Extramedullary plasmacytoma of the bladder: a case report and review of literature

Plasma cell neoplasms of the bladder: a series of 9 cases

From 2009 to 2017, we identified 9 cases of plasma cell neoplasms on biopsies of the bladder in patients without a history of plasma cell myeloma or transplantation (6 men and 3 women). Four of the nine showed amyloid deposition, of which one additionally revealed a clear cell adenocarcinoma of the bladder. Follow-up was obtained in 7 cases. Of 3 cases (including 2 with amyloid) for which electrophoresis and immunofixation results were obtained, the 2 amyloid cases showed evidence of serum or urine paraproteins: serum IgM kappa in a patient with kappa light chain-restricted plasma cell neoplasm and urine IgA lambda in a patient with lambda light chain-restricted plasma cell neoplasm. By way of contrast, 1 case with kappa light chain-restricted plasma cell neoplasm in the absence of amyloid showed no serum monoclonal protein. Bone marrow biopsy results were obtained in the 2 amyloid cases revealing a population of 5% or less plasma cells with no assessment of clonality and, thus, were not diagnostic of plasma cell myeloma. In congruence, the 2 amyloid cases also showed no radiologic evidence of systemic plasma cell myeloma. One patient with plasma cell neoplasm only received chemotherapy and radiation without subsequent biopsies; one patient with plasma cell neoplasm, amyloid, and clear cell adenocarcinoma received radiation with an absence of neoplastic disease on subsequent biopsies. In addition, no evidence of systemic amyloid was found in the cases with bladder amyloidosis. Plasma cell neoplasms of the bladder, with and without amyloid deposition, are rare; this is the first known case series. In 7 cases with follow-up, plasma cell myeloma did not appear to manifest in a 1- to 127-month follow-up. However, paraproteins were identified on further testing in 2 cases with amyloid. Although bladder plasma cell neoplasms with and without amyloid tend to have a favorable prognosis in short-term follow-up, our study supports the need for additional workup for systemic disease, particularly in those with concurrent amyloidosis.

Primary urethral plasmacytoma: a case report and literature review

Plasmacytomas of the urethra are extremely rare neoplasias; they may occur as isolated tumors or concomitantly with generalized multiple myeloma. Herein, we describe the clinical presentation and characteristics of a patient with primary plasmacytoma of the urethra. A 51-year-old man presented with terminal hematuria and a palpable penile mass. Magnetic resonance urethrography revealed a 3-cm long stenotic segment along which the urethral mucosa was found to be irregular. On urethroscopy, papillary mucosal projections extending to the presphincteric area were noted. Lesions were found to be composed primarily of neoplastic plasma cells capable of producing mainly lambda light chain. Upon diagnosis, the patient received external beam radiation therapy targeting the pelvic region. The lesion diminished in size progressively during the treatment course. He was disease-free after 6 months. Although it is a relatively rare disease, primary urethral plasmacystoma should be considered in the differential diagnosis of urethral tumors and radiation therapy should be an integral part of the treatment strategy.

Plasmacytoma of the urinary bladder in a renal transplant recipient

A 28-year-old woman underwent renal transplantation in 1993. Eight years later, she experienced macroscopic hematuria, and Epstein-Barr virus-negative solitary extramedullary plasmacytoma (EMP) of the urinary bladder was diagnosed. After the reduction of immunosuppressive therapy, she received combined chemotherapy, resulting in complete tumor disappearance. However, 10 months later, she relapsed with aggressive multiple EMP and died of disease progression in 2003. This report is the first of a case of solitary EMP of the urinary bladder appearing as posttransplantation plasma cell dyscrasias after renal transplantation.

CT features of abdominal plasma cell neoplasms

The aim of this study was to describe the CT features of abdominal plasma cell neoplasms. We reviewed CT imaging findings in 11 patients (seven men, four women; mean age 62 years) with plasma cell neoplasms and abdominal involvement. Helical CT of the entire abdomen and pelvis was performed following intravenous administration of contrast material. Images were analyzed in consensus by two radiologists. Diagnoses were made from biopsy, surgery and/or clinical follow-up findings. Multiple myeloma was found in seven patients and extramedullary plasmacytoma in four patients. All patients with multiple myeloma had multifocal disease with involvement of perirenal space (4/7), retroperitoneal and pelvic lymph nodes (3/7), peritoneum (3/7), liver (2/7), subcutaneous tissues (2/7) and kidney (1/7). In three of the four patients with extramedullary plasmacytoma, a single site was involved, namely stomach, vagina and retroperitoneum. In the fourth patient, a double site of abdominal involvement was observed with rectal and jejunal masses. Plasma cell neoplasm should be considered in the differential diagnosis of single or multiple enhancing masses in the abdomen or pelvis. Abdominal plasma cell neoplasms were most frequently seen as well-defined enhancing masses (10/11).

Extramedullary plasmacytoma invading the bladder: case report and review of the literature

Multiple myeloma is characterized by neoplastic proliferation of a single clone of plasma cells engaged in the production of a monoclonal protein. This condition affects mainly the bone marrow, but extramedullary manifestations can be seen in any organ. Urinary bladder involvement is extremely rare, with only 14 cases reported in the literature to our knowledge. Herein, we report a large extramedullary bladder plasmacytoma arising in a patient with history of multiple myeloma. A 78-year-old woman with history of multiple myeloma, currently in remission, presented with a large intravesical tumor. Because the tumor was considered to have characteristics of anaplastic neoplasm from transitional cell origin with evidence of deep muscular invasion, a radical cystectomy was performed. A subsequent microscopic evaluation of the cystectomy specimen revealed round cells with an eccentric cartwheel-like nucleus suggestive of plasmacytoma. The diagnosis was further confirmed with immunohistochemical studies. It is difficult, according to the literature, to distinguish bladder plasmacytoma from anaplastic transitional cell tumors. It is important to provide the pathologist with an appropriate history and to have a high index of suspicion for bladder plasmacytoma in patients with previous diagnosis of multiple myeloma and bladder mass.

Malignant lymphoma of the urinary bladder: a clinicopathological study of 11 cases

AIM

To report the clinical and histological features and outcome of primary and secondary malignant lymphomas of the urinary bladder.

METHODS

Eleven cases of malignant lymphoma of the urinary bladder were obtained from the registry of cases at St Bartholomews and the Royal London Hospitals. The lymphomas were classified on the basis of their morphology and immunophenotype, and the clinical records were reviewed.

RESULTS

There were six primary lymphomas: three extranodal marginal zone lymphomas of mucosa associated lymphoid tissue (MALT) type and three diffuse large B cell lymphomas. Of the five secondary cases, four were diffuse large B cell lymphomas, one secondary to a systemic follicular follicle centre lymphoma, and one nodular sclerosis Hodgkins disease. Four patients with secondary lymphoma for whom follow up was available had died of disease within 13 months of diagnosis. Primary lymphomas followed a more indolent course. In one case, there was evidence of transformation from low grade MALT-type to diffuse large B cell lymphoma. The most common presenting symptom was haematuria. Cystoscopic appearances were of solid, sometimes necrotic tumours resembling transitional cell carcinoma, and in one case the tumours were multiple. These cases represented 0.2% of all bladder neoplasms.

CONCLUSIONS

Diffuse large B cell lymphoma and MALT-type lymphoma are the most common primary malignant lymphomas of the bladder. Lymphoepithelial lesions in MALT-type lymphoma involve transitional epithelium, and their presence in high grade lymphoma suggests a primary origin owing to transformation of low grade MALT-type lymphoma. Primary and secondary diffuse large B cell lymphomas of the bladder are histologically similar, but the prognosis of the former is favourable.

Autologous bone marrow transplantation for intra-abdominal extramedullary plasmacytoma

A patient with an extramedullary plasmacytoma of the omentum and ovaries is described. In spite of the presence of a very high concentration of paraprotein (103.5 g/l IgG k), bone marrow involvement was not demonstrated either at presentation or during the course of the disease. After debulking surgery, chemotherapy (vincristine, prednisone, and cyclophosphamide) was initiated. Although this resulted in considerable improvement, the paraproteinemia persisted. After ten courses of chemotherapy there was recurrence of the tumor with involvement of the lymph nodes in the right axilla. Chemotherapy was changed to a CHOP regimen (cyclophosphamide, adriamycin, vincristine, and prednisone), followed by autologous bone marrow transplantation with the BEAM regimen (BCNU, etoposide, cytarabine, melphalan) as conditioning therapy. The patient was still in complete remission 1 year after transplantation. This case demonstrates that an extramedullary plasmacytoma may become manifest as extensive but localized disease with high levels of paraprotein, and that autologous bone marrow transplantation as a therapeutic modality can lead to prolonged complete remission of the disease.

Fine-needle aspiration of pancreatic extramedullary plasmacytoma: possible confusion with islet cell tumor

We report two cases of extramedullary plasmacytoma (EMP) of the pancreas, diagnosed by fine-needle aspiration (FNA). Plasmacytoma of the pancreas is a rare neoplasm with only 12 cases recorded in the literature. Because of its scarcity and the cytomorphologic similarity between plasma cells and endocrine cells, EMP of the pancreas may be confused with neuroendocrine (islet cell) tumors of the pancreas. Immunohistochemical staining for light chain and/or neuroendocrine markers will prevent diagnostic error when interpreting plasmacytoid neoplasms of any site susceptible to endocrine tumors, including the pancreas.

Extramedullary plasmacytoma of the bladder: case report and review of the literature

Primary plasmacytoma of the bladder is extremely rare, with only 10 cases reported in the literature. We report on a patient who was treated unsuccessfully with radiation and subsequently underwent anterior exenteration with ileo-conduit construction.

Massive hematuria due to extramedullary plasmacytoma invading the bladder

Bladder involvement by extramedullary plasmacytoma is a rare condition. A 46-year-old woman with known IgA-lambda multiple myeloma who developed this condition is described. The patient suffered from massive hematuria, which led to hypovolemic shock. Prompt supportive treatment by blood transfusions, fulguration of the bleeding mucosa and continuous bladder irrigation stopped the bleeding. Subsequent bladder irradiation lead only to partial response of the tumor.

Extramedullary plasmacytoma (EMP) of urinary bladder

An extramedullary plasmacytoma (EMP) is presented with an isolated lesion in the urinary bladder accompanying an IgG-K paraproteinemia. After a short-term oral melphalan administration, the tumor soon regressed together with the paraprotein, and has never recurred during the two-year follow-up. This is the fourth case of primary EMP of the urinary bladder reported in the literature.

Extramedullary plasmacytoma of the urethra: a case report

Extramedullary plasmacytomas are uncommon manifestations of plasma cell neoplasms, which occur rarely in the urinary tract. We report to our knowledge the third case of primary IgA plasmacytoma of the urethra. Diagnosis, therapy and followup with magnetic resonance imaging are presented.

Multiple myeloma of the bladder and vagina

A case is described of multiple myeloma with involvement of the urinary bladder and vagina. The patient was admitted with hematuria and postrenal obstruction. She was treated successfully with local radiotherapy and combination chemotherapy with vincristine, Adriamycin (doxorubicin), and dexamethasone (VAD).

Extramedullary plasmacytoma of the testicle. Sonographic appearance and ultrasonically guided biopsy

Extramedullary plasmacytomas of the testis are extremely rare. This is a report of a patient with plasmacytoma of the testicle who also had an extramedullary plasmacytoma of the epipharynx 12 months earlier. Sonography (US) scans showed a heterogeneous mass of the right testicle with hypoechoic echo pattern; ultrasonically guided fine-needle aspiration biopsy (UGFNAB) allowed confirmation of the diagnosis. Immunoperoxidase studies, performed on histologic specimen after a radical right orchiectomy showed a monoclonal staining pattern of intracellular immunoglobulin for IgA-K type. Bone marrow biopsy, skeletal X-ray and immunoelectrophoresis were all within normal limits. The patient was successfully treated by surgery and is still alive with no evidence of disease.

Plasmacytoma of the urethra treated with transurethral resection and radiotherapy

Plasmacytoma, which is a localized malignant plasma cell tumor, occurs rarely and is found mostly in the upper airways of older patients. Two urethral plasmacytomas have been reported, 1 of which was a primary lesion. We describe a primary plasmacytoma of the urethra in a 23-year-old woman who had been exposed to diethylstilbestrol in utero. The patient underwent transurethral resection of the tumor and radiation therapy and has been free of disease for more than 10 years.

Metastatic extramedullary plasmacytoma: a case report and review of the literature of a rare pseudocarcinoma

Extramedullary plasmacytomas are unusual plasma cell tumors arising outside the bone marrow. Most extramedullary plasmacytomas are solitary, but occasionally they disseminate, usually in conjunction with systemic myelomatosis. The authors report a case of disseminated extramedullary plasmacytoma with a picture suggestive of metastatic pancreatic carcinoma. This unusual presentation reconfirms the need for tissue diagnosis in all suspected cases of pancreatic carcinoma and demonstrates that extramedullary plasmacytoma can be an aggressive cancer without any sign of osseous or systemic disease.

Plasma cell dyscrasias: current status

This is a review of the current status of the monoclonal gammopathies (plasma cell dyscrasias). We begin with the recognition of a monoclonal protein in serum and urine. We briefly discuss the differential diagnosis of the monoclonal gammopathies. Clinical and laboratory findings as well as the management of multiple myeloma are addressed. Future approaches for the treatment of myeloma are provided. The variant forms of multiple myeloma, including smoldering myeloma, plasma cell leukemia, nonsecretory myeloma, IgD myeloma, osteosclerotic myeloma, solitary plasmacytoma of bone, and extramedullary plasmacytoma, are briefly reviewed. Diagnosis and treatment of Waldenström's macroglobulinemia are presented. The recognition and differential diagnosis of the heavy-chain diseases (gamma, alpha, and mu) are included. Monoclonal gammopathy of undetermined significance ("benign" monoclonal gammopathy) is presented in detail. Amyloidosis is not included in this review.

Renal plasmacytoma: a case report and summary of reported cases

Although multiple myelomas occur fairly frequently, extramedullary plasmacytomas are uncommon. To date, only 7 cases of renal plasmacytoma have been documented. We report case 8 and discuss its management.