Plasma Cell Problems

A plasma cell-based pericardial effusion leading to tamponade in a patient with multiple myeloma - a case report and review of the literature

A rare case of extramedullary multiple myeloma causing cardiac tamponade secondary to a plasma cell-based pericardial effusion is described. A systematic search using PubMed (National Library of Medicine) was used to identify a further 27 cases dating back to 1970. Case characteristics, treatment strategies, and survival time following tamponade are discussed. Linear regression demonstrated a weak but statistically significant correlation between survival time following tamponade and treatment with systemic chemotherapy and steroids (β=16.8 weeks, P=.009). However, this manifestation of extramedullary multiple myeloma still conveys a dismal prognosis with a median survival following tamponade of only 6 weeks based on our review.

Cardiac plasmacytoma: a rare clinical entity

Primary malignant cardiac tumors are rare. Among these tumors, cardiac plasmacytoma is extremely rare and is the subject of few case reports. We present the case of a 73-year-old man who had isolated cardiac plasmacytoma 26 years after successful treatment of an axillary plasmacytoma. Multiple imaging methods-including echocardiography, cardiac magnetic resonance, and positron-emission tomography/computed tomography-were valuable and complementary to each other in this patient's diagnosis and optimal management. His case illustrates the use of these techniques in the successful diagnosis and treatment of a rare clinical entity, cardiac plasmacytoma.

Simultaneous inflammatory pseudotumors of the coronary arteries and abdominal aorta

We herein report a rare case of cardiac and abdominal aortic inflammatory pseudotumors (IPTs). A 64-year-old male presented with a loss of appetite, abdominal distension and general fatigue. A cardiac tumor was suspected on the basis of computed tomography scans. A needle biopsy was performed, but it did not lead to a definitive diagnosis. At the same time, a 70-mm abdominal aortic aneurysm (AAA) was also detected. A full sternotomy was performed, and a huge, elastic hard tumor was found around the bilateral coronary arteries, anterior side of the right atria, ascending aorta and pulmonary artery. The pathological diagnosis was IPT, which was judged to be inoperable because of its anatomical location and the fact that the patient was a Jehovah's Witness, which precluded the administration of heterologous blood transfusions. The AAA was surgically treated, and the pathological diagnosis of the aneurysmal tissue also revealed IPT. Perioral steroid therapy was initiated, and the size of the tumor did not change for 1-2 years, but then gradually increased. The patient eventually died 8 years later, and the cause of his sudden death was considered to be heart failure caused by the pressure on the right atrium and ventricle due to the enlarged cardiac tumor.

Extramedullary Cardiac Plasmacytoma

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.