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Cenik F, Keilani M, Hasenöhrl T, Huber D, Stuhlpfarrer B, Pataraia A, Crevenna R. Relevant parameters for recommendations of physical activity in patients suffering from multiple myeloma : A pilot study. Wien Klin Wochenschr 2019; 132:124-131. [PMID: 31784826 PMCID: PMC7080662 DOI: 10.1007/s00508-019-01582-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/11/2019] [Accepted: 11/06/2019] [Indexed: 12/30/2022]
Abstract
Purpose This pilot study aimed to describe physical performance, self-reported physical activity, health-related quality of life, anxiety and depression in patients who were assigned from Austrian self-help groups for multiple myeloma patients. These parameters were then discussed in the context of clinical decision-making concerning the recommended type of regular physical activity and exercise. Methods Members of the self-help groups were invited to participate. Physical performance and physical activity were assessed with the 6 min walk test (6MWT), handgrip strength test, timed up and go test (TUG), Tinetti performance oriented mobility assessment (POMA), falls efficacy scale (FES), international physical activity questionnaire (IPAQ), health-related quality of life (EORTC QLQ-C30) and the hospital anxiety and depression scale (HADS). Results A total of 40 patients (female:male = 15:25, mean age: 63.8 ± 9.0 years, range 41–80 years) were identified. In total 20 (50%) reached the performance of healthy peers in the tests 6MWT, handgrip strength, TUG and POMA, while 50% showed at least 1 result below the reference value or cut-off-point for each test. Self-reported activity levels were high. Patients showed a tendency to overestimate the risk of falling but a case by case analysis revealed a tendency for underestimating the actual performance in the respective tests (TUG, POMA). Conclusion The performance of healthy peers was reached by a substantial number of the participants in tests of physical performance and they reported high levels of physical activity. Nevertheless, they tended to overestimate the specific risk of falling. Patients with notably impaired physical performance might be suitable to perform regular physical activity and exercise in an individual therapy, whereas those with good physical performance are suited for training in exercise groups; however, individual contraindications and clinical considerations should be noted in a multiprofessional and interdisciplinary setting.
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Solitary Extramedullary Plasmacytoma of the Sphenoid Sinus: A Case Report. Indian J Otolaryngol Head Neck Surg 2019; 71:1692-1694. [PMID: 31763226 DOI: 10.1007/s12070-015-0945-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 12/10/2015] [Indexed: 10/22/2022] Open
Abstract
Solitary extramedullary plasmacytomas are rare, discrete mass of neoplastic monoclonal plasma cells in the soft tissue with no evidence of multiple myeloma. They constitute 3 % of all plasma cell tumors and less than 1 % of head and neck malignancies. A 43 year old lady presented to our clinic with complains of diplopia and headache for 4 weeks. Computed Tomography scan showed a mass lesion in the sphenoid sinus eroding the sinus floor, right wall, basisphenoid and parasellar area. A biopsy of the mass reported as plasmacytoma. Systemic examination revealed no evidence of dissemination of the disease confirming the diagnosis of a solitary extramedullary plasmacytoma. The patient was subjected to 25 fractions of radiotherapy. Here, we report a rare case of solitary extramedullary plasmacytoma of the sphenoid sinus.
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Abstract
Radiation therapy plays a critical role in the management of a wide range of hematologic malignancies. The optimal radiation dose and target volume, and safe and effective ways of integrating radiation with systemic agents, vary depending on the histologic subtypes, stage at presentation, patient performance status, response to systemic therapy if given, treatment intent, and patient preferences. Limiting doses to surrounding organs without sacrificing disease control is of paramount importance. Reducing radiation doses and treatment volume in selected cases, and the use of advanced radiotherapy technology, can improve the therapeutic ratio of patients receiving radiation therapy for hematologic malignancies.
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Towards development of plasmacytoma cells-based expression systems utilizing alphavirus vectors: An NS0-VEE model. J Virol Methods 2019; 274:113734. [PMID: 31525396 DOI: 10.1016/j.jviromet.2019.113734] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Revised: 07/19/2019] [Accepted: 09/12/2019] [Indexed: 11/24/2022]
Abstract
Plasmacytoma (myeloma) cells have a large protein expression capacity, although their industrial use is confined to stable expression systems. Vectors derived from genomes of viruses from the genus Alphavirus allow obtaining of high yields of target proteins but their use is limited to transient expression. Little information has been published to date on attempts to combine the myeloma cells as hosts with alphaviruses as expression vectors. A plasmid construct which allows rescue of a model alphavirus Venezuelan equine encephalitis virus (VEE) upon transfection of a cell culture was created. Mutations in the capsid and nsP2 genes allow for less cytopathogenic propagation of the virus. A cDNA-copy of the genome was placed in a plasmid under the control of the CMV promoter for virus rescue following DNA transfection. Parameters for the virus rescue by electroporating of the infectious clone in murine myeloma cells (NS0) were optimized. The highest FFU counts (1.2 × 105 FFU per 10 ug DNA) were produced with 2 pulses (voltage 250 V, capacitance 960 u F) and the best electroporation buffer was selected from eight buffers. Self-sustained VEE infection was established in NS0 cultures with high titers (8 × 108 FFU/ml) of the virus, despite a fraction of infected cells dying during 5-days observation. Further development of the NS0-VEE expression system may require addressing of apoptosis induced by VEE.
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Abstract
Bone pathology can be challenging because the skeleton is a living tissue prone to developing a diverse array of inflammatory, metabolic, genetic, reactive, circulatory, and neoplastic abnormalities. Several areas of bone pathology are particularly difficult or problematic for hematopathologists given the close resemblance of some hematologic entities to primary/metastatic bone lesions; examples include plasmacytic disorders versus osteoblastic tumors and lymphoma/leukemia versus round cell tumors of bone. This article provides a conceptual and practical overview of selective bone disorders commonly encountered in the differential diagnosis of hematologic diseases.
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Kolarević V, Vidaković I, Šutalo M, Rapan V, Rapan D, Rapan S. VERTEBROPLASTY IN THE TREATMENT OF VERTEBRAL FRACTURES CAUSED BY PLASMACYTOMA. Acta Clin Croat 2019; 58:523-528. [PMID: 31969766 PMCID: PMC6971789 DOI: 10.20471/acc.2019.58.03.17] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
The aim of this study was to compare and evaluate clinical results before and after vertebroplasty in the treatment of myeloma-induced vertebral fractures. Success of the surgery was defined by increased or reduced pain intensity before and after the treatment, as assessed using the visual analog scale (VAS). The study was designed as a retrospective-prospective study. The study included 26 patients, 14 women and 12 men. Data on patients treated for myeloma-induced vertebral fractures were collected at the Department of Orthopedics, Osijek University Hospital Centre. The following data were analyzed: gender, duration of illness, intensity of pain before and after treatment (using VAS), radiological changes before and after treatment, grade of vertebral fracture, and extracorporeal cement leakage from the vertebral body to the surrounding tissue during the procedure. Difference in pain intensity before and after the surgery was statistically significant. All patients complained of pain before the surgery (pain intensity median 8), whereas after the surgery, pain intensity decreased in all patients (pain intensity median 2). In conclusion, improvement in clinical results of the treatment of myeloma-induced vertebral fractures with vertebroplasty proved to be significant.
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Elhammali A, Milgrom SA, Amini B, Gunther JR, Yoder A, Ludmir EB, Moon B, Weber DM, Thomas SK, Garg N, Manasanch EE, Patel KK, Orlowski RZ, Lee HC, Bird JE, Satcher R, Lin P, Pinnix CC, Dabaja BS. Postoperative Radiotherapy for Multiple Myeloma of Long Bones: Should the Entire Rod Be Treated? CLINICAL LYMPHOMA, MYELOMA & LEUKEMIA 2019; 19:e465-e469. [PMID: 31133526 DOI: 10.1016/j.clml.2019.04.015] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Accepted: 04/29/2019] [Indexed: 02/03/2023]
Abstract
PURPOSE To characterize local relapse after surgical fixation and postoperative radiotherapy (RT) for multiple myeloma (MM) with cortical involvement of long bones. PATIENTS AND METHODS We retrospectively identified patients with MM involving cortical long bones treated with surgical fixation followed by postoperative RT at our institution. Local failures, defined as radiographic recurrence along the surgical hardware, were documented, and potential associations of independent variables (RT dose, fractionation, and extent of hardware coverage) with local failure were assessed by univariate Cox regression. RESULTS We identified 33 patients with 40 treated sites with a median follow-up of 25.7 months; 68% of treatments were for pathologic fracture, and 32% were for impending fracture. The most common dose and fractionation were 20 to 25 Gy in 8 to 12 fractions. On average, 76% of the surgical hardware was covered by the postoperative RT field (median, 80%; range, 28%-100%). Local failure was observed in 5 cases (12.5%), 2 within the RT field and 3 out of field. None of the relapses resulted in hardware failure, and 2 were retreated with RT. The extent of hardware coverage predicted disease relapse along the hardware (hazard ratio = 6.44; 95% confidence interval, 1.09-37.97; P = .04); however, total RT dose, biologically effective dose, and number of fractions did not. CONCLUSION After internal fixation of long bones with MM, full hardware coverage with the RT field could reduce the risk, though small, of disease developing in the future in the proximate hardware. Postoperative RT doses of 20 to 25 Gy in 8 to 10 fractions can achieve excellent local control.
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Sioka C, Sakelariou K, Papoudou-Bai A, Tolis C, Al-Boucharali J, Fotopoulos A. Osteoblastic Solitary Plasmacytoma of Bone. Turk J Haematol 2019; 36. [PMID: 30820260 PMCID: PMC6516098 DOI: 10.4274/tjh.galenos.2019.0218.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Mwinyogle AA, Bhatt A, Kapisoda K, Somerville J, Cunningham SC. Plasmacytoma as a cause of small bowel obstruction in a virgin abdomen in a patient with multiple myeloma: a case report. J Med Case Rep 2019; 13:148. [PMID: 31097019 PMCID: PMC6524270 DOI: 10.1186/s13256-019-2068-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Accepted: 04/02/2019] [Indexed: 12/19/2022] Open
Abstract
Background Multiple myeloma is a hematological malignancy that classically results in an abnormal clonal proliferation of plasma cells in the bone marrow. Extramedullary disease in the setting of multiple myeloma, referred to as secondary extramedullary plasmacytoma, is found in 7–17% of cases of multiple myeloma at the time of diagnosis and can involve any organ system. Small bowel obstruction is a rare but important gastrointestinal manifestation of multiple myeloma that should be considered in patients with multiple myeloma who present with concerning abdominal symptoms. Case presentation We present the case of a 52-year-old African-American man with a history of deep venous thrombosis (he is on anticoagulation) and pathologic fracture secondary to multiple myeloma diagnosed 4 months prior to our encounter. He presented with abdominal pain, constipation, nausea, and vomiting. An abdominal X-ray showed distended bowel loops concerning for bowel obstruction and a contrast-enhanced computed tomography scan of his abdomen and pelvis showed a 5.4 cm soft tissue mass involving a loop of distal ileum. He underwent laparoscopic exploration of his abdomen with small bowel resection and primary anastomosis for a small intussusception. He had an uneventful postoperative course and was discharged on postoperative day 6. Conclusions Multiple myeloma has myriad presentations. Gastrointestinal involvement, although rare, can manifest as small bowel obstruction for which early recognition and appropriate surgical management are key to improving outcome. Intussusception is the most common mechanism of obstruction from extramedullary plasmacytoma causing small bowel obstruction and this has been seen in five of six case reports, including this case. It is important to recognize and consider the risks of immunosuppression, venous thromboembolism, and malnutrition in the surgical management of gastrointestinal complications of multiple myeloma.
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Sioka C, Sakelariou K, Papoudou-Bai A, Tolis C, Al-Boucharali J, Fotopoulos A. Osteoblastic Solitary Plasmacytoma of Bone. Turk J Haematol 2019; 36:117-119. [PMID: 30820260 DOI: 10.4274/tjh.galenos.2019.2018.0419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
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Li H, Huang Y, Li Y, Zheng B, Cui J, Liu M. Endocrine Manifestations in POEMS Syndrome: a case report and literature review. BMC Endocr Disord 2019; 19:33. [PMID: 30902082 PMCID: PMC6431048 DOI: 10.1186/s12902-019-0355-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2017] [Accepted: 03/01/2019] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND POEMS syndrome, a rare systemic disease, is characterized by 5 components: Peripheral neuropathy, Organomegaly, Endocrinopathy, M protein elevation, and Skin changes. It usually presents with multiplex endocrine manifestations and is easily misdiagnosed and incorrectly treated. CASE PRESENTATION We report herein a case of POEMS syndrome that initially presented as hyperpigmentation and severe pitting edema of the lower extremities. Throughout the patient's multiple hospitalizations for more than one year, he was treated erroneously for Addison's disease and primary hypothyroidism due to the presence of limb numbness and weight loss. In addition, he was misdiagnosed with diabetic peripheral neuropathy due to a history of type 2 diabetes mellitus. CONCLUSION Endocrinopathy is a critical feature of POEMS syndrome but its mechanisms are still poorly understood. The most common endocrine abnormality is hypogonadism, and the second is adrenal insufficiency, followed by hypothyroidism and subclinical hypothyroidism, then diabetes or glucose intolerance. In cases of the coexistence of endocrinopathy and unexplained peripheral neuropathy, especially in multisystem disorders, POEMS syndrome should be considered. Endocrine evaluation including thyrotropin, free thyroxine, fasting glucose, gonadal hormones, prolactin, cortisol, ACTH, and calcium should be assessed. The purpose of the current report was to provide increased awareness of POEMS syndrome.
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Urano M, Denewar FA, Okabe R, Komatsu H, Wanifuchi-Endo Y, Toyama T, Shibamoto Y. Relapsed multiple myeloma manifesting as extramedullary plasmacytoma of the breast: Imaging findings. Radiol Case Rep 2019; 14:584-587. [PMID: 30891107 PMCID: PMC6406076 DOI: 10.1016/j.radcr.2019.02.018] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2019] [Revised: 02/18/2019] [Accepted: 02/18/2019] [Indexed: 12/01/2022] Open
Abstract
Extramedullary plasmacytoma of the breast (EPB), a manifestation of multiple myeloma (MM), is very rare. It is important to recognize the imaging findings of EPB because it may be the first manifestation of relapsed MM. An 85-year-old woman presented with a lump in her right breast 4 years after the complete remission of MM. She underwent mammography and ultrasonography, which showed an oval circumscribed mass and an irregular circumscribed heterogeneous solid mass, respectively. Following ultrasound-guided vacuum-assisted breast biopsy, this lesion was confirmed to be EPB. Whole-body computed tomography showed multiple new osteolytic lesions and other multiple extramedullary lesions in addition to EPB in the right breast. The final diagnosis was relapsed MM with multiple extramedullary plasmacytoma.
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Skipina TM, Sane DC, Cui C, Song S, Phillips SG, Jarrett RW. A plasma cell-based pericardial effusion leading to tamponade in a patient with multiple myeloma - a case report and review of the literature. Cardiovasc Pathol 2019; 40:41-46. [PMID: 30852296 DOI: 10.1016/j.carpath.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 12/25/2022] Open
Abstract
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.
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Ghiassi-Nejad Z, Ru M, Moshier E, Chang S, Jagannath S, Dharmarajan K. Overall Survival Trends and Clinical Characteristics of Plasmacytoma in the United States: A National Cancer Database Analysis. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:310-319. [PMID: 30878315 DOI: 10.1016/j.clml.2019.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2018] [Revised: 12/30/2018] [Accepted: 01/10/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Given the rarity of plasmacytoma, large-scale database analysis can provide useful information regarding the clinical presentation and patient-related factors impacting overall survival (OS). MATERIALS AND METHODS The National Cancer Data Base was queried for patients with plasmacytoma between 2004 and 2013, excluding patients with systemic disease. Plasmacytomas were classified as originating in bone (P-bone), in extramedullary tissue (P-EM), or unspecified. Survival was estimated using the Kaplan-Meier and log-rank test method. We used Cox regression to determine specific outcomes adjusting for demographic, socioeconomic, geographic, facility type, year of diagnosis, and comorbid factors. RESULTS In total, 6225 patients were identified, of which 61.5% were men. The median age at diagnosis was 64 years (range, 18-90 years), and the median follow-up was 58 months. The primary site of disease was P-bone in 4056 (65.1%) patients and P-EM in 1468 (23.6%), and the remaining 701 patients were P-unspecified. The unadjusted median survival for solitary P-bone was 89 months (95% confidence interval, 82.9-95.0 months), and for solitary P-EM was 117.3 months (95% confidence interval, 108.8 months to not reached). Factors associated with improved OS include younger age, private insurance, higher income, solitary lesion, and lower comorbidity score. Patients with P-bone disease treated at academic facilities had improved OS. Only 65% of patients with solitary plasmacytoma lesions received radiation treatment. Age greater than 75 years and increased distance to treatment facility was associated with a decreased likelihood of receiving radiation. CONCLUSIONS This is the largest study examining outcomes of patients with plasmacytoma using a large database analysis, revealing unique aspects of P-EM versus P-bone and underutilization of radiation treatment.
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Abstract
Skeletal lesions caused by multiple myeloma often lead to pain, pathological fractures, spinal instability, and compression of the spinal cord and nerve roots. The choice of therapy options is made by an interdisciplinary basis with oncologists and radiotherapists on the basis of comorbidities, prognosis, localization, and number of lesions. Surgical management has a supportive role in pain relief, the prevention and treatment of pathological fractures, and the decompression of the spinal cord and nerve roots. An adequate preoperative workup is essential for planning surgical treatment, which includes magnetic resonance imaging of the spine. In the case of unstable spinal lesions, minimally invasive and open surgical procedures, as well as their combination, are available for stabilization and decompression. In impending and pathological fractures of the extremities, surgical procedures are superior to conservative therapy for pain relief, restoring stability, walking ability, and limb function. There are multiple options available, including osteosynthesis using bone cement and plates, intramedullary nails, and bone replacement with implants and tumor endoprostheses with good functional results. Permanent reconstruction of the lesions should be the goal of any surgical intervention. The indication for curative, wide resection of the tumor should be considered for solitary plasmocytomas of the bone. Adjuvant radiotherapy leads to significantly improved local tumor control and should be considered after resection and stabilization.
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dos Santos KM, Gerber JT, Mendes Okazaki PT, Cândida de Almeida Kintopp C, Klüppel LE, Giovanini AF, Scariot R. Marginal resection of solitary plasmacytoma in the anterior region of the mandible and dental implant rehabilitation: Report of an unusual case. Ann Med Surg (Lond) 2018; 36:158-161. [PMID: 30479763 PMCID: PMC6240598 DOI: 10.1016/j.amsu.2018.10.028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/24/2018] [Accepted: 10/24/2018] [Indexed: 11/25/2022] Open
Abstract
INTRODUCTION Plasmacytoma describes a neoplastic proliferation of plasma cells affecting different groups of patients according to location, and may demonstrate heterogeneous tumor progression and survival rate. The present article describes a case of solitary plasmacytoma in the mandible. PRESENTATION OF CASE A 57-year-old male smoker was referred to the oral and maxillofacial service with extensive injury, approximately 4-5 cm in size, involving the anterior inferior region of mandible. After confirming diagnosis of plasmacytoma through incisional biopsy, because it was a recurrent lesion, excision of the lesion was performed through marginal resection of the mandible under general anesthesia. During the same surgical procedure, a 2.4-mm system fixation plate was placed to mitigate the risk for pathological fracture of the mandible. In a second surgery, a region in the base of the mandible was rehabilitated using implants and prosthesis. CONCLUSION The patient is currently undergoing clinical and radiological follow-up of 2 years with success.
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Intracranial multiple myeloma with intraparenchymal involvement: Case report and literature review. J Clin Neurosci 2018; 59:335-337. [PMID: 30442452 DOI: 10.1016/j.jocn.2018.10.125] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Accepted: 10/28/2018] [Indexed: 11/20/2022]
Abstract
Intraparenchymal extension of multiple myeloma is a rare manifestation of the disease. Here, we present a case of a patient with multiple myeloma lesions situated adjacent to the meninges and intraparenchymally.
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Plasmacytoma-like post-kidney-transplant lymphoproliferative disorder confined to renal allograft and urinary tract: A case report. Nephrol Ther 2018; 14:544-547. [PMID: 30301610 DOI: 10.1016/j.nephro.2018.07.404] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/27/2018] [Accepted: 07/02/2018] [Indexed: 11/21/2022]
Abstract
Post-transplantation lymphoproliferative disorder (PTLD) is a well-know complication after organ transplantation. We report a case of a patient who developed an extramedullary plasmacytoma-like PTLD around his transplanted kidney treated with standard multiple myeloma chemotherapy. Three years after benefiting of a deceased donor kidney transplant for an end stage kidney disease secondary to nephroangiosclerosis, our patient developed an extra-medullary plasmacytoma confined to the transplant compartment. The transplant function was unaltered, and due to the absence of reduction of the lesion after immunosuppression reduction, a chemotherapy by bortezomib-cyclophosphamide-dexamethasone (VCD) known to be efficient in multiple myeloma was initiated. After 6 cycles, positron emission tomography (PET) scan showed complete metabolic remission confirming the biological exams. This case report suggests that a chemotherapy such as VCD can efficiently treat plasmacytoma-like PTLD allowing graft survival. Therefore, transplant removal may not be mandatory as the best second line treatment after unsuccessfulness reduction of immunosuppression.
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Takanosu M, Okada K, Kagawa Y. PCR-based clonality analysis of antigen receptor gene rearrangements in canine cutaneous plasmacytoma. Vet J 2018; 241:31-37. [PMID: 30340657 DOI: 10.1016/j.tvjl.2018.09.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Revised: 07/20/2018] [Accepted: 09/18/2018] [Indexed: 01/14/2023]
Abstract
Plasmacytomas are discrete, B cell-derived, round cell tumours that sometimes are difficult to distinguish from canine cutaneous histiocytomas or T cell lymphosarcomas (lymphomas). Diagnosis of plasmacytomas relies on morphological observations and immunohistochemistry for multiple myeloma oncogene-1 (MUM-1) and cluster of differentiation 3 (CD3). Clonality testing often is used as an adjunct diagnostic tool to examine lymphoproliferative diseases. In this study, the sensitivity of PCR-based clonality analysis of antigen receptor gene rearrangements in canine cutaneous plasmacytomas was determined. Formalin-fixed paraffin-embedded sections of 29 canine plasmacytomas, 23 diffuse large B cell lymphomas (DLBCLs) and 23 lymph nodes without lymphoma were used for clonality analysis. New oligonucleotide primers for the framework (FR)2 and FR3 regions of the immunoglobulin heavy chain (IGH) V gene subgroup 3 were designed and used with previously reported FR3 primers. Although plasma cells are of B cell lineage, the detected frequency of IGH clonality in plasmacytoma was 0-34.5% with the seven primers used, whereas in DLBCLs it was 8.7-78.3%. In 23 lymph nodes without lymphoma, IGH clonality was detected in only one case with two out of the seven primers used. Sequence analysis of PCR products from plasmacytomas revealed mismatches in the annealing region of the FR3 primers. The sensitivity of detecting IGH clonality in canine plasmacytomas was lower than in DLBCLs. The low detection rate of IGH clonality in canine plasmacytoma may be due to somatic hypermutation of the variable region.
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Morris RW, Kumar V, Saad AG. Anaplastic plasmacytoma: a rare tumor presenting as a pathological fracture in a younger adult. Skeletal Radiol 2018; 47:995-1001. [PMID: 29388036 DOI: 10.1007/s00256-018-2884-x] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Revised: 01/05/2018] [Accepted: 01/09/2018] [Indexed: 02/02/2023]
Abstract
Solitary plasmacytoma is the rarest type of plasma cell neoplasm, and the anaplastic form is even more uncommon. Plasmacytoma most commonly originates in bone and predominantly affects older patients. We describe the case of a 35-year-old woman with solitary osseous anaplastic plasmacytoma that presented initially with a pathological fracture following minor trauma. The patient was immunocompetent and had no predisposing conditions for a plasma cell tumor. Left lower extremity radiographs revealed an oblique fracture of the distal femur, and CT imaging indicated a primary osseous lesion at the fracture site. MRI confirmed the diagnosis of pathological fracture. Initial surgical pathology of the lesion was concerning because it could have been an osteosarcoma. Further immunostaining demonstrated CD138 positivity and kappa light chain restriction, confirming the diagnosis of plasmacytoma. In addition, the presence of marked anaplastic cellular changes confirmed the anaplastic variant. Further workup showed no evidence of multiple myeloma. This case is unusual given the age and gender of the patient. Awareness of the anaplastic variant of plasmacytoma is important to avoid erroneous diagnoses.
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Çelebi İ, Bozkurt G, Polat N. Tonsillar Plasmacytoma: clues on magnetic resonance imaging. BMC Med Imaging 2018; 18:19. [PMID: 29914385 PMCID: PMC6006941 DOI: 10.1186/s12880-018-0261-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2017] [Accepted: 06/11/2018] [Indexed: 12/20/2022] Open
Abstract
Background Malignant plasma cell proliferation may present as a disseminated disease (multiple myeloma), a solitary plasmacytoma of bone, or an extramedullary plasmacytoma of soft tissue. The latter plasmacytomas represent approximately 3% of all plasma cell proliferations, and 80% develop in the head-and-neck region. The unexpected clinical presentation of such masses may be present. Case presentation Here, we report a rare case of primary tonsillar plasmacytoma in a 42-year-old female. The patient presented with asymmetric tonsillar hypertrophy that was resistant to antibiotherapy. Upon further workup, we found no evidence of multiple myeloma or light-chain disease. The patient underwent surgery and, at the last follow-up, exhibited no evidence of such disease. Conclusions In adults presenting with asymptomatic tonsillar enlargement, the possibility of submucosal masses should be considered, thus encouraging the radiologist to evaluate crypts within the palatine tonsil on a postcontrast MRI, besides enlargement and signal change.
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Puri A, Lau MW, Zhao XF, Chan KC, Bader K. A rare case of a minimally secretory plasma cell leukemia with a hemorrhagic gastric plasmacytoma. Leuk Res Rep 2018; 9:23-27. [PMID: 29892544 PMCID: PMC5993264 DOI: 10.1016/j.lrr.2018.01.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 01/02/2018] [Accepted: 01/12/2018] [Indexed: 11/19/2022] Open
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98
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Lombardo EM, Maito FLDM, Heitz C. Solitary plasmacytoma of the jaws: therapeutical considerations and prognosis based on a case reports systematic survey. Braz J Otorhinolaryngol 2018; 84:790-798. [PMID: 29941386 PMCID: PMC9442862 DOI: 10.1016/j.bjorl.2018.05.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Revised: 04/24/2018] [Accepted: 05/01/2018] [Indexed: 11/29/2022] Open
Abstract
Introduction Solitary plasmacytoma is a rare malignant tumor of plasma cells with no evidence of systemic proliferation. There are two known subtypes: extramedullary solitary plasmacytoma and solitary bone plasmacytoma. The etiology is still unknown. Both lesions present a risk of progression to multiple myeloma. A number of approaches have been used for treatment of solitary plasmacytoma. Objective To carry out a systematic review of the case reports described in the literature, focusing on therapeutic and prognostic aspects. Methods A search of clinical case reports was performed in the PubMed database using Mesh Terms related to “plasmacytoma” under the following criteria: type of study (case report), articles in English language, conducted in humans, with no publication date limits. Results Of the 216 articles found, only 21 articles met the pre-established inclusion criteria. Conclusion The occurrence of solitary bone plasmacytoma in the bones of the face is a rare condition prevalent between the 4th and 6th decades of life, located in the posterior region of the mandible in most cases. Histopathological examination and systemic investigation are mandatory for confirmation of diagnosis.
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99
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Pasricha S, Singh N, Panaych A, Mehta A. Bizarre multilobated myeloma cells mimicking megakaryocytes. Hematol Oncol Stem Cell Ther 2018; 11:248-250. [PMID: 29792844 DOI: 10.1016/j.hemonc.2018.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2018] [Revised: 03/27/2018] [Accepted: 04/27/2018] [Indexed: 10/16/2022] Open
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100
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Lok R, Golovyan D, Smith J. Multiple myeloma causing interstitial pulmonary infiltrates and soft-tissue plasmacytoma. Respir Med Case Rep 2018; 24:155-157. [PMID: 29977785 PMCID: PMC6010646 DOI: 10.1016/j.rmcr.2018.05.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2017] [Revised: 05/18/2018] [Accepted: 05/18/2018] [Indexed: 11/24/2022] Open
Abstract
Multiple Myeloma (MM) is a relatively rare disease and MM presenting outside the bone marrow, known as extramedullary myeloma (EMM), is rarer still. While the liver and CNS are most commonly affected in EMM, the lung parenchyma is an especially unusual site of involvement. We present the case of a 64-year-old male with known history of MM admitted with acute respiratory failure and a chest wall mass. Chest CT revealed patchy interstitial and alveolar opacities with no pulmonary masses or nodules. Bronchoalveolar lavage (BAL) was performed, with flow cytometry demonstrating monoclonal plasma cells expressing CD38, CD138 and CD56 with lambda light chain restriction. Fine Needle Aspiration of chest wall mass revealed CD138-positive cells as well. Review of the literature revealed only one other documented case of a patient presenting with both interstitial lung parenchymal involvement with MM as well as soft tissue plasmacytoma, with this occurring in a patient who had previously underwent stem cell transplant. To our knowledge, we report the first recorded case of this presentation in a patient without a history of stem cell transplantation. Furthermore, it demonstrates the utility of using BAL, rather than lung biopsy, to establish the diagnosis through less invasive means.
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