The patient came to the clinic 08-March-2008 complaining right sciatica for two months with numbness right S1 territory. The pain increases during night.

MRI cervical spine done 26-February-2008 showing huge sacral mass in the right side with destruction of bone at the level of S2-3-4 right side.

On examination: the patient is dragging his right leg and has scoliotic stance. There is weak dorsi and planterflexion right foot. SLRS was 70 degrees in the right with pain.

Bone scan was confirming the absence of MTS.

Midline incision over the sacrum and the using drilling the right S2 and S3 were identified. The mass was pushing them medially and it was grayish violet in color and friable in consistency and highly vascular. It was possible to remove it radically and the periosteum of the sacrum was not involved. The bone cavity was filled with healthy bone harvested from the surround and muscles were used to fulfill the cavity. An external drain was inserted with ready-vac drain and negative pressure.

Routine closure of the wound and smooth postoperative recovery with normalization of the power of the right foot.

The final histologic studies confirmed the presence of pasmacytoma of extramedullary type and Bence-Jones proteins were negative in daily urine collection with ESR 60 mm/h.

The patient was advised to undergo hematologic workup and to undergo radiotherapy locally with 40-45 Kg over 6 weeks.

Plasmocytomas are frequent in localization in the sacrum.