Primary orbital plasmacytoma mimicking lacrimal gland tumor

Extramedullary plasmacytoma is a rare plasma cell malignancy, comprising 3% of the whole group. The involvement of orbit is even rarer since 80% of extramedullary plasmacytoma have been reported from upper respiratory tract, followed by gastrointestinal tract. The disease is thrice more common in males than females and is more common in 6th to 7th decade of life, but we are reporting a case of extramedullary plasmacytoma presenting as lacrimal gland tumor in a 59-year-old female. The correct diagnosis is essential since the disease is highly radiosensitive and responds well to radiotherapy unlike other malignancy in this region. A high index of suspicion with imaging and careful use of fine needle aspiration cytology helps in diagnosis and prompt treatment.

Rare pancreas tumor mimicking adenocarcinoma: Extramedullary plasmacytoma

Neoplastic proliferation of plasma cells is called plasma cell dyscrasias, and these neoplasms can present as a solitary neoplasm or multiple myeloma. Extramedullary plasmacytoma, in particular pancreatic plasmacytoma, is a rare manifestation of multiple myeloma. Although computerized tomography is useful for the diagnosis of extramedullary plasmacytoma, there are no specific radiologic markers that distinguish it from adenocarcinoma. Histological confirmation by biopsy is necessary for accurate diagnosis and management of the tumor. Endosonography is the most sensitive method for the diagnosis of pancreatic tumors, and the use of fine needle aspiration by endosonography is associated with a lower risk for malignant seeding and complications. Here, we report a case of pancreatic plasmacytoma in newly identified multiple myeloma as diagnosed by endosonography. Endosonography is a reliable and rapid method for the diagnosis of extramedullary plasmacytoma. Therefore, endosonographic fine needle aspiration should be the first choice for histological evaluation when pancreatic plasmacytoma is suspected. Ideally, the pathology would be performed at the same site as endosonographic biopsy.

Cranial plasmacytoma: a case series and review of the literature

Plasmacytomas are malignant proliferations of plasma cells which can occur with different plasma cell dyscrasias. Solitary plasmacytomas of bone or extraosseous plasmacytomas, depending on the tissue of origin, develop in isolation without systemic manifestations of multiple myeloma. Three cases of cranial plasmacytomas are described, two in patients with multiple myeloma and one extraosseous plasmacytoma. Management options are discussed.

Anaplastic Solitary plasmacytoma of mandible, masquerading as sarcoma

Plasma cell neoplasm is characterized by a monoclonal neoplastic proliferation of plasma cells and solitary plasmocytoma of bone (SPB) is a localized form. It usually occurs in vertebrae and secondarily in long bones. Its presence in mandible is extremely rare event. A 48-year-old man consulted to our clinic with a chief complaint of pain in his mandible. Radiography revealed a destructive lesion in body and ramus. The initial pathologic evaluation revealed a high grade pleomorphic neoplasm. The diagnosis was confirmed by immunohistochemical markers. Overall, plasmacytoma with anaplastic features can be confused with high grade sarcoma clinically and histologically.

Solitary plasmacytoma of the sternum

Plasmacytoma is a plasma cell neoplasm that locally infiltrates a bone or spreads to extramedullary areas. A new World Health Organization criterion defines solitary plasmacytoma of bone as a localized bone tumor consisting of plasma cells identical to those seen in plasma cell myeloma, which is manifested as a solitary osteolytic lesion in a radiological evaluation. Primary tumors of the sternum are generally malignant, and solitary plasmacytomas of the sternum are very rare tumors. We present herein the case of a patient who had a primary sternal tumor with solitary plasmacytoma and no evidence of multiple myeloma.

TORC1 and class I HDAC inhibitors synergize to suppress mature B cell neoplasms

Enhanced proliferative signaling and loss of cell cycle regulation are essential for cancer progression. Increased mitogenic signaling through activation of the mTOR pathway, coupled with deregulation of the Cyclin D/retinoblastoma (Rb) pathway is a common feature of lymphoid malignancies, including plasmacytoma (PCT), multiple myeloma (MM), Burkitt's lymphoma (BL), and mantle cell lymphoma (MCL). Here we evaluate the synergy of pharmacologically affecting both of these critical pathways using the mTOR inhibitor sirolimus and the histone deacetylase inhibitor entinostat. A dose-matrix screening approach found this combination to be highly active and synergistic in a panel of genetically diverse human MM cell lines. Synergy and activity was observed in mouse PCT and human BL and MCL cell lines tested in vitro, as well as in freshly isolated primary MM patient samples tested ex vivo. This combination had minimal effects on healthy donor cells and retained activity when tested in a co-culture system simulating the protective interaction of cancer cells with the tumor microenvironment. Combining sirolimus with entinostat enhanced cell cycle arrest and apoptosis. At the molecular level, entinostat increased the expression of cell cycle negative regulators including CDKN1A (p21) and CDKN2A (p16), while the combination decreased critical growth and survival effectors including Cyclin D, BCL-XL, BIRC5, and activated MAPK.

Outcome of surgical decompression of spinal mass lesions in non-Hodgkin's lymphoma and plasmacytoma

OBJECTIVE

Surgical treatment for spinal mass lesions due to non-Hodgkin's lymphoma (NHL) or plasmacytoma is necessary only in rare instances. The purpose of this study was to investigate long-term outcome and quality of life of surgery combined with postoperative chemotherapy or radiochemotherapy.

METHODS

The data of patients, who underwent spinal surgery for mass lesions in a 10-year periods were reviewed, identifying 10 patients with a histopathological diagnosis of NHL or plasmacytoma. Functional outcome were assessed by the Karnofsky Performance Score (KPS), quality of life by the Short Form-36 (SF-36) Health Survey Questionnaire, and pain by the Visual Analog Scale (VAS).

RESULTS

Clinical presentations included pain (n=10), paresis (n=5), and sensory deficits (n=5). Surgical treatment included removal of the mass lesion (total, n=5; subtotal, n=5) for decompression, interbody fusion (n=3), and corporectomy followed by stabilization (n=1). Histopathological findings revealed NHL in five patients and plasmacytoma/multiple myeloma in five other patients. Postoperatively, all patients underwent chemotherapy or radiochemotherapy. Mean follow-up time was 38 months. At the last follow-up, 2 patients had succumbed to progression of disease. Pain intensity remained significantly reduced as compared to preoperatively (p=0.049). The KPS was 90-100% in five patients still alive, 70% in two, and 60% in one. SF-36 subscores were lower as compared to age-matched healthy controls.

CONCLUSIONS

This retrospective study shows that surgical decompression of spinal mass lesions is a valuable option in selected patients with NHL or plasmacytoma to improve neurological deficits and control pain. Long-term outcome after postoperative adjuvant therapy confirms prolonged stability of quality of life.

Primary Isolated Extramedullary Plasmacytoma in the Colon

Primary isolated extramedullary plasmacytoma is a rare tumor. Although it commonly involves nasopharynx or upper respiratory tract, only 10% of cases involves the gastrointestinal tract. Stomach and small intestine are the most commonly involved sites in the gastrointestinal tract. Primary isolated extramedullary plasmacytoma of colon is extremely rare. We report a case of 45-year-old man who presented with 1-year history of lower abdominal pain. Colonoscopy showed a colonic stricture about 50 cm from the anal verge. Colonoscopic biopsy showed lymphoid hyperplasia. On computed tomography, enhancing circumferential wall thickening and luminal narrowing with pericolic lymph node enlargement in the transverse colon was identified. Patient underwent extended left hemicolectomy. Histopathologic examination of resected colon identified an isolated primary colonic plasmacytoma of 1.7 cm in diameter with regional lymph node involvement (8/50 positive). To administer adequate treatment, further study about clinical features of primary isolated extramedullary plasmacytoma of colon is necessary.

A case of mucosa-associated lymphoid tissue lymphoma of the gastrointestinal tract showing extensive plasma cell differentiation with prominent Russell bodies

A 73-year-old Japanese woman was hospitalized for detailed examination of nausea, diarrhea and loss of appetite. Atypical erosion in the ileum was found on endoscopy. Biopsy of this erosion showed proliferation of cells containing numerous Russell bodies. Differential diagnoses considered were Russell body enteritis, crystal-storing histiocytosis, Mott cell tumor, immunoproliferative small intestinal disease (IPSID) and mucosa-associated lymphoid tissue (MALT) lymphoma. The cells containing prominent Russell bodies showed diffuse positivity for CD79a and CD138, but negative results for CD20, CD3, UCHL-1, CD38 and CD68. Russell bodies were diffusely positive for lambda light chain, but negative for kappa light chain, and immunoglobulin (Ig) G, IgA and IgM. Based on these findings, Russell body enteritis, crystal-storing histiocytosis and IPSID were ruled out. As the tumor formed no mass lesions and was restricted to the gastrointestinal tract, MALT lymphoma with extensive plasma cell differentiation was finally diagnosed. The patient showed an unexpectedly aggressive clinical course. The number of atypical lymphocytes in peripheral blood gradually increased and T-prolymphocytic leukemia (T-PLL) emerged. The patient died of T-PLL 7 mo after admission. Autopsy was not permitted.

Isolated laryngeal plasmacytosis

INTRODUCTION

Laryngeal plasmacytosis (LP) is a rare benign lesion of mature polyclonal plasma cells, which should be differentiated from extramedullary plasmacytoma.

CASE REPORT

Isolated laryngeal plasmacytosis was discovered in a 59-year-old woman, free of symptoms other than chronic hoarseness.

DISCUSSION

Histological presentation, treatment modalities and prognosis are discussed.

CONCLUSION

Laryngeal plasmacytosis is a rare benign lesion that must be considered in case of submucosal polyclonal plasma cell infiltrate.

Helical tomotherapy and systemic targeted therapies in solitary plasmacytoma: Pilot study

AIM: To assess the feasibility of the combination of helical tomotherapy^® (HT) and a concurrent systemic targeted therapy in patients with solitary plasmacytoma (SP) with the aim to decrease toxicity while improving therapeutic efficacy.

METHODS: Six patients with biologically, histologically, and radiologically confirmed SP were treated using HT and a systemic targeted treatment concomitantly. Total dose was 40 Gy/20 fractions. Four patients received 4 cycles of concurrent lenalidomide-dexamethasone combination and two patients were treated with concomitant bortezomib-dexamethasone. All toxicities were described using the Common Terminology Criteria for Adverse Effects v3.0.

RESULTS: Five patients had a bone tumor and one patient had an isolated pancreatic mass. Five patients presented with pain, one had neurologic symptoms related to medullary compression, which was treated by an emergency surgery. Median age was 59.5 years (range, 50-74 years). All patients had initial positron emission tomography-computed tomographys, three patients had total body bone magnetic resonance imaging examination, and three patients had computed tomodensitometry scans. The toxicity profile was excellent with no higher than grade 1 toxicity. Four of the six patients experienced a partial radiological response, four had complete response on positions emission tomography and 5/6 patients experienced a complete relief of their symptoms 4 mo after treatment. At a median follow-up of 18 mo, 5/6 patients were controlled clinically, radiologically, and biologically.

CONCLUSION: Using HT, we could deliver a highly conformal irradiation concurrently with a molecularly targeted therapy. This association yielded in a high response rate and a low toxicity. A prospective study with longer follow-up will help determining the true benefit of such strategy.

Occurrence of multiple myeloma in the head and neck: a report of two cases

Multiple myeloma (MM) is a disease reported to account for 1% of all cancers and 10% of hematological malignant diseases. Unlike other malignant diseases that are transferred to the osseous tissues, MM does not show new bone formation, is associated with characteristic osteolytic lesions, and shows monoclonal protein (M-protein) on the immunohematological test, which is an important index in its diagnosis. Solitary lesions of MM are rare in the head and neck area, and, in most cases, MM of the head and neck area is related to systemic sympomts.

Extramedullary plasmacytoma of the nasal cavity report of three cases with review of the literature

Extramedullary plasmacytoma is a rare neoplasm characterized by monoclonal proliferation of plasma cells. Most lesions occur in the head and neck, primarily in the upper aerodigestive tract. The nasal cavity and nasal septum are the most common sites of occurrence. In this report, three patients admitted in our clinic with history of nasal obstruction and/or epistaxis. Patients were diagnosed with extramedullary plasmacytoma and mass were completely excised. This entity usually occurred in 5th-6th decade of life. One of our patients, a young man, was completely asymptomatic and following a paroxysm of coughing, a polypoid mass was expectorated. The clinical and histopathologic findings of plasmacytoma are discussed. In order to exclude systemic involvement, systematic approach using clinical, laboratory, and radiologic investigations was performed. Extramedullary plasmacytoma of the nasal cavity is rare and should be considered in the differential diagnosis of nasal cavity masses especially in young age group.

A hole in the skull: CT manifestations of a solitary plasmacytoma in skull

Plasmacytoma can present as multiple myeloma, solitary plasmacytoma of the bone (SPB), or extramedullary plasmacytoma. SPB is a rare entity that composes of malignant plasma cells and involves the bone to form only one or two lesions without evidence of disease dissemination. It accounts for only 4% of malignant plasma cell tumors. We report a case of SPB in the skull in a 59-year-old male. CT scan revealed an 8 cm ×9 cm osteolytic lesion on the scalp of skull with a well demarcated margin. A cake-like mass was revealed at CT soft tissue window. The mass was completely excised and histological examination revealed plasmacytoma. The diagnosis of SPB was established after ruling out multiple myeloma.

Extramedullary plasmacytoma presenting as a solitary mass in the intracranial posterior fossa

A patient with a 3-month history of headache refractory to pain medication was admitted. The CT scan and MRI showed evidence of a posterior fossa mass. This was pathologically confirmed as an extra medullary plasmacytoma (EMP). He had a pathologic fracture of the left humerus 7 years ago while the radiologist was unaware at the time of diagnosis. A solitary bone plasmacytoma (SBP) was the cause of the pathologic fracture. This report includes the first description of MRI findings in a patient with a rare-incidence intracranial solitary extra medullary plasmacytoma (SEP) in Iran. There is a striking similarity between the features of intracranial SEP and meningiomas. Intracranial SEP, although rare, should be included in the differential diagnosis of brain tumors in areas where meningiomas commonly arise. The MRI findings and differential diagnosis of plasmacytoma are reviewed. Before this case report, only few cases have been reported in the literature. Nonetheless, this is the first report of posterior fossa EMP from Iran.

Solitary plasmacytoma of the rib

Solitary plasmacytoma of the bone, and especially of a single rib, is a rare disease. Here we report a 73-year old male patient complaining of continuous chest wall pain around the right 5th rib shaft who underwent a wide excision of the rib tumor with surrounding connective tissue. He was diagnosed with solitary plasmacytoma and will undergo radiation therapy. We report this case with a review of the literature.

[Primary pancreatic plasmacytoma]

Extramedullary plasmacytomas are uncommon malignant plasma cell tumors that present outside the bone marrow; 80% of extramedullary plasmacytomas are located in the upper respiratory tract, and gastrointestinal plasmacytomas are rare. We present the case of an asymptomatic 65-year-old man in whom a pancreatic mass was found incidentally. The lesion was determined to be a pancreatic plasmacytoma after fine-needle aspiration cytology and surgical resection. No clinical, laboratory, or imaging findings indicative of multiple myeloma or association with other plasmacytomas were found, so the tumor was considered to be a primary pancreatic plasmacytoma.

Plasmacytoma of the nasolacrimal duct simulating dacryocystitis: an uncommon presentation for extramedullary relapse of multiple myeloma

The most common site for localized forms of plasma cell neoplasms (extramedullary plasmacytoma; EMP) is the upper respiratory tract, including the oropharynx, nasal cavities, sinuses and larynx. A 50-year-old woman with a history of myeloma in complete remission after autologous stem cell transplantation complained of two weeks of epiphora of the left eye with subsequent diplopia, bloody nasal discharge and progressive swelling around the nasolacrimal sac. A solitary mass in the left sinonasal area, extending to the nasolacrimal duct (NLD) was detected on MRI, whose histopathological examination was consistent with plasmacytoma. Further clinical investigation ruled out multiple myeloma (MM). The patient underwent debulking surgery and adjuvant chemotherapy followed by local radiotherapy in an attempt to achieve complete response. Despite being a rare entity, EMP of the NLD should be considered in the differential diagnosis of epiphora and dacryocystitis. To our knowledge, this is the first case of a plasmacytoma of the NLD presenting as isolated extramedullary relapse of MM. The follow-up in EMPs should include appropriate imaging studies, a systemic workup to rule out MM.

[Percutaneous Image-guided cryoablation for localized bone plasmacytoma treatment]

Bone plasmacytoma (BP) occurs in most patients with multiple myeloma and is highly disabling. Radiotherapy is the primary treatment modality for BP and, although local control rates are excellent, several weeks are needed before the treatment is completed and for patients to note significant pain relief. Over the past decade, percutaneous image-guided cryoablation has emerged as a safe and effective alternative in the management of localized bone metastasis in solid tumours. In this report the author's show that a localized BP was successfully treated using this procedure. Furthermore, some of the most relevant potential advantages that makes this procedure more attractive than other alternative techniques are highlighted.

Paratesticular solitary plasmacytoma

Primary solid neoplasms of the extratesticular tissues are rare. The reported prevalence rate of paratesticular neoplasms is between 3% and 16% of all patients referred for scrotal ultrasonography. A plasmacytoma is a discrete, solitary mass of malignant monoclonal plasma cells that can arise in any part of the body. In this report, we present a case of a paratesticular solid mass detected in an 80-year-old patient that proved to be primary extraosseous plasmacytoma on surgery, and discuss its sonographic features.

Solitary extramedullary plasmacytoma of the sinonasal region

Less than 10% of the patients with plasma cell neoplasms present with a solitary plasmacytoma. Though the nasal cavity is a common extramedullary site, the occurrence is extremely rare. Two cases of solitary extramedullary plasmacytoma of the sinonasal region are reported. The first of which is sinonasal plasmacytoma with concomitant HIV, an association that has been reported rarely in literature to date and is matter of much debate. In the second case report, we present an instance of surgical excision of the tumor using KTP 532 laser. The diagnosis was established using immunohistochemical techniques and multiple myeloma workups were negative in all cases.

Plasmacytoma of tonsil diagnosed by fine-needle aspiration cytology

Extramedullary plasmacytoma of tonsil is rare. Even though biopsy is necessary for final diagnosis, fine-needle aspiration cytology (FNAC) can provide useful information in the management of such cases. We report a case of plasmacytoma of tonsil diagnosed by FNAC in a 43-year-old man who presented with a swelling in the right tonsillar area. FNAC smears revealed sheets of plasma cells at various stages of maturation. Subsequent histopathological and immunohistochemical studies confirmed the diagnosis of plasmacytoma. This case is reported for the rarity of site for extramedullary plasmacytoma and to highlight the usefulness of FNAC in lesions of tonsil.

Complete endoscopic resection of very early stage gastric plasmacytoma

Gastric plasmacytomas are very rare, and most are not detected until the disease has progressed to an advanced stage. However, there have been recent reports of cases of early-stage gastric plasmacytoma, in which neoplastic cells are confined to the mucosa or submucosa. Here we report a case of a very early stage gastric plasmacytoma that was confined to the lamina propria of the gastric mucosa. The lesion was successfully and completely removed by endoscopic submucosal dissection, and the surveillance endoscopy showed no recurrence during the follow-up of 40 months. This report appears to be the first documented case of complete endoscopic removal of a primary gastric plasmacytoma.

Update on the Diagnosis and Classification of the Plasma Cell Neoplasms

The plasma cell neoplasms are malignancies of the most terminally differentiated cells in B-cell ontogeny and are usually associated with the production of a monoclonal immunoglobulin molecule or M protein. These malignancies include tumors whose clinical manifestations are directly attributable to the end-organ damage induced by the dysregulated proliferation of neoplastic plasma cells. In contrast, disorders, such as primary amyloidosis, have a paradoxically low burden of neoplastic plasma cells, rendered highly pathogenic by the end-organ damage induced by deposition of the secreted paraprotein. In this article, discussion focuses on plasma cell myeloma. The molecular pathogenesis of plasma cell myeloma is reviewed and the diagnosis of the plasma cell neoplasms discussed.