Unsuspected multiples myeloma presenting as bilateral pleural effusion - a cytological diagnosis

Myelomatous pleural effusion in multiple myeloma- A rare presentation

Multiple myeloma is a malignant plasma cell condition that mostly affects the skeletal system and bone marrow. Pleural effusions are uncommon and typically result from other conditions coexisting with multiple myeloma. Malignant myelomatous pleural effusions are rare complications of multiple myeloma, occurring in less than 1% of patients and are associated with poor prognosis having mean survival of less than 4 months. The present case report is a 41-year-old multiple myeloma patient who developed bilateral pleural effusion at a disease relapse. Chemotherapeutic regimen of cyclophosphamide, bortezomib, and dexamethasone given. Despite a positive response to treatment, the patient's condition worsened over the course of following month and he eventually passed away. Myelomatous pleural effusion indicates poor prognosis and early consideration helps in quick diagnosis and initiation of treatment which may help in improving prognosis.

Exceptional Manifestation of Multiple Myeloma

Despite being a rare occurrence, multiple myeloma (MM) has been reported as an alternative cause of pleurisy, with approximately 50 documented cases in the literature so far. In this case report, we present the clinical scenario of a patient who sought medical attention due to symptoms of dyspnea, chest pain, and weight loss. Through a comprehensive diagnostic evaluation, it was determined that the patient's pleural involvement was attributable to MM, a hematological malignancy. This case highlights the importance of considering MM as a potential etiology in patients presenting with pleural manifestations, even in settings where tuberculosis is the prevailing cause.

Cytologic and flowcytometric findings in a case of myelomatous pleural effusion: A rare and ominous presentation of multiple myeloma

Plasma cell myeloma is a hematologic malignancy characterized by multifocal clonal proliferation of plasma cells usually associated with M protein secretion in serum and/or urine and evidence of organ damage. Generally, the presenting features are related to anemia, bone lesions, and renal failure. Pleural effusion is rare in multiple myeloma and when present is often due to nonmalignant causes. Myelomatous pleural effusion that is, effusions directly due to pleural infiltration by plasma cells is even rarer. We present a case of a patient presenting with dyspnea due to myelomatous pleural effusion. The fluid in such a case may be subjected to cytology examination, protein electrophoresis, flowcytometric analysis, and cytogenetics. The case highlights the utility of cytomorphology and flowcytometry in the diagnosis of myelomatous pleural effusion and also highlights that this type of presentation portends a poor prognosis to the patient.

Myelomatous pleural effusion: A rare case entity reported from a tertiary care cancer center in South India

Multiple myeloma (MM) is a plasma cell neoplasm and constitutes 10% of hematologic malignancies. Malignant myelomatous pleural effusions are very rare and occur in <1% of cases of MM. In this article, we report a rare case of a patient who initially presented with pleural effusion and was subsequently found to be secondary to MM with an underlying raised IgG paraprotein. The patient symptomatically improved and was in partial remission with palliative radiotherapy, VTD chemotherapy, and bisphosphonates.

Solitary pleural myeloma diagnosed by semi-rigid thoracoscopy: A case report and literature review

Multiple myeloma (MM) is characterized by abnormal proliferation of neoplastic plasma cells. Pleural effusion as an initial presentation of this disease is rare, as is true pleural myeloma. We herein present a case of solitary pleural myelomatous lesion in a 70-year-old male patient diagnosed by pleural biopsy via semi-rigid thoracoscopy followed by histopathological examination. Furthermore, a review of the related English literature identified 22 cases of pleural myeloma, only 3 of which were diagnosed by video-assisted thoracoscopy. To the best of our knowledge, this is the first reported case of a solitary pleural myelomatous lesion diagnosed by pleural biopsy via semi-rigid thoracoscopy. Patients with MM with pleural involvement, including the present case, appear to have a short survival despite aggressive treatment. Our patient received chemotherapy with bortezomib, epiadriamycin and dexamethasone; however, he deteriorated rapidly after one cycle of chemotherapy and succumbed to the disease 8 weeks after the initial presentation. According to our experience, semi-rigid thoracoscopy is an effective and safe method for obtaining a pleural specimen for histopathological evaluation.

Cytology of plasma cell rich effusion in cases of plasma cell neoplasm

Background:

Multiple myeloma or plasmacytoma resulting in malignant effusion is rarely described in literature.

Aims:

In this paper, we have studied the seven rare cases of plasma cell infiltration in effusion fluid.

Materials and Methods:

We studied six cases of pleural fluid and one case of ascetic fluid. Detailed cytological features, clinical history, bone marrow examinations, serum electrophoresis, and immunofixation data were analyzed.

Result:

There were two cases of plasmacytoma, four cases of multiple myeloma, and one case of plasmablastic lymphoma. On cytology, all the cases showed excess plasma cells along with mesothelial cells and lymphocytes on effusion cytology smear.

Conclusion:

Plasma cell rich effusion in cases of plasma cell tumor is rare. However, on cytology these cases do not pose much problem if relevant history is known.

Myelomatous pleural effusion - Thoracoscopic evaluation of a rare entity

Multiple myeloma is a malignant neoplasm of plasma cell origin that mainly affects bone marrow and skeletal system, producing large amount of light chain immunoglobulins. Pleural involvement in multiple myeloma is a rare complication which carries very poor prognosis. We report a case of multiple myeloma who presented with recurrent pleural effusion that was evaluated by means of thoracoscopy.

Myelomatous pleural effusion as an initial sign of multiple myeloma-a case report and review of literature

OBJECTIVE

Discuss and improve the understanding of the clinical characters and diagnostic methods of myelomatous pleurisy, particularly of the patients with pleural effusion as an initial manifestation.

BACKGROUND

A 53-year-old male, who had been misdiagnosed as tuberculous pleurisy in a local hospital, was diagnosed as multiple myeloma (MM) with pleural infiltration. We reviewed the literature on clinical manifestations, serum and pleural effusion characters, treatment and diagnostic options of this exceptionally rare presentation of MM.

METHODS

We conducted a search of the published medical literature since 2000 in MEDLINE and PubMed using search criteria [("pleural effusion" and "MM") or "myelomatous pleural effusions"]. The search led to 64 case reports, and 16 cases with pleural effusion as an initial manifestation were included in this review. We have also searched for recent advances in diagnosis.

RESULTS AND CONCLUSIONS

Myelomatous pleurisy is a rare complication of MM. Its clinical and laboratory findings are non-specific. Definitive diagnosis relies on the histopathology of pleural biopsy or pleural effusion. Thoracoscopic pleural biopsy is reliable, safe and effective. Chemotherapy is the mainstay of treatment for myelomatous pleural effusion. However, the response rate is low with an overall median survival time of 4 months.

A case of bilateral pleural effusion as the first sign of multiple myeloma

Multiple myeloma (MM) is a type of hematological malignancy that can affect all types of tissues in human. However, it is extremely rare that pleural effusion presents as the first sign in MM patients. A 54-year-old male patient attended our department of respiratory medicine complaining of shortness of breath for the past 3 months. A chest computer tomography (CT) radiograph revealed a bilateral pleural effusion, which was further assessed as exudative type. Sinus spiral CT scan demonstrated diffuse bone destruction of craniofacial bone. A broad reduction of the lumbar bone signal was confirmed by MRI. Furthermore, pleural biopsy showed abnormal proliferation of plasmocytes whereas bone marrow biopsy showed active hyperplasia of plasmacytoid cells. Interestingly, Bence-Jones protein in urine and serum protein electrophoresis was negative. The patient was diagnosed as non-secretory MM. He then underwent chemotherapy with vincristine, adriamycin and dexamethasone. Partial regression of the pleural effusion was achieved after two rounds of chemotherapy, and the patient has been followed for more than one year.

Myelomatous pleural effusion-A case report

Multiple myeloma is a malignant proliferation of plasma cells, predominantly involving the bone marrow and skeletal system. Pleural effusions are rarely associated with multiple myeloma and most often signify a concurrent disease process, e.g. amyloidosis.^1,2 Malignant myelomatous pleural effusions are even more unusual, occurring in less than 1% of cases of multiple myeloma.¹

Here we report the case of a patient with multiple myeloma presenting with a myelomatous pleural effusion at disease recurrence.

Myelomatous pleural effusion: A rare presentation of multiple myeloma

Myelomatous pleural effusion is a very rare presentation of multiple myeloma. A 65-year-old male patient presented to us with complaints of dyspnea and left-sided chest pain. His contrast enhanced computed tomography of the thorax showed left-sided pleural effusion with multiple pleural nodules. His pleural fluid cytology shows malignant plasma cells with eccentric nuclei and cart wheel chromatin and a few cells showing binucleation and multinucleation suggestive of plasma cell myeloma. His pleural fluid and serum electrophoresis showed a distinct band in the gamma globulin region (M-spike). On immunofixation of pleural fluid and serum, immunoglobulin G lambda light chain band was detected. Bone marrow aspiration showed sheets of malignant plasma cells with large and binucleated cells suggestive of multiple myeloma. The patient was diagnosed with multiple myeloma presenting as myelomatous pleural effusion. Intercostal tube drainage and then pleurodesis with talc was performed.

A review of uncommon cytopathologic diagnoses of pleural effusions from a chest diseases center in Turkey

BACKGROUND

After pneumonia, cancer involving the pleura is the leading cause of exudative pleural effusion. Cytologic examination of pleural effusions is an important initial step in management of malignant effusions. The aim of this study is to evaluate the spectrum of uncommon malignant pleural effusions in a chest disease center in Turkey.

MATERIALS AND METHODS

A retrospective study of samples of pleural effusions submitted to Ataturk Chest Diseases and Chest Surgery Education and Research Hospital Department of Pathology between March 2005 and November 2008 was performed.

RESULTS

Out of a total of 4684 samples reviewed 364 (7.8%) were positive for cancer cells. Of the malignant pleural effusions 295 (81%) were classified as adenocarcinoma or carcinoma not otherwise specified (NOS). Pleural effusion specimens revealing a diagnosis other than adenocarcinoma/carcinoma NOS were: 32 (8.8%) malignant mesotheliomas, 14 (3.8%) small cell carcinomas, 13 (3.5%) hematolymphoid malignancies and 10 (2.7%) squamous cell carcinoma. Hematolymphoid malignancies included non- Hodgkin lymphoma (diffuse B large cell lymphoma, mantle cell lymphoma), multiple myeloma, chronic myeloid leukemia, and acute myeloid leukemia.

CONCLUSIONS

Despite that adenocarcinoma is the most common cause of malignant pleural effusions, there is a significant number of hematological and non-hematological uncommon causes of such effusions. Cytopathologists and clinicians must keep in mind these uncommon entities in routine practice for an accurate diagnosis.

Myelomatous Pleural Effusion: Case report and review of the literature

Plasma cell myeloma is an uncommon disease which, besides primarily involving the bone marrow, has a tendency to involve other organs thus presenting with different clinical manifestations. While pleural effusions are infrequent in this disease, true myelomatous pleural effusions are extremely rare. We report the case of a middle-aged Omani man with relapsed plasma cell myeloma who developed bilateral pleural effusions. The diagnosis of myelomatous pleural effusion was made by finding many abnormal plasma cells as well as a high level of a monoclonal protein (IgG κ) in the pleural fluid. In spite of a good initial response to therapy, the patient had progressive disease and died 6 months later with bacterial sepsis. We present a review of the literature that indicates the rarity of such a manifestation and its association with poor prognosis and short survival.

Multiple myeloma presenting as eosinophilic pleural effusion

An elderly man, with no comorbidity, presented with rapidly accumulating left pleural effusion. He also had generalized adenopathy. Pleural fluid cytology showed exudative pleural effusion with eosinophilia. Supraclavicular lymph node biopsy was reported as amyloid. On further investigation he was found to have kappa-light chain multiple myeloma. The final diagnosis was eosinophilic pleural effusion in a patient with multiple myeloma.