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Mousavizadeh Ahmadabadi SM, Banar S, Parvas E, Shahbazi N, Biranvand H. Uncommon manifestation of multiple myeloma: A case report of intracardiac plasmacytoma presenting with severe heart failure and bilateral pleural effusion. Int J Surg Case Rep 2024; 114:109187. [PMID: 38160518 PMCID: PMC10800586 DOI: 10.1016/j.ijscr.2023.109187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Extramedullary intracardiac plasmacytoma is a rare type of plasma cell neoplasm that involves the heart. This article presents a case report of a patient with this condition and describes the surgical management of the disease. CASE PRESENTATION The patient was a 65-year-old male with a history of multiple myeloma in remission for two years who presented with shortness of breath and chest pain. Imaging studies revealed a mass in the right atrium of the heart, which was confirmed to be extramedullary intracardiac plasmacytoma on biopsy. The patient underwent surgical resection of the mass. CLINICAL DISCUSSION Extramedullary intracardiac plasmacytoma is a rare condition that can occur in patients with multiple myeloma. Early diagnosis and prompt treatment are crucial for improving the prognosis of affected individuals. Surgical resection may be a viable treatment option for some patients. CONCLUSION This case report highlights the potential risks and complications associated with surgical intervention in patients with extramedullary intracardiac plasmacytoma. Further research is needed to determine the best treatment approach for this rare condition and to improve patient outcomes.
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Affiliation(s)
- Seyed Mohammadali Mousavizadeh Ahmadabadi
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Shahid Rajaei Research & Training Hospital, Next to Mellat Park, Vali-Asr Ave, Tehran Postal code: 1995614331, Iran
| | - Sepideh Banar
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Shahid Rajaei Research & Training Hospital, Next to Mellat Park, Vali-Asr Ave, Tehran Postal code: 1995614331, Iran
| | - Ehsan Parvas
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran
| | - Narges Shahbazi
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran
| | - Hamidreza Biranvand
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran.
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Innocenti S, Bacchi B, Allinovi M, Perfetto F, Antonioli E, Marchionni N, Di Mario C, Caroti L, Cappelli F, Stefàno P. A multidisciplinary case report of multiple myeloma with renal and cardiac involvement: a look beyond amyloidosis. BMC Nephrol 2022; 23:370. [DOI: 10.1186/s12882-022-02984-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 10/23/2022] [Indexed: 11/18/2022] Open
Abstract
Abstract
Background
Multiple myeloma (MM) is a malignant neoplasm associated with kidney involvement in nearly half of the patients. Cast nephropathy, monoclonal immunoglobulin deposition disease (MIDD), and light chain (AL) amyloidosis are the most common monoclonal immunoglobulin-mediated causes of renal injury.
Cardiac involvement is also present in MM, characterized by restrictive cardiomyopathy generated by light chain deposit or amyloid. Thromboembolic complications such as deep vein thrombosis or pulmonary embolism are also described.
Case presentation
We present an unusual multidisciplinary case of a woman with a newly diagnosed MM associated with severe proteinuria and high natriuretic peptide. A renal and fat pad biopsy with Congo red staining were performed but amyloid deposition was not discovered. While immunofluorescence on fresh frozen unfixed tissue was not contributory, the immunofluorescence on fixed tissue and electron microscopy revealed the correct diagnosis.
During subsequent investigations, two intracardiac right-sided masses and massive pulmonary embolism were also detected.
Conclusions
This case highlights that multiple organ involvement in patients with MM may result from a combination of paraprotein-dependent and -independent factors. Moreover, renal diseases induced by monoclonal gammopathies are a group of complex and heterogeneous disorders. Their subtle presentation and their potential multiorgan involvement require the expertise of a multidisciplinary team able to provide the most appropriate diagnostic and therapeutic assessment.
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3
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Extramedullary intracardiac multiple myeloma misdiagnosed as a thrombus: a case report. BMC Surg 2021; 21:375. [PMID: 34689771 PMCID: PMC8543969 DOI: 10.1186/s12893-021-01377-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Accepted: 10/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Extramedullary intracardiac multiple myeloma (MM) is extremely rare. Patients with extramedullary intracardiac MM may suffer from a poor prognosis. Experience in the diagnosis and therapy of cardiac involvement in MM is limited. Herein, we describe a 67-year-old male with extramedullary intracardiac MM who was initially misdiagnosed with a thrombus. Case presentation A 67-year-old male was admitted for exertional dyspnea and fatigue. The patient was diagnosed with MM one year earlier and had complete remission after chemotherapy. He was implanted with a permanent pacemaker two months prior due to sick sinus syndrome. After this admission, transthoracic echocardiography (TTE) and computed tomography (CT) confirmed the existence of a large right atrial mass extending to the superior and inferior vena cava. We initially considered the right atrial mass as a thrombus and performed surgical treatment for the patient. The surgical intervention partially relieved the obstruction of the superior and inferior vena cava and improved hemodynamics. Postoperative pathological examination of the right atrial mass suggested malignant plasmacytoma associated with MM. After recovery from the surgery, the patient received one cycle of chemotherapy. A follow-up of seven months revealed that our patient was still alive with a good general condition. Conclusions Increasing the awareness of extramedullary intracardiac lesions in patients with MM is warranted. Our case confirmed that surgical intervention followed by adjuvant chemotherapy could improve the patient’s hemodynamics and achieve remission of cardiac symptoms.
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Wang S, Zhao R, Tan K, Liu C, Zhang L, Xu M, Xiong F. Multiple myeloma with cardiac involvement accompanied by partial superior vena cava obstruction: A case report and literature review. Echocardiography 2021; 38:1652-1656. [PMID: 34346524 DOI: 10.1111/echo.15169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/04/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
Multiple myeloma is a malignant proliferative disorder of plasma cells. Extramedullary involvement of the endocardium is rare in multiple myeloma. Here, we reported a 57-year-old male, once was diagnosed with multiple myeloma. The echocardiography reveled multiple solid masses in the right atrium, along with partial obstruction of superior vena cava. The mass resection alleviated the edema of upper limbs and identified the mass as extramedullary plasmablastic transformation and endocardial involvement. We also conducted a literature review and summary analysis of space-occupying lesions in the heart in 12 patients with multiple myeloma (including the current case) in the last 10 years. Echocardiography is the preferred radiologic examination method for diagnosis and follow-up in multiple myeloma with cardiac involvement, and surgical resection is effective for alleviating symptoms.
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Affiliation(s)
- Shuzhen Wang
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Ruohan Zhao
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Kunyue Tan
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Chunxia Liu
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Lijuan Zhang
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Min Xu
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Feng Xiong
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
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Kashyap JR, Tahlan A, Kumar S, Reddy S, Kundu R. Rapidly Progressive Atrial Mass and Cardiac Tamponade: A Rare Presentation of Multiple Myeloma. JACC Case Rep 2020; 2:279-281. [PMID: 34317222 PMCID: PMC8298296 DOI: 10.1016/j.jaccas.2019.11.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Revised: 10/31/2019] [Accepted: 11/03/2019] [Indexed: 06/13/2023]
Abstract
Cardiac involvement in multiple myeloma is rare. We report a rapidly progressive atrial mass and plasma cell-infiltrated pericardial effusion with tamponade. Bone marrow biopsy and plasma immunoelectrophoresis confirmed multiple myeloma (Revised International Staging System Stage III). The patient died within 18 weeks of presentation, suggesting aggressive disease with poor prognosis. (Level of Difficulty: Beginner.).
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Affiliation(s)
- Jeet Ram Kashyap
- Department of Cardiology, Government Medical College & Hospital, Chandigarh, India
| | - Anita Tahlan
- Department of Pathology, Government Medical College & Hospital, Chandigarh, India
| | - Suraj Kumar
- Department of Cardiology, Government Medical College & Hospital, Chandigarh, India
| | - Sreenivas Reddy
- Department of Cardiology, Government Medical College & Hospital, Chandigarh, India
| | - Reetu Kundu
- Department of Pathology, Government Medical College & Hospital, Chandigarh, India
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Abstract
RATIONALE Extramedullary plasmacytoma (EMP) is a very rare malignant neoplasm arising from clonal proliferation of atypical plasma cells. Most EMPs involve mucosal lymphoid tissue, particularly in the nasopharyngeal area, respiratory tract, and head and neck region. Such neoplasms of the kidney in patients with a human immunodeficiency virus (HIV) infection are extremely rare. PATIENT CONCERNS A 55-year-old male who had been diagnosed with HIV 1 year previously presented with a 2-week history of intermittent right abdominal pain and gross hematuria. DIAGNOSES Ultrasonography and computed tomography detected a mass that occupied the upper half of the right kidney. A clinical diagnosis of a renal tumor was suspected. INTERVENTIONS The patient subsequently underwent a retroperitoneal radical nephrectomy. The postoperative pathological diagnosis was solitary EMP of the kidney. Adjuvant radiation therapy was provided at doses of 50 Gy in 20 fractions. OUTCOMES Currently, the patient is alive and disease free at 7 months postoperatively. To the best of our knowledge, this is the first case of a primary renal EMP in a patient with HIV. LESSONS The present case illustrates that this rare type of solitary EMP associated with acquired immune deficiency syndrome can occur in the kidney. Additionally, although rare, solitary EMP should be considered in the differential diagnosis of a renal mass in HIV-infected patients.
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Affiliation(s)
| | - Chundan Wang
- Pathology, The First Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang, Hangzhou, PR China
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7
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Oliveira C, Rego I, Ramos R, Magalhães R, Sousa P, Cunha M. Internal jugular vein tumor thrombus due to parapharyngeal extraosseous plasmacytoma. Radiol Case Rep 2019; 14:894-896. [PMID: 31193268 PMCID: PMC6522840 DOI: 10.1016/j.radcr.2019.04.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Revised: 04/09/2019] [Accepted: 04/20/2019] [Indexed: 11/29/2022] Open
Abstract
Tumor thrombosis of the internal jugular vein (IJV) represents an uncommon event, usually in the setting of underlying thyroid neoplasms. Extraosseous plasmacytoma (EMP) with tumor thrombosis of the IJV has not yet been reported in the literature. We present a unique case of a plasmacytoma in the left parapharyngeal space with direct extension to the left IJV, documented with contrast enhanced computed tomography and US Doppler. Presence of avid thrombus enhancement allowed differentiation between tumoral extension and thrombothic changes.
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Abstract
Extramedullary multiple myeloma (EM) has negative prognostic implications on the overall survival as well as progression-free survival. Testis is a rare site of EM, which can be a part of diffuse involvement in multiple myeloma or a site of recurrence in patients with remission. We present a case of EM of testes and left spermatic cord in an 80-year-old man who presented with painless progressive enlargement of the scrotum. F-FDG PET/CT revealed tracer avidity of both testes and left spermatic cord. Bilateral radical orchidectomy was subsequently performed, and the diagnosis of multiple myeloma was confirmed on histopathology.
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9
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Sudden and unexpected death due to intracranial sellar extramedullary plasmacytoma. J Forensic Leg Med 2018; 61:89-91. [PMID: 30503990 DOI: 10.1016/j.jflm.2018.11.012] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2018] [Revised: 10/03/2018] [Accepted: 11/22/2018] [Indexed: 11/21/2022]
Abstract
The incidence of sudden death caused by undiagnosed primary intracranial neoplasm in young adults is extremely low. The aim of the work is to present a case report of the sudden death of a 24-year-old woman. The autopsy has revealed enlargement of sella turcica with an intrasellar tumorous mass extending into the adjacent basal parts of the brain. A tumour was diagnosed as an extramedullary plasmacytoma. The cause of death was established as a failure of the central nervous system. Toxicological analyses of biological materials were negative. According to the case history, a woman reportedly had no serious health problems. Finding of an extensive intracranial tumour in the sella turcica was random and surprising. The presented case is an extremely rare case of sudden death caused by intracranial intrasellar extramedullary plasmacytoma without previous clinical manifestation.
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10
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Shimokihara K, Kawahara T, Chiba S, Takamoto D, Yao M, Uemura H. Extramedullary plasmacytoma of the testis: A case report. Urol Case Rep 2017; 16:101-103. [PMID: 29204364 PMCID: PMC5711662 DOI: 10.1016/j.eucr.2017.11.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2017] [Revised: 10/31/2017] [Accepted: 11/17/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Kota Shimokihara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Takashi Kawahara
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Sawako Chiba
- Division of Diagnostic Pathology, Yokohama City University Medical Center, Yokohama, Japan
| | - Daiji Takamoto
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
| | - Masahiro Yao
- Department of Urology, Yokohama City University Graduate School of Medicine, Yokohama, Japan
| | - Hiroji Uemura
- Departments of Urology and Renal Transplantation, Yokohama City University Medical Center, Yokohama, Japan
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11
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Townend PJ, Kraus G, Coyle L, Nevell D, Engelsman A, Sidhu SB. Bilateral extramedullary adrenal plasmacytoma: case report and review of the literature. INTERNATIONAL JOURNAL OF ENDOCRINE ONCOLOGY 2017; 4:67-73. [PMID: 28758008 PMCID: PMC5480130 DOI: 10.2217/ije-2016-0023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Accepted: 02/23/2017] [Indexed: 01/16/2023] Open
Abstract
Extramedullary plasmacytoma (EMP) accounts for only 3% of plasma cell malignancies; others include multiple myeloma, plasma cell leukemia and solitary plasmacytoma of bone. The majority of EMPs are found in the upper respiratory tract. Other sites include the GI tract, bladder, CNS, thyroid, breast, testes, parotid gland, lymph nodes and skin. There are eight cases in the literature of adrenal plasmacytoma, however, only two were bilateral. We describe our recent experience of bilateral adrenal plasmacytoma and review of the literature. While EMP may present as aggressive locally destructive lesions, excellent local control can be achieved in a majority of cases. Follow-up should be lifelong due to risk of progression to multiple myeloma.
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Affiliation(s)
- Philip J Townend
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Sydney, Australia
| | - Gabriel Kraus
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Sydney, Australia
| | - Luke Coyle
- Department of Hematology, Royal North Shore Hospital, Sydney, Australia
| | - David Nevell
- Department of Anatomic Pathology, Royal North Shore Hospital, Sydney, Australia
| | - Anton Engelsman
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Sydney, Australia
| | - Stan B Sidhu
- University of Sydney Endocrine Surgery Unit, Royal North Shore Hospital, Sydney, Australia
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12
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Al-Riyami YM, Bakathir A, Al-Farsi K, Al-Azri F. Relapse of Multiple Myeloma Presenting as Lower Lip Numbness. Sultan Qaboos Univ Med J 2016; 16:e500-e503. [PMID: 28003900 DOI: 10.18295/squmj.2016.16.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2016] [Revised: 06/29/2016] [Accepted: 07/19/2016] [Indexed: 11/16/2022] Open
Abstract
Multiple myeloma (MM) is an uncommon malignancy characterised by the proliferation of clonal plasma cells. There are few published reports describing the extramedullary presentation of MM manifesting primarily in the head and neck region. In addition, the occurrence of an isolated relapse of MM in these sites is exceedingly rare. We report a 56-year-old female who presented to the Sultan Qaboos University Hospital, Muscat, Oman, in 2010 with sudden-onset numbness of the lower lip. She had a history of MM in remission following chemotherapy and a bone marrow transplant. Clinical and radiographic examinations were indicative of a possible relapse of MM, which was subsequently confirmed by bone marrow aspiration and histopathological evaluation. This unique case highlights the unusual site of relapse of a haematolymphoid malignancy.
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Affiliation(s)
- Yusra M Al-Riyami
- Oral & Maxillofacial Surgery Residency Program, Oman Medical Specialty Board, Muscat, Oman
| | - Abdulaziz Bakathir
- Department of Oral Health, Sultan Qaboos University Hospital, Muscat, Oman
| | - Khalil Al-Farsi
- Department of Haematology, Sultan Qaboos University Hospital, Muscat, Oman
| | - Faisal Al-Azri
- Department of Radiology & Molecular Imaging, Sultan Qaboos University Hospital, Muscat, Oman
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13
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Coakley M, Yeneneh B, Rosenthal A, Fonseca R, Mookadam F. Extramedullary Cardiac Multiple Myeloma—A Case Report and Contemporary Review of the Literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:246-52. [DOI: 10.1016/j.clml.2016.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 12/12/2022]
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Khan M, Rajarubendra N, Azer S, Skene A, Harrison SJ, Campbell B, Lawrentschuk N. Plasmacytoma of the testis in a patient with relapsed and refractory multiple myeloma: Case report and review of the literature. Urol Ann 2015; 7:530-3. [PMID: 26692682 PMCID: PMC4660713 DOI: 10.4103/0974-7796.164844] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Testicular plasmacytoma, whether occurring as a primary lesion or as a reflection of underlying multiple myeloma (MM), is a rare disease. We report the case of a 38-year-old male with multiply relapsed MM, who was found to have a testicular plasmacytoma. He presented with a gradually enlarging scrotal mass. Following orchidectomy, pathologic examination of the specimen demonstrated a plasmacytoma. In the context of active MM, the specimen was also sent for cytogenetic analysis but this was unhelpful in guiding a chemotherapy regime, which still continues at time of reporting. Although a rare lesion, there remains no definitive treatment protocol for the management of testicular plasmacytoma representing an extramedullary manifestation of MM.
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Affiliation(s)
- Munad Khan
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | | | - Sarah Azer
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Alison Skene
- Department of Pathology, Austin Hospital, Melbourne, Australia
| | - Simon J Harrison
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia ; Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia
| | - Belinda Campbell
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia ; Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia ; Olivia Newton-John Cancer Research Department, Austin Hospital, Melbourne, Australia ; Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
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16
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Behzadnia N, Sheybani-Afshar F, Hossein-Ahmadi Z, Ansari-Asl Z, Sharif-Kashani B, Dorudinia A. Late relapse of multiple myeloma presenting as a right atrial mass. Asian Cardiovasc Thorac Ann 2013; 22:1106-8. [DOI: 10.1177/0218492313495402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intracardiac involvement is a rare presentation of relapsed multiple myeloma. We present a case of lobulated mass in the wall of the right atrium, with extension to the inferior vena cava and obliteration and encasement of the interatrial septum in a 57-year-old man, a known case of multiple myeloma, with progressive exertional dyspnea and anasarca.
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Affiliation(s)
- Neda Behzadnia
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faezeh Sheybani-Afshar
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zargam Hossein-Ahmadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Ansari-Asl
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atosa Dorudinia
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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17
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Zhang C, Zhang X, Chen XH. Sequential signs of palpitation, bloody multiple cavity membrane effusion, and myocardial infarction: a case report of multiple myeloma and a literature review. CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2013; 13:499-501. [PMID: 23747078 DOI: 10.1016/j.clml.2013.04.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2013] [Accepted: 04/17/2013] [Indexed: 06/02/2023]
Affiliation(s)
- Cheng Zhang
- Department of Hematology, Xinqiao Hospital, Third Military Medical University, Chongqing 400037, People's Republic of China.
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18
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Incidental discovery of a testicular plasmacytoma at initial presentation of multiple myeloma. Case Rep Hematol 2013; 2013:752921. [PMID: 23738163 PMCID: PMC3662151 DOI: 10.1155/2013/752921] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2013] [Accepted: 04/15/2013] [Indexed: 11/18/2022] Open
Abstract
Testicular plasmacytomas are a rare phenomenon reported in the literature and they can occur as a solitary plasmacytoma, as a recurrence of multiple myeloma, or concurrently in an active myeloma. We report the case of a 43-year-old man who presented with back pain and was diagnosed with multiple myeloma. A CT scan performed to determine the extent of disease revealed an incidental mass in the testicle. Immunohistochemical staining of the mass revealed monoclonal cytolpasmic IgA in the tumor cells and serum studies showed this same immunoglobulin. Following orchiectomy, radiotherapy to the vertebra, chemotherapy with bortezomib, dexamethasone, and doxorubicin, and an autologous bone marrow transplant, the patient is alive twelve months after diagnosis and is in complete remission.
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Chen HF, Wu TQ, Li ZY, Shen HS, Tang JQ, Fu WJ, Yuan ZG, Hou J. Extramedullary plasmacytoma in the presence of multiple myeloma: clinical correlates and prognostic relevance. Onco Targets Ther 2012; 5:329-34. [PMID: 23152688 PMCID: PMC3496411 DOI: 10.2147/ott.s35348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective We studied the clinical and laboratory features and outcomes of multiple myeloma (MM) with extramedullary plasmocytoma (EP) disease both at diagnosis and during the course of MM. Patients and methods Forty-two patients of 467 patients with MM were retrospectively analyzed from both the 100th Hospital of the People’s Liberation Army and Shanghai Changzheng Hospitals. The clinical characteristics, laboratory parameters, responses, risk factors, and outcomes were analyzed. Results The median age was 53 years with a male/female sex ratio of 34:8. Twenty-six patients had EP disease at the time of diagnosis, and 16 patients developed EP during the course of the disease. We found that the Durie–Salmon stage, serum lactate dehydrogenase level, beta-2-microglobulin, complete blood counts, albumin, and the type of immunoglobulin (Ig) were not associated with the development of EP disease. Patients who developed EP during the course of MM had a higher ratio of plasmocytes and premature plasmocytes in the bone marrow with lower C-reactive protein level and earlier stage of International Staging System for Lung Cancer at the diagnosis of MM compared with patients who presented with EP at diagnosis. Once the patients developed EP disease, they frequently showed resistance to chemotherapy. With a median follow-up of 30 months, 19 patients were alive. Log-rank univariate analysis showed that patients with EP who had normal C-reactive protein, higher hemoglobin, lower serum lactate dehydrogenase, and stage I of International Staging System for Lung Cancer had longer survival. However, cyclooxygenase multivariate analysis failed to show statistical significance for any factor. Conclusions EP disease is the MM end-phase and is not a rare manifestation of MM with a cumulative incidence of 9% of MM. The prognosis is very poor once the diagnosis of EP disease is concurrent with MM.
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Affiliation(s)
- Hai-Fei Chen
- Department of Hematology, 100th Hospital of People's Liberation Army, Medical Centre of Hematologic and Oncologic Diseases of Nanjing Military Command, Suzhou, China
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La Verde N, Moretti A, Bramati A, Bianchi F, Gherardi G, Piva S, Girelli S, Pedretti D, Farina G. Multiple myeloma with prostate involvement: a case report. J Clin Oncol 2012; 30:e306-8. [PMID: 22965957 DOI: 10.1200/jco.2012.42.7179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nicla La Verde
- Oncology Department, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121 Milan.
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Vigo F, Ciammella P, Valli R, Cagni E, Iotti C. Extraskeletal multiple myeloma presenting with an atrial mass: a case report and a review of the literature. J Med Case Rep 2012; 6:236. [PMID: 22883512 PMCID: PMC3459698 DOI: 10.1186/1752-1947-6-236] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2012] [Accepted: 06/08/2012] [Indexed: 11/26/2022] Open
Abstract
Introduction Extraskeletal presentation at diagnosis or during the course of multiple myeloma is a rare event. The prognosis is usually very poor. At the moment there is no agreed gold standard for the treatment of this presentation. Case presentation A 79-year-old Caucasian woman was treated at our hospital for right atrial myeloma localization. Our patient showed the following signs and symptoms of congestive heart failure: dyspnea, hypotension, cyanosis and facial edema. Surgery was not considered feasible due to the extent of the disease. Our patient underwent external-beam radiation therapy using an intensity modulated technique, thus obtaining a persistent complete remission. Our patient has been in continuous complete local remission for 25 months since the end of radiotherapy. Conclusion The role of radiotherapy is not defined in multiple myeloma with extraskeletal presentation. Our regimen seems to be effective in controlling the disease in this patient. This case report adds to the existing literature as it describes an unusual presentation of the disease and a new therapeutic approach to this rare presentation of multiple myeloma.
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Affiliation(s)
- Federica Vigo
- Department of Advanced Technologies, Radiation Oncology Unit, Arcispedale Santa Maria Nuova - IRCCS, Reggio Emilia, Italy.
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23
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Quinton RA. Extramedullary Cardiac Plasmacytoma. Acad Forensic Pathol 2011. [DOI: 10.23907/2011.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
An 86 year old female presented to the emergency department with a one week history of leg swelling and recent weight gain. An echocardiogram revealed an 8.7 x 5 cm mass of the right atrium that appeared to be adherent to the atrial wall and filled over 90% of the volume of the right atrial chamber. The patient expired approximately one month later, and an autopsy limited to the heart and pericardial sac was requested. The autopsy confirmed the presence of a 9 cm mass involving the right atrium and completely encasing the right coronary artery. Microscopically the tumor was composed of sheets of plasma cells. Immunohisto-chemical studies showed that the cells were kappa light chain restricted, strongly positive for LCA and CD79a, and negative for CD138 and CD20. Given the gross and microscopic findings, the lesion was diagnosed as an extramedullary plasmacytoma of the heart.
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Affiliation(s)
- Reade A. Quinton
- Medical Examiner at the Southwestern Institute of Forensic Sciences and University of Texas Southwestern Medical Center at Dallas
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Paulus A, Swaika A, Miller KC, Spangenthal EJ, Guo R, VonFricken K, Lee K, Chanan-Khan AA. Clinical Relapse in a Patient With Multiple Myeloma Presenting As an Atrial Plasmacytoma. J Clin Oncol 2011; 29:e47-9. [DOI: 10.1200/jco.2010.30.3370] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
| | | | | | | | | | | | - Kelvin Lee
- Roswell Park Cancer Institute, Buffalo, NY
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Oka K, Nagayama R, Kabata T, Saito H, Mori N. Aggressive and fatal extramedullary plasmacytoma: a report of two cases. APMIS 2010; 118:418-20. [PMID: 20477820 DOI: 10.1111/j.1600-0463.2010.02610.x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Guo YK, Yang ZG, Li Y, Deng YP, Ma ES, Min PQ, Zhang XC. Uncommon adrenal masses: CT and MRI features with histopathologic correlation. Eur J Radiol 2007; 62:359-70. [PMID: 17532488 DOI: 10.1016/j.ejrad.2006.12.011] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2006] [Revised: 12/27/2006] [Accepted: 12/30/2006] [Indexed: 02/05/2023]
Abstract
Adrenal glands are common sites of diseases. With dramatically increased use of computed tomography (CT) and magnetic resonance (MR) imaging, more and more uncommon adrenal masses have been detected incidentally at abdominal examinations performed for other purposes. In this article, uncommon adrenal masses are classified as cystic masses (endothelial cysts, epithelial cysts, parasitic cysts, and pseudocysts), solid masses (ganglioneuroma, ganglioneuroblastoma, extramedullary plasmacytoma (EMP), neurilemmoma, and lymphoma), fat-containing masses (myelolipoma, teratoma), and infectious masses (tuberculoma), and the imaging features of these uncommon masses are demonstrated. Although most of these lesions do not have specific imaging features, some fat-containing masses and cystic lesions present with characteristic appearances, such as myelolipoma, teratoma, and hydatid. Combination with histopathologic characteristic of these uncommon masses of adrenal gland, radiological features of these lesions on CT and MR imaging can be accurately understood with more confidences. Moreover, CT and MRI are highly accurate in localization of uncommon adrenal masses, and useful to guide surgical treatments.
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Affiliation(s)
- Ying-Kun Guo
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, China
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28
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Li Y, Guo YK, Yang ZG, Ma ES, Min PQ. Extramedullary plasmacytoma involving the bilateral adrenal glands on MR imaging. Korean J Radiol 2007; 8:246-8. [PMID: 17554194 PMCID: PMC2627410 DOI: 10.3348/kjr.2007.8.3.246] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
We report here on a 64-year-old woman with extramedullary plasmacytoma involving the bilateral adrenal glands. Primary adrenal extramedullary plasmacytoma is extremely rare and only three cases of extramedullary plasmacytoma in the unilateral adrenal gland have currently been reported on. This case is of interest in that the bilateral adrenals were involved. In this article, we present the MRI findings and we briefly review the relevant literature.
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Affiliation(s)
- Yuan Li
- Department of Radiology, West China Hospital, Sichuan University, Sichuan, China
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29
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Damaj G, Mohty M, Vey N, Dincan E, Bouabdallah R, Faucher C, Stoppa AM, Gastaut JA. Features of extramedullary and extraosseous multiple myeloma: a report of 19 patients from a single center. Eur J Haematol 2005; 73:402-6. [PMID: 15522061 DOI: 10.1111/j.1600-0609.2004.00331.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Extramedullary (EM) localizations at diagnosis or during the course of multiple myeloma (MM) are rare. We conducted a large retrospective study to more accurately describe the clinical and laboratory features of this entity, and the outcome of these manifestations. The charts of 19 eligible patients out of 432 patients with MM were retrieved from the hematology department of the Institut Paoli-Calmettes Cancer Center. Median age was 61 (range: 39-79) with a female/male sex ratio of 8/11. Ten patients were found to have EM and extraosseous tumor at the time of MM diagnosis, and nine patients developed EM tumor during the course of the disease. Neither the stage of the disease, the LDH level, or the type of immunoglobulin (Ig) was found to be associated with the development of EM disease. Patients who developed EM tumor during the course of MM had a lower serum Ig and a higher monoclonal Bence-Jones proteinuria at the diagnosis of MM than patients who presented with EM tumor at diagnosis. Multiple sites were usually involved. Resistance to chemotherapy was frequent and response to thalidomide was poor. Eight out of the 19 patients responded to high-dose chemotherapy. The remaining 11 patients progressed while on therapy. With a median follow-up of 13 months (range: 2-65), six patients are alive, four patients are in partial remission and two patients in present progressive disease. In conclusion, EM tumors are a rare manifestation of MM, with a cumulative incidence of 4.6% of MM. Multiple sites are usually involved. The response to chemotherapy is very poor with a very low response rate to thalidomide. The prognosis is very poor, especially when the diagnosis of EM tumor is concurrent with the diagnosis of MM.
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Affiliation(s)
- G Damaj
- Department of Hematology, Institut Paoli Calmettes and Université de la Méditerranée, Marseille, France.
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Nappi O, Boscaino A, Wick MR. Extramedullary hematopoietic proliferations, extraosseous plasmacytomas, and ectopic splenic implants (splenosis). Semin Diagn Pathol 2004; 20:338-56. [PMID: 14694984 DOI: 10.1053/j.semdp.2003.08.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Hematopoietic proliferations are well known to present ectopically outside the bone marrow, either in benign or malignant form. As such, they present a distinct problem with respect to morphologic interpretation because of their uncommonality in extramedullary sites and their capacity to simulate other lesions histologically. This review considers extramedullary myeloid tumors ("granulocytic sarcoma," "erythroblastic sarcoma," "megakaryocytic sarcoma"), tumefactive extramedullary hematopoiesis, and the peculiar condition known as "splenosis," with consideration of their clinical, microscopic, and cytohistochemical chararacteristics.
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Affiliation(s)
- Oscar Nappi
- Division of Anatomic Pathology, Histopathology, & Diagnostic Cytopathology, Department of Laboratory Medicine & Pathology, A. Cardarelli Hospital, Naples, Italy
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Das-Gupta EP, Sidra GM, Bessell EM, Lush RJ, Byrne JL, Russell NH. High-dose melphalan followed by radical radiotherapy for the treatment of massive plasmacytoma of the chest wall. Bone Marrow Transplant 2003; 32:759-61. [PMID: 14520418 DOI: 10.1038/sj.bmt.1704221] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
We report three cases of massive chest wall plasmacytoma, each greater than 10 cm in diameter, without evidence of overt myeloma, whom we treated with a combination of VAD chemotherapy consolidated by high-dose melphalan and autologous peripheral blood stem cell transplantation and radical radiotherapy. All three patients completed all components of their therapy without experiencing any major side effects and one patient has had a durable remission. The other two patients have had disease progression but at sites other than the original tumour.
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Affiliation(s)
- E P Das-Gupta
- Department of Haematology, Nottingham City Hospital, Nottingham, UK.
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