-5454","authenticated-orcid":true,"given":"Max","family":"Reed","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, NewYork-Presbyterian Hospital\/Weill Cornell Medicine, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew B.","family":"Yang","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, NewYork-Presbyterian Hospital\/Weill Cornell Medicine, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gary","family":"Kocharian","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, NewYork-Presbyterian Hospital\/Weill Cornell Medicine, New York, New York"},{"name":"Department of Radiation Oncology, NewYork-Presbyterian Hospital\/Weill Cornell Medicine, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kai-Ming","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, NewYork-Presbyterian Hospital\/Weill Cornell Medicine, New York, New York"},{"name":"Department of Radiation Oncology, NewYork-Presbyterian Hospital\/Weill Cornell Medicine, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"2","key":"bib1","series-title":"Ann Oncol","first-page":"325","article-title":"Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients","volume":"21","author":"Varettoni","year":"2010","unstructured":"Varettoni MCorso APica GMangiacavalli SPascutto CLazzarino M.Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients. Ann Oncol. 2010;21(2):325-330."},{"issue":"1","key":"bib2","series-title":"Eur J Haematol","first-page":"65","article-title":"Clinicopathological features of extramedullary recurrence\/relapse of multiple myeloma","volume":"81","author":"Cerny","year":"2008","unstructured":"Cerny JFadare OHutchinson LWang SA.Clinicopathological features of extramedullary recurrence\/relapse of multiple myeloma. Eur J Haematol. 2008;81(1):65-69."},{"issue":"2","key":"bib3","series-title":"Leuk Lymphoma","first-page":"230","article-title":"The impact of extramedullary disease at presentation on the outcome of myeloma","volume":"50","author":"Wu","year":"2009","unstructured":"Wu PDavies FEBoyd KThe impact of extramedullary disease at presentation on the outcome of myeloma. Leuk Lymphoma. 2009;50(2):230-235."},{"issue":"3","key":"bib4","series-title":"Br J Haematol","first-page":"496","article-title":"Expert review on soft-tissue plasmacytomas in multiple myeloma: definition, disease assessment and treatment considerations","volume":"194","author":"Rosi\u00f1ol","year":"2021","unstructured":"Rosi\u00f1ol LBeksac MZamagni EExpert review on soft-tissue plasmacytomas in multiple myeloma: definition, disease assessment and treatment considerations. Br J Haematol. 2021;194(3):496-507."},{"issue":"9","key":"bib5","series-title":"Blood Cancer J","first-page":"135","article-title":"Paraskeletal and extramedullary plasmacytomas in multiple myeloma at diagnosis and at first relapse: 50-years of experience from an academic institution","volume":"12","author":"Jim\u00e9nez-Segura","year":"2022","unstructured":"Jim\u00e9nez-Segura RRosi\u00f1ol LCibeira MTParaskeletal and extramedullary plasmacytomas in multiple myeloma at diagnosis and at first relapse: 50-years of experience from an academic institution. Blood Cancer J. 2022;12(9):135."},{"issue":"6","key":"bib6","series-title":"Muscle Nerve","first-page":"E27","article-title":"Isolated nerve plasmacytoma in a patient previously in systemic myeloma remission","volume":"55","author":"Menon","year":"2017","unstructured":"Menon PVarikkat WVucic S.Isolated nerve plasmacytoma in a patient previously in systemic myeloma remission. Muscle Nerve. 2017;55(6):E27-E28."},{"issue":"3","key":"bib7","series-title":"Neurol Sci","first-page":"487","article-title":"Extramedullary plasmacytoma of median and sural nerve","volume":"35","author":"Gennaro","year":"2014","unstructured":"Gennaro SFiaschi PPacetti MQuarto EMerciadri P.Extramedullary plasmacytoma of median and sural nerve. Neurol Sci. 2014;35(3):487-488."},{"issue":"6","key":"bib8","series-title":"Cureus","first-page":"e62447","article-title":"A rare tumor causing optic and oculomotor nerve compression: clivus plasmacytoma case report","volume":"16","author":"Sevindik","year":"2024","unstructured":"Sevindik BUysal EUgras S.A rare tumor causing optic and oculomotor nerve compression: clivus plasmacytoma case report. Cureus. 2024;16(6):e62447."},{"issue":"1","key":"bib9","series-title":"Cureus","first-page":"e12888","article-title":"Cauda equina syndrome as the initial presentation of concurrent plasmacytoma and multiple myeloma","volume":"13","author":"Pisklakova","year":"2021","unstructured":"Pisklakova AAlmanzar CSambataro JPAnsari OManji F.Cauda equina syndrome as the initial presentation of concurrent plasmacytoma and multiple myeloma. Cureus. 2021;13(1):e12888."},{"issue":"4","key":"bib10","series-title":"J Formos Med Assoc","first-page":"277","article-title":"Multiple myeloma associated with extramedullary plasmacytoma causing nerve root compression: a case report","volume":"100","author":"Hu","year":"2001","unstructured":"Hu KCLin JChuang YCCheng SJChang KM.Multiple myeloma associated with extramedullary plasmacytoma causing nerve root compression: a case report. J Formos Med Assoc. 2001;100(4):277-280."},{"issue":"24","key":"bib11","series-title":"Cancer Med","first-page":"4743","article-title":"Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts\u2014a follow-up","volume":"11","author":"Holler","year":"2022","unstructured":"Holler ACicha IEckstein MExtramedullary plasmacytoma: tumor occurrence and therapeutic concepts\u2014a follow-up. Cancer Med. 2022;11(24):4743-4755."},{"issue":"14","key":"bib12","series-title":"J Clin Oncol","first-page":"1228","article-title":"Treatment of multiple myeloma: ASCO and CCO joint clinical practice guideline","volume":"37","author":"Mikhael","year":"2019","unstructured":"Mikhael JIsmaila NCheung MCTreatment of multiple myeloma: ASCO and CCO joint clinical practice guideline. J Clin Oncol. 2019;37(14):1228-1263."},{"issue":"6","key":"bib13","series-title":"Br J Haematol","first-page":"802","article-title":"D(T)PACE as salvage therapy for aggressive or refractory multiple myeloma","volume":"161","author":"Gerrie","year":"2013","unstructured":"Gerrie ASMikhael JRCheng LD(T)PACE as salvage therapy for aggressive or refractory multiple myeloma. Br J Haematol. 2013;161(6):802-810."},{"issue":"4","key":"bib14","series-title":"Neurosurgery","first-page":"833","article-title":"The surgical management of symptomatic peripheral nerve sheath tumors","volume":"66","author":"Levi","year":"2010","unstructured":"Levi ADRoss ALCuartas EQadir RTemple HT.The surgical management of symptomatic peripheral nerve sheath tumors. 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J Hand Surg Am. 2001;26(4):776-780."},{"issue":"10","key":"bib17","series-title":"Arch Pathol Lab Med","first-page":"1074","article-title":"Plasmablastic lymphoma: a review of clinicopathologic features and differential diagnosis","volume":"140","author":"Harmon","year":"2016","unstructured":"Harmon CMSmith LB.Plasmablastic lymphoma: a review of clinicopathologic features and differential diagnosis. Arch Pathol Lab Med. 2016;140(10):1074-1078."},{"issue":"2","key":"bib18","series-title":"Adv Anat Pathol","first-page":"61","article-title":"Lymphoid neoplasms with plasmablastic differentiation: a comprehensive review and diagnostic approaches","volume":"27","author":"Chen","year":"2020","unstructured":"Chen BJChuang SS.Lymphoid neoplasms with plasmablastic differentiation: a comprehensive review and diagnostic approaches. Adv Anat Pathol. 2020;27(2):61-74."},{"issue":"6","key":"bib19","series-title":"Neurology","first-page":"e209777","article-title":"Neurologic clinical, electrophysiologic, and pathologic characteristics of primary vs secondary neurolymphomatosis","volume":"103","author":"Skolka","year":"2024","unstructured":"Skolka MPSuanprasert NMartinez-Thompson JMNeurologic clinical, electrophysiologic, and pathologic characteristics of primary vs secondary neurolymphomatosis. Neurology. 2024;103(6):e209777."},{"issue":"5","key":"bib20","series-title":"Clin Med (Lond)","first-page":"e191","article-title":"Clinical presentation and outcomes of solitary plasmacytoma in a tertiary hospital in the UK","volume":"20","author":"Agbuduwe","year":"2020","unstructured":"Agbuduwe CYang HGaglani JAjithkumar T.Clinical presentation and outcomes of solitary plasmacytoma in a tertiary hospital in the UK. Clin Med (Lond). 2020;20(5):e191-e195."},{"issue":"1","key":"bib21","series-title":"Pathology","first-page":"6","article-title":"Lymphoplasmacytic lymphoma and Waldenstr\u00f6m macroglobulinaemia: clinicopathological features and differential diagnosis","volume":"52","author":"Wang","year":"2020","unstructured":"Wang WLin P.Lymphoplasmacytic lymphoma and Waldenstr\u00f6m macroglobulinaemia: clinicopathological features and differential diagnosis. Pathology. 2020;52(1):6-14."},{"key":"bib22","series-title":"World Neurosurg","first-page":"e490","article-title":"Understanding the pathognomonic tumefactive appearance of neurolymphomatosis: a unifying theory of neurolymphoma","volume":"141","author":"Murthy","year":"2020","unstructured":"Murthy NKH\u00e9bert-Blouin MNCapek SPrasad NKAmrami KKSpinner RJ.Understanding the pathognomonic tumefactive appearance of neurolymphomatosis: a unifying theory of neurolymphoma. World Neurosurg. 2020;141:e490-e497."},{"issue":"4","key":"bib23","series-title":"Br J Haematol","first-page":"661","article-title":"Progression of a solitary plasmacytoma to multiple myeloma. A population-based registry of the northern Netherlands","volume":"175","author":"de Waal","year":"2016","unstructured":"de Waal EGLeene MVeeger NProgression of a solitary plasmacytoma to multiple myeloma. A population-based registry of the northern Netherlands. Br J Haematol. 2016;175(4):661-667."},{"issue":"2","key":"bib1","series-title":"Ann Oncol","first-page":"325","article-title":"Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients","volume":"21","author":"Varettoni","year":"2010","unstructured":"Varettoni MCorso APica GMangiacavalli SPascutto CLazzarino M.Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients. Ann Oncol. 2010;21(2):325-330."},{"issue":"1","key":"bib2","series-title":"Eur J Haematol","first-page":"65","article-title":"Clinicopathological features of extramedullary recurrence\/relapse of multiple myeloma","volume":"81","author":"Cerny","year":"2008","unstructured":"Cerny JFadare OHutchinson LWang SA.Clinicopathological features of extramedullary recurrence\/relapse of multiple myeloma. Eur J Haematol. 2008;81(1):65-69."},{"issue":"2","key":"bib3","series-title":"Leuk Lymphoma","first-page":"230","article-title":"The impact of extramedullary disease at presentation on the outcome of myeloma","volume":"50","author":"Wu","year":"2009","unstructured":"Wu PDavies FEBoyd KThe impact of extramedullary disease at presentation on the outcome of myeloma. Leuk Lymphoma. 2009;50(2):230-235."},{"issue":"3","key":"bib4","series-title":"Br J Haematol","first-page":"496","article-title":"Expert review on soft-tissue plasmacytomas in multiple myeloma: definition, disease assessment and treatment considerations","volume":"194","author":"Rosi\u00f1ol","year":"2021","unstructured":"Rosi\u00f1ol LBeksac MZamagni EExpert review on soft-tissue plasmacytomas in multiple myeloma: definition, disease assessment and treatment considerations. Br J Haematol. 2021;194(3):496-507."},{"issue":"9","key":"bib5","series-title":"Blood Cancer J","first-page":"135","article-title":"Paraskeletal and extramedullary plasmacytomas in multiple myeloma at diagnosis and at first relapse: 50-years of experience from an academic institution","volume":"12","author":"Jim\u00e9nez-Segura","year":"2022","unstructured":"Jim\u00e9nez-Segura RRosi\u00f1ol LCibeira MTParaskeletal and extramedullary plasmacytomas in multiple myeloma at diagnosis and at first relapse: 50-years of experience from an academic institution. Blood Cancer J. 2022;12(9):135."},{"issue":"6","key":"bib6","series-title":"Muscle Nerve","first-page":"E27","article-title":"Isolated nerve plasmacytoma in a patient previously in systemic myeloma remission","volume":"55","author":"Menon","year":"2017","unstructured":"Menon PVarikkat WVucic S.Isolated nerve plasmacytoma in a patient previously in systemic myeloma remission. Muscle Nerve. 2017;55(6):E27-E28."},{"issue":"3","key":"bib7","series-title":"Neurol Sci","first-page":"487","article-title":"Extramedullary plasmacytoma of median and sural nerve","volume":"35","author":"Gennaro","year":"2014","unstructured":"Gennaro SFiaschi PPacetti MQuarto EMerciadri P.Extramedullary plasmacytoma of median and sural nerve. Neurol Sci. 2014;35(3):487-488."},{"issue":"6","key":"bib8","series-title":"Cureus","first-page":"e62447","article-title":"A rare tumor causing optic and oculomotor nerve compression: clivus plasmacytoma case report","volume":"16","author":"Sevindik","year":"2024","unstructured":"Sevindik BUysal EUgras S.A rare tumor causing optic and oculomotor nerve compression: clivus plasmacytoma case report. Cureus. 2024;16(6):e62447."},{"issue":"1","key":"bib9","series-title":"Cureus","first-page":"e12888","article-title":"Cauda equina syndrome as the initial presentation of concurrent plasmacytoma and multiple myeloma","volume":"13","author":"Pisklakova","year":"2021","unstructured":"Pisklakova AAlmanzar CSambataro JPAnsari OManji F.Cauda equina syndrome as the initial presentation of concurrent plasmacytoma and multiple myeloma. Cureus. 2021;13(1):e12888."},{"issue":"4","key":"bib10","series-title":"J Formos Med Assoc","first-page":"277","article-title":"Multiple myeloma associated with extramedullary plasmacytoma causing nerve root compression: a case report","volume":"100","author":"Hu","year":"2001","unstructured":"Hu KCLin JChuang YCCheng SJChang KM.Multiple myeloma associated with extramedullary plasmacytoma causing nerve root compression: a case report. J Formos Med Assoc. 2001;100(4):277-280."},{"issue":"24","key":"bib11","series-title":"Cancer Med","first-page":"4743","article-title":"Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts\u2014a follow-up","volume":"11","author":"Holler","year":"2022","unstructured":"Holler ACicha IEckstein MExtramedullary plasmacytoma: tumor occurrence and therapeutic concepts\u2014a follow-up. Cancer Med. 2022;11(24):4743-4755."},{"issue":"14","key":"bib12","series-title":"J Clin Oncol","first-page":"1228","article-title":"Treatment of multiple myeloma: ASCO and CCO joint clinical practice guideline","volume":"37","author":"Mikhael","year":"2019","unstructured":"Mikhael JIsmaila NCheung MCTreatment of multiple myeloma: ASCO and CCO joint clinical practice guideline. J Clin Oncol. 2019;37(14):1228-1263."},{"issue":"6","key":"bib13","series-title":"Br J Haematol","first-page":"802","article-title":"D(T)PACE as salvage therapy for aggressive or refractory multiple myeloma","volume":"161","author":"Gerrie","year":"2013","unstructured":"Gerrie ASMikhael JRCheng LD(T)PACE as salvage therapy for aggressive or refractory multiple myeloma. Br J Haematol. 2013;161(6):802-810."},{"issue":"4","key":"bib14","series-title":"Neurosurgery","first-page":"833","article-title":"The surgical management of symptomatic peripheral nerve sheath tumors","volume":"66","author":"Levi","year":"2010","unstructured":"Levi ADRoss ALCuartas EQadir RTemple HT.The surgical management of symptomatic peripheral nerve sheath tumors. Neurosurgery. 2010;66(4):833-840."},{"issue":"7","key":"bib15","series-title":"Cancers (Basel)","first-page":"1930","article-title":"Diagnosis and treatment of peripheral and cranial nerve tumors with expert recommendations: an European network for RAre CANcers (EURACAN) initiative","volume":"15","author":"Pellerino","year":"2023","unstructured":"Pellerino AVerdijk RMNichelli LAndratschke NHIdbaih AGoldbrunner R.Diagnosis and treatment of peripheral and cranial nerve tumors with expert recommendations: an European network for RAre CANcers (EURACAN) initiative. Cancers (Basel). 2023;15(7):1930."},{"issue":"4","key":"bib16","series-title":"J Hand Surg Am","first-page":"776","article-title":"Plasmacytoma of the superficial radial nerve","volume":"26","author":"Stuart","year":"2001","unstructured":"Stuart JESmith AC.Plasmacytoma of the superficial radial nerve. J Hand Surg Am. 2001;26(4):776-780."},{"issue":"10","key":"bib17","series-title":"Arch Pathol Lab Med","first-page":"1074","article-title":"Plasmablastic lymphoma: a review of clinicopathologic features and differential diagnosis","volume":"140","author":"Harmon","year":"2016","unstructured":"Harmon CMSmith LB.Plasmablastic lymphoma: a review of clinicopathologic features and differential diagnosis. Arch Pathol Lab Med. 2016;140(10):1074-1078."},{"issue":"2","key":"bib18","series-title":"Adv Anat Pathol","first-page":"61","article-title":"Lymphoid neoplasms with plasmablastic differentiation: a comprehensive review and diagnostic approaches","volume":"27","author":"Chen","year":"2020","unstructured":"Chen BJChuang SS.Lymphoid neoplasms with plasmablastic differentiation: a comprehensive review and diagnostic approaches. Adv Anat Pathol. 2020;27(2):61-74."},{"issue":"6","key":"bib19","series-title":"Neurology","first-page":"e209777","article-title":"Neurologic clinical, electrophysiologic, and pathologic characteristics of primary vs secondary neurolymphomatosis","volume":"103","author":"Skolka","year":"2024","unstructured":"Skolka MPSuanprasert NMartinez-Thompson JMNeurologic clinical, electrophysiologic, and pathologic characteristics of primary vs secondary neurolymphomatosis. Neurology. 2024;103(6):e209777."},{"issue":"5","key":"bib20","series-title":"Clin Med (Lond)","first-page":"e191","article-title":"Clinical presentation and outcomes of solitary plasmacytoma in a tertiary hospital in the UK","volume":"20","author":"Agbuduwe","year":"2020","unstructured":"Agbuduwe CYang HGaglani JAjithkumar T.Clinical presentation and outcomes of solitary plasmacytoma in a tertiary hospital in the UK. Clin Med (Lond). 2020;20(5):e191-e195."},{"issue":"1","key":"bib21","series-title":"Pathology","first-page":"6","article-title":"Lymphoplasmacytic lymphoma and Waldenstr\u00f6m macroglobulinaemia: clinicopathological features and differential diagnosis","volume":"52","author":"Wang","year":"2020","unstructured":"Wang WLin P.Lymphoplasmacytic lymphoma and Waldenstr\u00f6m macroglobulinaemia: clinicopathological features and differential diagnosis. Pathology. 2020;52(1):6-14."},{"key":"bib22","series-title":"World Neurosurg","first-page":"e490","article-title":"Understanding the pathognomonic tumefactive appearance of neurolymphomatosis: a unifying theory of neurolymphoma","volume":"141","author":"Murthy","year":"2020","unstructured":"Murthy NKH\u00e9bert-Blouin MNCapek SPrasad NKAmrami KKSpinner RJ.Understanding the pathognomonic tumefactive appearance of neurolymphomatosis: a unifying theory of neurolymphoma. World Neurosurg. 2020;141:e490-e497."},{"issue":"4","key":"bib23","series-title":"Br J Haematol","first-page":"661","article-title":"Progression of a solitary plasmacytoma to multiple myeloma. A population-based registry of the northern Netherlands","volume":"175","author":"de Waal","year":"2016","unstructured":"de Waal EGLeene MVeeger NProgression of a solitary plasmacytoma to multiple myeloma. A population-based registry of the northern Netherlands. 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