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Wang J, Yang X, Liu X, He T, Liu B, Yang L, Yuan F, Li J. Solitary extramedullary plasmacytoma in the lung misdiagnosed as lung cancer: A case report and literature review. Front Oncol 2022; 12:950383. [PMID: 36110956 PMCID: PMC9468772 DOI: 10.3389/fonc.2022.950383] [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: 05/22/2022] [Accepted: 08/08/2022] [Indexed: 11/29/2022] Open
Abstract
Background Extramedullary plasmacytoma (EMP) is an extremely rare kind of soft tissue plasma cell neoplasm without bone marrow involvement or other systemic characteristics of multiple myeloma. Primary pulmonary plasmacytoma (PPP), with no specific clinical manifestations, is an exceedingly rare type of EMP. Because of its complexity, PPP is often difficult to diagnose. Computed tomography-guided percutaneous core needle biopsy (CT-guided PCNB) has been shown to have high sensitivity, specificity and accuracy for characterization of pulmonary lesion, particularly if malignancy is suspected. Here we presented a rare case of PPP diagnosed with CT-guided PCNB. Case presentation A 78-year-old female smoker who visited our outpatient clinic for a mass in the left lower lobe of the lung. Pathological based on CT-guided PCNB yielded a PPP with no lymph node or other distant metastasis. Conclusions Extramedullary plasmacytoma should be considered in the differential diagnosis of a pulmonary mass.
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Affiliation(s)
- Jingjing Wang
- Department of Critical Care Medicine, Tianjin First Central Hospital, Tianjin, China
| | - Xiaoyun Yang
- Department of Radiology, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
| | - Xiaomei Liu
- Department of Radiology, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
| | - Tao He
- Department of Pathology, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
| | - Bin Liu
- Department of Pulmonary and Critical Care Medicine, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
| | - Lei Yang
- Department of Radiology, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
| | - Fei Yuan
- Department of Radiology, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
- *Correspondence: Jing Li, ; Fei Yuan,
| | - Jing Li
- Department of Radiology, Characteristic Medical Center of Chinese People’s Armed Police Force, Tianjin, China
- *Correspondence: Jing Li, ; Fei Yuan,
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2
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Saidi I, EL Idrissi Tourane LO, Ait Batahar S, Amro L. A case of Multiple Myeloma with lung plasmacytoma. Respir Med Case Rep 2022; 39:101713. [PMID: 35958347 PMCID: PMC9358463 DOI: 10.1016/j.rmcr.2022.101713] [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: 03/05/2022] [Revised: 07/11/2022] [Accepted: 07/20/2022] [Indexed: 11/30/2022] Open
Abstract
Multiple Myeloma (MM) is a malignant proliferation of the plasma cells mainly affecting bone marrow. Most common sites of extramedullary dissemination reported in the literature are skin, liver, kidneys and central nervous system. Multiple Myeloma is rarely associated with lung plasmacytoma. In fact; dissemination of MM in lung is relatively uncommon being described in only 5% of cases and therefore the diagnosis of this entity can be misleading to most clinicians. We report a rare case of lung plasmacytoma with MM in a 65-year-old, smoker, male who presented with shortness of breath and a heterogeneous mass involving the lower left lobe visualized on CT scan. Careful integration of the clinical manifestations with the radiological and pathological data from CT-guided transparietal lung biopsy and bone marrow biopsy led to the diagnosis of Multiple Myeloma with lung plasmacytoma. Given the rarity of this localization, the purpose of this study was to increase knowledge of this disease among pulmonologists, in order to provide more timely diagnosis.
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Affiliation(s)
- Imane Saidi
- Corresponding author. Department of Respiratory Medicine, Arrazi Hospital, Mohammed VI University Hospital Center, LRMS Laboratory, Faculty of Medicine and Pharmacy, Cadi Ayyad University, 40010, Marrakech, Morocco.
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3
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Panduranga S, Kade S, Shivakumar S, V H, Mehta RM. A novel differential diagnosis for diffuse cavitating nodules: primary pulmonary plasmacytoma. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2021. [DOI: 10.1186/s43168-021-00101-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Extramedullary plasmacytoma is a rare monoclonal plasma cell neoplasm that originates from tissues other than the bone marrow and constitutes only 3%–5% of all plasma cell neoplasms. Most cases involve the upper respiratory tract. Extramedullary plasmacytoma involving the lung is extremely rare. Primary pulmonary plasmacytoma is a rare type of extramedullary plasmacytoma, usually presenting with a nodule or mass in hilar region. Literature search has shown very few cases of immunohistochemically confirmed cases of pulmonary plasmacytoma. Diffuse pulmonary infiltration is an unusual presentation.
Case presentation
We report the case of a 56 year old lady with history of cough and breathlessness since one month. Computed Tomography revealed diffusely scattered multiple cavitating nodules and consolidation in both lungs. Computed Tomography guided biopsy of one of the lung nodules was done. Histopathologic examination and immunohistochemistry showed features of pulmonary plasmacytoma .This is an unique case of primary pulmonary plasmacytoma with the rare presentation as diffusely scattered multiple cavitating nodules and consolidation. According to our literature search, primary pulmonary plasmacytoma manifesting as cavitating nodules is being reported for the first time.
Conclusions
Primary pulmonary plasmacytoma should be also be considered in the differential diagnosis of multiple diffusely scattered cavitating lung nodules.
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4
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Zhou Y, Wang XH, Meng SS, Wang HC, Li YX, Xu R, Lin XH. Primary pulmonary plasmacytoma accompanied by overlap syndrome: A case report and review of the literature. World J Clin Cases 2020; 8:4999-5006. [PMID: 33195673 PMCID: PMC7642528 DOI: 10.12998/wjcc.v8.i20.4999] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 05/25/2020] [Accepted: 08/27/2020] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Extramedullary plasmacytoma (EMP) is a rare kind of soft tissue plasma cell neoplasm without bone marrow involvement; this type of plasma cell neoplasm involves a lack of other systemic characteristics of multiple myeloma. Primary pulmonary plasmacytoma (PPP), with no specific clinical manifestations, is an exceedingly rare type of EMP. Because of its complexity, PPP is often difficult to diagnose, and there is no report in the literature on cases accompanied by overlap syndrome (OS).
CASE SUMMARY A 61-year-old woman without a familial lung cancer history was admitted to our hospital in 2018, for intermittent cough, expectoration, and a stuffy feeling in the chest for 50 years; these symptoms appeared intermittently, especially occurred after being cold, and had been aggravated for the last 10 d. She was diagnosed with pulmonary fibrosis and emphysema, bronchiectasis, OS, and autoimmune hepatic cirrhosis in 2017. A pulmonary examination revealed rough breath sounds in both lungs; other physical examinations found no obvious abnormalities. A routine laboratory work-up showed decreased haemoglobin, increased ESR, and abnormal GGT, ALT, IgG, γ-globulin, κ-light chain, λ-light chain, rheumatoid factor, and autoimmune antibodies. Emission computed tomography demonstrated abnormally concentrated 99mTc-MDP. Chest computed tomography revealed a soft tissue mass in the middle and lower lobes of the right lung. After right middle and inferior lobe resection with complete mediastinal lymph node dissection, immunohistochemical analysis revealed an isolated pulmonary plasmacytoma. The patient received chemotherapy for more than 1.5 years and remains in good general condition.
CONCLUSION PPP is a type of EMP, and we report an exceedingly rare presentation of PPP accompanied by OS.
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Affiliation(s)
- Yi Zhou
- Department of Radiology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Xiao-Hong Wang
- Department of Invasive Technology, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Shuang-Shuang Meng
- Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Hui-Chao Wang
- Department of Nephrology, First Affiliated Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Yu-Xia Li
- Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Rui Xu
- Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
| | - Xu-Hong Lin
- Department of Clinical Laboratory, Translational Medicine Center, Huaihe Hospital of Henan University, Kaifeng 475000, Henan Province, China
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5
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Rahim Y, Tareen FZ, Ahmed R, Khan JA. Primary pulmonary plasmacytoma presenting with rare IgG lambda monoclonal gammopathy. BMJ Case Rep 2019; 12:12/3/e227514. [PMID: 30846451 PMCID: PMC6424279 DOI: 10.1136/bcr-2018-227514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
Extramedullaryplasmacytoma (EMP) represents a peculiar and typically progressive malignancy that can originate outside the bone marrow. Primary pulmonary plasmacytoma (PPP) is a rare subset of EMP, confined to the lung. A 55-year-old man, diabetic, non-smoker presented to our clinic with a right chest wall swelling. A routine chest radiograph showed a well-circumscribed opacity in the right upper lung zone. A CT of the chest revealed a large right upper lobe mass with extensive local infiltration. Biopsy and immunohistochemical evaluation led to a diagnosis of PPP. Screening for multiple myeloma was negative. Serum immunofixation showed an IgG lambda monoclonal gammopathy, found in a minority of PPP patients. In view of disease extent, treatment with chemotherapy and radiotherapy was initiated. The patient is currently in out patient follow-up and has shown a favourable response to the treatment with a considerable decrease in serum IgG levels.
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Affiliation(s)
- Yasmin Rahim
- Department of Pulmonology and Critical Care, Aga Khan University, Karachi, Pakistan
| | - Farrukh Zia Tareen
- Department of Hematology and Oncology, Aga Khan University, Karachi, Pakistan
| | - Rashida Ahmed
- Department of Pathology and Microbiology, Aga Khan University, Karachi, Pakistan
| | - Javaid Ahmed Khan
- Department of Pulmonary Medicine, Aga Khan University Hospital, Karachi, Pakistan
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Extramedullary Plasmacytoma Arising From the Anterior Mediastinum. Ann Thorac Surg 2017; 103:e393-e395. [PMID: 28431708 DOI: 10.1016/j.athoracsur.2016.10.064] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 10/07/2016] [Accepted: 10/22/2016] [Indexed: 11/20/2022]
Abstract
Plasmacytomas are a localized proliferation of plasma cells in the bone marrow and soft tissue. Extramedullary plasmacytomas are rare and typically solitary plasma cell neoplasms originating from extraosseous organs and tissues. A 31-year-old woman was referred to our hospital with a rapidly growing abnormal shadow on a chest roentgenogram. Chest computed tomography showed that the lesion was located in the anterior mediastinum. She underwent surgery, and the tumor was diagnosed as an extramedullary plasmacytoma. She remains well 2 years postoperatively without recurrence. An extremely rare case of an anterior mediastinal extramedullary plasmacytoma is presented.
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7
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Abstract
Amyloidosis is a disorder of protein folding in which normally soluble plasma proteins aggregate in an abnormal fibrillar form causing progressive disruption to tissue structure and organ function. This review covers systemic AA and AL amyloidosis which may arise as a consequence of chronic respiratory conditions; the manifestations of both systemic and of localised amyloid deposition within the respiratory tract and provides a summary of current approaches to diagnosis and management.
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Affiliation(s)
- H J Lachmann
- National Amyloidosis Centre and Centre for Amyloidosis and Acute Phase Proteins, Department of Medicine, Royal Free and University College Medical School, Royal Free Campus, London, UK.
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8
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Agrawal SR, Chaudhary P, Rajput A, Jain AP. Pulmonary plasmacytoma with endobronchial extension: A rare presentation of solitary extramedullary plasmacytoma: A case report and brief review of literature. J Cancer Res Ther 2016; 11:1026. [PMID: 26881595 DOI: 10.4103/0973-1482.150350] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Extramedullary plasmacytoma is the malignant proliferation of single clone of plasma cells arising outside the bone marrow. Solitary extramedullary plasmacytoma (SEP) are solitary lesion mostly located in upper respiratory tract and nasopharynx. Involvement of lower respiratory tract is rarely seen in case of SEP. Here, we report a rare case of pulmonary plasmacytoma in a 50-year-old male presenting as left lower lobe lung mass with endobronchial extension. Subsequent investigations, histological and immunohistochemical examination of tumor confirmed the diagnosis of plasmacytoma. Work-up for the multiple myeloma came out to be negative, thus confirming the diagnosis of SEP. Pulmonary plasmacytoma, a rare presentation of extramedullary plasmacytoma should be kept in mind by dealing with the patients of lung mass and endobronchial extension.
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Affiliation(s)
- Sachin R Agrawal
- Department of Medicine, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Maharashtra, India
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9
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Rai S, Sridevi HB, Acharya V, Lobo F, Kini J. Pulmonary plasmacytoma in multiple myeloma: a rare case of extramedullary spread. THE EGYPTIAN JOURNAL OF BRONCHOLOGY 2015. [DOI: 10.4103/1687-8426.165938] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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10
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Abstract
Primary lung lymphoma (PLL) is a rare disease that comprises <0.5% of all primary lung tumors. It is defined as lymphoma confined to the lung with or without hilar lymph node involvement at the time of diagnosis or up to 3 months thereafter. Patients with PLL may be asymptomatic or manifest nonspecific clinical symptoms, for example, cough, chest pain, and dyspnea. Some individuals may be immunosupressed or have an autoimmune disorder. Radiologically, PLL can mimic pneumonia, lung carcinoma, or metastasis, and therefore, histologic confirmation is mandatory for definitive diagnosis. Primary lung marginal zone lymphoma of mucosa-associated lymphoid tissue type comprises 70% to 80% of cases. Less common B-cell lymphomas include diffuse large B-cell lymphoma, lymphomatoid granulomatosis (LyG), plasmacytoma, and other small lymphocytic lymphomas. PLLs of T-cell origin, largely represented by anaplastic large cell lymphoma, are extremely rare. LyG is an Epstein-Barr virus (EBV)-driven B-cell lymphoid neoplastic proliferation rich in T cells that produces vasculitis. The disease may present at different stages of progression. Differential diagnosis of PLL varies according to the lymphoma subtype: pulmonary mucosa-associated lymphoid tissue lymphoma should be distinguished from reactive inflammatory conditions, whereas high-grade lymphomas may resemble poorly differentiated lung carcinoma, metastatic disease, and other lymphomas. LyG can resemble inflammatory, infectious, and other lymphoid neoplastic processes. A panel of immunohistochemical markers, flow cytometry, and molecular methods are necessary to confirm the diagnosis in the majority of cases. In this article we review the clinical, radiologic, pathologic, and molecular characteristics of several B-cell and T-cell PLLs with exception of Hodgkin lymphoma and posttransplant lymphoproliferative disorder.
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11
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Lung postmortem autopsy revealing extramedullary involvement in multiple myeloma causing acute respiratory distress syndrome. Case Rep Hematol 2014; 2014:635237. [PMID: 25165587 PMCID: PMC4140120 DOI: 10.1155/2014/635237] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Revised: 07/17/2014] [Accepted: 07/21/2014] [Indexed: 11/20/2022] Open
Abstract
Pulmonary involvement with multiple myeloma is rare. We report the case of a 61-year-old man with past medical history of chronic respiratory failure with emphysema, and a known multiple myeloma (Durie and Salmon stage III B and t(4;14) translocation). Six months after diagnosis and first line of treatment, he presented acute dyspnea with interstitial lung disease. Computed tomography showed severe bullous emphysema and diffuse, patchy, multifocal infiltrations bilaterally with nodular character, small bilateral pleural effusions, mediastinal lymphadenopathy, and a known lytic lesion of the 12th vertebra. He was treated with piperacillin-tazobactam, amikacin, oseltamivir, and methylprednisolone. Finally, outcome was unfavourable. Postmortem analysis revealed diffuse and nodular infracentimetric infiltration of the lung parenchyma by neoplastic plasma cells. Physicians should be aware that acute respiratory distress syndrome not responding to treatment of common causes could be a manifestation of the disease, even with negative BAL or biopsy and could be promptly treated with salvage therapy.
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12
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Restrepo CS, Carrillo J, Rosado de Christenson M, Ojeda Leon P, Lucia Rivera A, Koss MN. Lymphoproliferative Lung Disorders: A Radiologic-Pathologic Overview. Part II: Neoplastic Disorders. Semin Ultrasound CT MR 2013; 34:535-49. [DOI: 10.1053/j.sult.2013.05.003] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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13
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Ujiie H, Okada D, Nakajima Y, Yoshino N, Akiyama H. A case of primary solitary pulmonary plasmacytoma. Ann Thorac Cardiovasc Surg 2013; 18:239-42. [PMID: 22790997 DOI: 10.5761/atcs.cr.11.01749] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Most solitary extramedullary plasmacytomas are plasma cell tumors that tend to develop in mucosa-associated lymphoid tissues including the upper respiratory tract. We present a 43-year-old patient who was diagnosed with a solitary plasmacytoma in the lung. Primary plasmacytoma of the lung is exceedingly rare, and the treatment is surgical excision. This malignancy advances to multiple myeloma in a minority of patients. Multiple myeloma is a plasma cell malignancy that typically presents in the bone marrow.
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Affiliation(s)
- Hideki Ujiie
- Department of Thoracic Surgery, Saitama Cancer Center, Ina, Saitama, Japan.
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14
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Primary endobronchial plasmacytoma involving local lymph nodes and presenting with rare immunoglobulin G lambda monoclonal gammopathy. Can Respir J 2012; 19:e28-30. [PMID: 22679619 DOI: 10.1155/2012/968254] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Extramedullary plasmacytoma occurring as a primary pulmonary lesion is rare. The present report describes a 42-year-old Chinese man diagnosed with primary pulmonary plasmacytoma following left lower lobectomy. Of note, an extremely rare immunoglobulin G lambda paraprotein was documented in the patient's serum by immunofixation electrophoresis. The patient has been well, showing no local recurrence or multifocal disease during a 15-month follow-up.
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Abstract
Malignant myeloma (MM) is a clonal proliferation of plasma cells with multiple osteolytic lesions. Extramedullary dissemination of multiple myeloma in lung is relatively uncommon. Hereby, we present a case of multiple myeloma with lung plasmacytoma of lung in a 45-years-old, non-smoker, female.
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Affiliation(s)
- Rajendra Prasad
- Department of Pulmonary Medicine, Chatrapati Sahuji Maharaj Medical University (Earlier KGMU), Kanpur, India
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16
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Mohammad Taheri Z, Mohammadi F, Karbasi M, Seyfollahi L, Kahkoei S, Ghadiany M, Fayazi N, Mansouri D. Primary pulmonary plasmacytoma with diffuse alveolar consolidation: a case report. PATHOLOGY RESEARCH INTERNATIONAL 2010; 2010:463465. [PMID: 21151727 PMCID: PMC2990464 DOI: 10.4061/2010/463465] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/15/2009] [Accepted: 04/13/2010] [Indexed: 02/06/2023]
Abstract
Solitary extramedullary plasmacytomas are plasma cell tumors that tend to develop in mucosa-associated lymphoid tissues including the sinonasal or nasopharyngeal regions. Primary plasmacytoma of the lung is exceedingly rare and often presents as a solitary mass or nodule in mid-lung or hilar areas and diagnosed after resection. Herein, we report a case of primary pulmonary plasmacytoma that presented with diffuse alveolar consolidation and diagnosed by transbronchial lung biopsy.
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Affiliation(s)
- Zohreh Mohammad Taheri
- Department of Pathology, National Research Institute of Tuberculosis and Lung Disease, Tehran 19569, Iran
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17
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A Practical Approach to the Evaluation of Lymphoid and Plasma Cell Infiltrates in the Lung. Surg Pathol Clin 2010; 3:129-54. [PMID: 26839030 DOI: 10.1016/j.path.2010.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Pulmonary biopsy specimens demonstrate varying degrees of infiltration by lymphoid cells and plasma cells, which may raise concern about involvement of a lymphoid or plasma cell neoplasm. Although paraffin section immunohistochemical stains and molecular genotyping studies are capable of assisting in the distinction between reactive and neoplastic infiltrates, it can be difficult to decide what studies to perform. This article describes a practical approach for the evaluation of lymphoid and plasma cell infiltrates in the lung through the identification of several key histologic features.
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18
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Presence of immunoglobulin heavy chain rearrangement in so-called "plasma cell granuloma of the lung". Pathol Res Pract 2010; 206:83-7. [PMID: 19954895 DOI: 10.1016/j.prp.2009.09.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 08/03/2009] [Accepted: 09/03/2009] [Indexed: 11/23/2022]
Abstract
Inflammatory pseudotumor of the lung appears to be a set of heterogeneous disorders. Histologically, three subtypes of pulmonary IPTs have been delineated. Among these, plasma cell granuloma (PCG) is characterized by prominent lymphoplasmacytic infiltration, and PCG has been added to the list of differential diagnostic problems of mucosa-associated lymphoid tissue (MALT) type lymphoma. To investigate the presence or absence of monoclonal B-cell proliferation, we analyzed the immunohistological and genotypic findings in three cases of pulmonary PCGs. Histologically, the three lesions were characterized by severe infiltration of mature plasma cells, plasmacytoid cells, and small lymphocytes intermixed. Scattered Russell bodies (intracytoplasmic inclusions) were present in all three cases, but there were no Dutcher bodies (intranuclear inclusions) or centrocyte-like cells. Immunohistochemical studies of light chain determinants demonstrated the polytypic nature of B-cells. There was no CD5(+), CD43(+) or cyclin D1(+) B-lymphocytes in any of the three lesions. There were no lymphoepithelial lesions detected within any of the three lesions even by immunostaining for cytokeratin. However, polymerase chain assay for immunoglobulin heavy chain gene demonstrated a clonal band in one of the three cases. It currently remains unclear whether this one case, demonstrating IgH gene rearrangement in our series, could be a sign of the prelymphomatous stage (e.g. incipient MALT type lymphoma) or merely represents an exaggeration of normal B-cell clonal response.
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19
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Sung PS, Song JH, Park CW. A Case of Multiple Pulmonary Plasmacytomas after Complete Remission of Multiple Myeloma. Tuberc Respir Dis (Seoul) 2010. [DOI: 10.4046/trd.2010.69.2.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Pil Soo Sung
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Joon Ho Song
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
| | - Chong Won Park
- Department of Internal Medicine, The Catholic University of Korea College of Medicine, Seoul, Korea
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20
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[Primary bronchial plasmacytoma: computed tomography findings]. RADIOLOGIA 2009; 51:504-7. [PMID: 19523660 DOI: 10.1016/j.rx.2009.04.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2008] [Revised: 04/01/2009] [Accepted: 04/03/2009] [Indexed: 11/21/2022]
Abstract
Extramedullary plasmacytomas are malignant neoplasms of the plasmatic cells of the soft tissues. Primary pulmonary plasmacytoma is the rarest type of extramedullary plasmacytoma. The radiologic findings are unspecific and the diagnosis is histologic. Chest CT is useful for confirming its location and planning surgery. We present a case of primary endobronchial plasmacytoma in an adult diagnosed at histology. We describe the findings at plain-film chest X-ray and at CT, and we analyze the usefulness of 3D reconstructions for planning surgery.
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21
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[Three cases of primary pulmonary plasmacytoma]. Arch Bronconeumol 2009; 45:564-6. [PMID: 19523733 DOI: 10.1016/j.arbres.2009.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2009] [Revised: 04/03/2009] [Accepted: 04/06/2009] [Indexed: 11/24/2022]
Abstract
Extramedullary plasmacytoma is a plasma cell malignancy that most commonly occurs in the upper respiratory tract. Plasmocytoma located in the lung is an unusual finding, and in such cases the disease may be confined to the lung and regional lymph nodes or may be disseminated. When only located in the lower respiratory tract (primary pulmonary plasmacytoma), diagnosis is difficult and is usually based on the excised tissue. We present 3 cases, 2 of which were particularly unusual in that diagnosis was confirmed by bronchial biopsy. Other important findings included the detection of paraprotein in the blood and urine of 2 of the patients, and follow-ups over 10 and 15 years without recurrence of the disease in 2 of the cases.
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22
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Huwer H, Jacobs G, Kalweit G, Püschel W. Solitary pulmonary plasmacytoma: report of two cases. Med Oncol 2009; 27:59-61. [PMID: 19212709 DOI: 10.1007/s12032-009-9171-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2008] [Accepted: 01/21/2009] [Indexed: 10/21/2022]
Abstract
We report two cases of solitary plasmacytoma of the lung. Computed tomographic scan disclosed in case A a solid tissue formation in a cystic pulmonary lesion and in case B a solitary nodule. Suggesting aspergilloma in A and pulmonary malignancy in B diagnostic thoracotomies were performed and the respective findings were resected. In both cases a diagnosis of plasmacytoma was made. Postoperatively multiple myeloma was ruled out. Solitary pulmonary plasmacytoma is a very rare condition and to the best of our knowledge plasmacytoma within a cystic lung lesion has not been described so far. After curative resection treatment the prognosis of these circumscript lesions should be excellent.
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Affiliation(s)
- Hanno Huwer
- Department of Cardiothoracic Surgery, Voelklingen Heart Centre, Voelklingen/Saar, Germany.
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25
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Haresh KP, Sharma DN, Prabhakar R, Naik KK, Mannan AASR, Julka PK, Rath GK. Plasmacytoma of bronchus treated by radical radiotherapy--a rare case with four and a half years follow up. J Thorac Oncol 2007; 2:980-2. [PMID: 17909364 DOI: 10.1097/jto.0b013e31814b86c0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Plasmacytoma of the bronchus is a very rare plasma cell neoplasm affecting the bronchus. Here we report a case of plasmacytoma of the bronchus treated by radical radiotherapy in July 2002. The tumor responded very well to treatment and showed a slow but sustained regression in the size over two years. Presently, he has completed four and a half years of follow-up and is free of disease.
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Affiliation(s)
- K P Haresh
- Department of Radiotherapy and Oncology, All India Institute of Medical Sciences, New Delhi, India.
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Thoennissen NH, Schliemann C, Hungermann D, Bremer J, Juergens KU, Semik M, Müller-Tidow C, Zuehlsdorf M, Berdel WE. Solitary plasmacytoma of the lung with coexisting sarcoid-like lesions. Ann Hematol 2007; 87:417-20. [DOI: 10.1007/s00277-007-0405-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2007] [Accepted: 09/29/2007] [Indexed: 10/22/2022]
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Chang CC, Chang YL, Lee LN, Lee YC. Primary pulmonary plasmacytoma with immunoglobulin G/lambda light chain monoclonal gammopathy. J Thorac Cardiovasc Surg 2006; 132:984-5. [PMID: 17000323 DOI: 10.1016/j.jtcvs.2006.07.013] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 05/29/2006] [Accepted: 07/17/2006] [Indexed: 11/23/2022]
Affiliation(s)
- Chin-Chih Chang
- Department of Surgery, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
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Ross P, Magro CM. Clonal light chain restricted primary intrapulmonary nodular amyloidosis. Ann Thorac Surg 2006; 80:344-7. [PMID: 15975406 DOI: 10.1016/j.athoracsur.2004.03.075] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2004] [Accepted: 01/14/2004] [Indexed: 11/22/2022]
Abstract
Primary intrapulmonary nodular amyloidosis is a rare form of immunoglobulin associated amyloidosis, also falling under the alternative appellation of amyloidoma. Although amyloidomas in other organ sites may be reflective of a localized or more generalized plasma cell dyscrasia, in the context of its presentation in the lung the presumptive basis has long been held to be one of chronic inflammation. We encountered 2 patients with nodular amyloidosis in whom the pathologic examination disclosed the basis to be one of a light chain restricted clonal lymphocytic plasma cell infiltrate, although without morphologic features of coexisting pulmonary lymphoma. These 2 patients serve to underscore the potential categorization of some cases of pulmonary nodular amyloidosis as a form of low grade B cell lymphoproliferative disease.
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Affiliation(s)
- Patrick Ross
- Division of Cardiothoracic Surgery, The Ohio State University, Columbus, Ohio 43210, USA.
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Abstract
Multiple myeloma is a haematological malignancy characterized by the occurrence of plasma cell tumours within the bone marrow. In advanced multiple myeloma, metastatic deposits outside the bone marrow (extramedullary) are rare. Reported extramedullary sites include the upper respiratory tract and lymph nodes. Parenchymal pulmonary plasmacytoma is exceptionally rare. We describe such a case in a 51-year-old male, who underwent allogenic marrow transplantation. 6 months post-transplantation developing nodal and hilar pulmonary multiple myeloma, the radiological appearances mimicking lymphoma.
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Affiliation(s)
- P O'Sullivan
- Department of Radiology, University of British Columbia, Vancouver, BC, Canada
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Iagaru A, Mari C, Segall G. F-18 FDG PET Evaluation of Bronchial Plasmacytoma With CT and MRI Correlation. Clin Nucl Med 2006; 31:279-80. [PMID: 16622337 DOI: 10.1097/01.rlu.0000210516.90261.64] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Andrei Iagaru
- Division of Nuclear Medicine, Stanford University Medical Center, VA Palo Alto Health Care System, Stanford, CA 94305, USA.
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31
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Niitsu N, Kohri M, Hayama M, Nakamine H, Nakamura N, Bessho M, Higashihara M. Primary pulmonary plasmacytoma involving bilateral lungs and marked hypergammaglobulinemia: differentiation from extranodal marginal zone B-cell lymphoma of mucosa-associated lymphoid tissue. Leuk Res 2005; 29:1361-4. [PMID: 15878199 DOI: 10.1016/j.leukres.2005.04.009] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2005] [Indexed: 12/28/2022]
Abstract
A 71-year-old woman was referred to our hospital because of hyperproteinemia and serum M-protein (IgG-lambda type). Chest computed tomographic (CT) scan revealed a tumor in each lung and transbronchial lung biopsy was performed. Histopathological examination showed monotonous medullary proliferation of morphologically mature plasma cells. These cells were cIgG+, cIg-lambda+, CD 20+, CD 79 a+, CD 138+, cIg-kappa-, and CD3-. Since there were very few non-neoplastic plasma cells and small lymphocytes in addition to the absence of reactive lymph follicles and fibrosis, the patient was diagnosed as having plasmacytoma. There was no proliferation of plasma cells in the bone marrow. Thus, the lesion was finally characterized as primary pulmonary plasmacytoma. Treatment with melphalan/prednisolone resulted in considerable decrease in the serum IgG level and regression of the pulmonary tumors. The effectiveness of the chemotherapy could confirm our diagnosis, although MALT-type lymphoma with plasmacytic differentiation cannot be completely ruled out.
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MESH Headings
- Aged
- Diagnosis, Differential
- Female
- Humans
- Hypergammaglobulinemia/diagnosis
- Hypergammaglobulinemia/diagnostic imaging
- Hypergammaglobulinemia/pathology
- Lung Diseases/diagnosis
- Lung Diseases/diagnostic imaging
- Lung Diseases/pathology
- Lung Neoplasms/diagnosis
- Lung Neoplasms/diagnostic imaging
- Lung Neoplasms/pathology
- Lymphoma, B-Cell/diagnosis
- Lymphoma, B-Cell/diagnostic imaging
- Lymphoma, B-Cell/pathology
- Lymphoma, B-Cell, Marginal Zone/diagnosis
- Lymphoma, B-Cell, Marginal Zone/diagnostic imaging
- Lymphoma, B-Cell, Marginal Zone/pathology
- Plasmacytoma/diagnosis
- Plasmacytoma/diagnostic imaging
- Plasmacytoma/pathology
- Tomography, X-Ray Computed/methods
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Affiliation(s)
- Nozomi Niitsu
- Department of Hematology, Saitama Medical School, 38 Morohongo, Moroyama, Iruma-Gun, Saitama 350-0495, Japan.
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Edelstein E, Gal AA, Mann KP, Miller JI, Mansour KA. Primary solitary endobronchial plasmacytoma. Ann Thorac Surg 2005; 78:1448-9. [PMID: 15464514 DOI: 10.1016/s0003-4975(03)01474-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/25/2003] [Indexed: 12/21/2022]
Abstract
Twenty-two cases of pulmonary plasmacytoma have been reported in the literature and verified by immunohistochemistry or other diagnostic tests. The treatment for this rare tumor has included various combinations of surgical resection, chemotherapy, and radiation therapy. We report a case of a middle-age man who underwent endoscopic debulking followed by laser ablation for a pulmonary plasmacytoma, which showed a prominent endobronchial location with clinical and histopathologic verification.
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Affiliation(s)
- Evgeny Edelstein
- Department of Pathology, Meir Hospital, Saphir Medical Center, Kfar Saba, Israel
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Etienne G, Grenouillet M, Ghiringhelli C, Vatan R, Lazaro E, Germain P, Mercié P, Longy-Boursier M. [Pulmonary plasmacytoma: about two new cases and review of the literature]. Rev Med Interne 2004; 25:591-5. [PMID: 15276291 DOI: 10.1016/j.revmed.2004.04.024] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2003] [Accepted: 04/07/2004] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Extramedullary plasmacytoma is an uncommon plasma cell malignancy mainly located to the upper aerodigestive tract. Primary pulmonary plasmacytoma is extremely rare. EXEGESIS We report two new cases of primary pulmonary plasmacytoma and then proceed to a review of the literature concerning 35 similar cases previously described. CONCLUSION Complete or partial responses were obtained in 24 cases (65%). Five patients (14%) have developed multiple myeloma within 3 years following plasmacytoma diagnostic. In spite of sustained responses with radiotherapy or chemotherapy, surgical resection while feasible remains the first therapeutic option.
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Affiliation(s)
- G Etienne
- Service de médecine interne et maladies tropicales, groupe hospitalier Saint-André, 1, rue Jean-Burguet, 33075 Bordeaux, France.
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Wong B, Teo K, Taylor D, Nguyen GK. Cardiac plasmacytoma. Cardiovasc Pathol 2004; 13:49-53. [PMID: 14761785 DOI: 10.1016/s1054-8807(03)00095-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/08/2003] [Revised: 08/08/2003] [Accepted: 08/20/2003] [Indexed: 11/23/2022] Open
Abstract
A 69-year-old white woman presented with a 3-month history of progressive dyspnea, orthopnea, fatigue and weakness. Clinical, diagnostic imaging and echocardiographic investigations suggested an occult primary cancer with metastasis to the heart. The patient's condition deteriorated gradually, and she died 2 months later. At autopsy, a malignant tumor encasing the heart and a 1-cm solitary tumor nodule in the lower lobe of the left lung were found. Histologic and electron microscopic studies revealed a plasmacytoma predominantly involving the epicardium and a small solitary plasmacytoma located in the left lung. The two tumors were further confirmed by immunohistochemical studies that showed monoclonal IgG expression and kappa light chain restriction.
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Affiliation(s)
- Brian Wong
- Department of Medicine (Cardiology), University of Alberta Hospitals, Edmonton, Alberta, Canada
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Abstract
Most extramedullary plasmacytomas are associated with the upper respiratory tract. Primary pulmonary plasmacytomas are rare, and the treatment is surgical excision. This malignancy advances to multiple myeloma in a minority of patients. The patient in our case report is the first to experience renal failure due to hematologic monoclonal gammopathy. Postoperatively, serum protein electrophoresis reverted to normal.
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Affiliation(s)
- J N Wise
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
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Dimopoulos MA, Kiamouris C, Moulopoulos LA. Solitary plasmacytoma of bone and extramedullary plasmacytoma. Hematol Oncol Clin North Am 1999; 13:1249-57. [PMID: 10626148 DOI: 10.1016/s0889-8588(05)70124-6] [Citation(s) in RCA: 146] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
A small proportion of patients with plasma cell myeloma have a solitary plasmacytoma of bone. Strict staging criteria, including normal MR imaging studies of the axial skeleton and the long bones and absence of monoclonal plasma cells detected by flow cytometry or PCR, are required for diagnosis. Radiotherapy at a dose of 4500 cGy is required to eradicate the local tumor. Many patients enjoy prolonged disease-free survival, but the incidence of systemic relapse is high. It is expected, however, that if strict diagnostic criteria are applied some patients may be cured. Extramedullary plasmacytoma is an even rarer plasma cell disease which usually occurs in the head and neck area. Careful microscopic and immunohistochemical studies are required for the correct diagnosis, because this disease can be confused with other malignancies, particularly lymphomas. The treatment of choice is radiotherapy which, in cases of head and neck plasmacytomas, should encompass the adjacent lymph nodes. Most patients with extramedullary plasmacytoma can be cured, and fewer than 30% develop a distant failure in the form of multiple myeloma or multiple extramedullary tumors.
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Affiliation(s)
- M A Dimopoulos
- Department of Clinical Therapeutics, University of Athens School of Medicine, Greece
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