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Zhang YH, He YF, Yue H, Zhang YN, Shi L, Jin B, Dong P. Solitary hyoid plasmacytoma with unicentric Castleman disease: A case report and review of literature. World J Clin Cases 2022; 10:13364-13372. [PMID: 36683640 PMCID: PMC9850993 DOI: 10.12998/wjcc.v10.i36.13364] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/17/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Solitary plasmacytoma and unicentric Castleman disease (UCD) are rare lymphoproliferative disorders characterized by monoclonal plasma cells and a single set of locally enlarged lymph nodes, respectively.
CASE SUMMARY A 48-year-old Han Chinese man presented to our department with a neck mass and progressive foreign body sensation in his throat. 18F-FDG positron emission tomography revealed focally increased radioactivity centered around the hyoid, and computed tomography (CT) revealed osteolytic lesions. Histopathology revealed Castleman-like features and CD138/CD38-positive mature plasma cells. Systemic work-up ruled out the possibility of POEMS syndrome, lymphoma, and multiple myeloma, leading to a final diagnosis of solitary hyoid plasmacytoma with UCD. The patient underwent partial hyoid resection and selective neck dissection, followed by intensity-modulated radiotherapy. 99mTc-MDP single-photon emission computed tomography/CT reevaluation showed neither local recurrence nor distant bone metastasis at the 40-mo follow-up.
CONCLUSION The diagnostic process and differential diagnosis of this rare case provided valuable educational information to clinicians.
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Affiliation(s)
- Yan-Hui Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Yi-Feng He
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Hao Yue
- Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Yue-Ni Zhang
- NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150028, Heilongjiang Province, China
| | - Lei Shi
- NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150028, Heilongjiang Province, China
| | - Bin Jin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Pin Dong
- Department of Otolaryngology-Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
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Lan X, Sun W, Guo Y, Chang X, Wang G, Hu R. Better prognosis in POEMS patients with cerebral infarction before polyneuropathy. Heliyon 2022; 8:e12201. [PMID: 36578403 PMCID: PMC9791334 DOI: 10.1016/j.heliyon.2022.e12201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Revised: 07/14/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022] Open
Abstract
POEMS syndrome is a plasma cell disease. Clinical manifestations and clinical onset are variable. In recent years, more and more cases of POEMS syndrome with cerebrovascular disease and ischemic stroke have been reported. However, it is rare for patients with POEMS syndrome to present with a cerebrovascular accident as the first clinical manifestation. We presented three cases of POEMS syndrome with cerebral infarction in different phases of the disease. We then searched the literature for studies involving POEMS syndrome complicated with cerebral infarction. There were 81 cases in total. In nine patients, cerebral infarctions occurred before polyneuropathy. Patients with cerebral infarction before polyneuropathy have better prognosis of POEMS than those with cerebral infarction after polyneuropathy.
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Affiliation(s)
- Xiaoxi Lan
- Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Wanling Sun
- Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Yixian Guo
- Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Xiaoli Chang
- Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Guoxiang Wang
- Xuanwu Hospital Capital Medical University, Beijing 100053, China
| | - Ronghua Hu
- Xuanwu Hospital Capital Medical University, Beijing 100053, China
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Shibata S, Tabata S, Morita H, Endo T, Kawasaki N, Okamoto Y, Inano S, Takiuchi Y, Fukunaga A, Kitano T. Borderline Case of TAFRO Syndrome and POEMS Syndrome. Intern Med 2021; 60:1589-1595. [PMID: 33328401 PMCID: PMC8188039 DOI: 10.2169/internalmedicine.5860-20] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
TAFRO syndrome and POEMS syndrome are lymphoproliferative disorders with elevated interleukin-6 and vascular endothelial growth factor (VEGF) levels; however, their underlying pathogenic mechanisms remain unclear. Similarities have been reported in the pathological findings of the lymph nodes of TAFRO syndrome, Multicentric Castleman disease (MCD), and some cases of POEMS syndrome. However, there is no consensus on the relationship among them. We encountered a case of lymphoproliferative disorder that presented with manifestations of both TAFRO syndrome and POEMS syndrome. This case may be a subtype of idiopathic MCD and will be very important for establishing the disease concept of TAFRO syndrome and POEMS syndrome.
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Affiliation(s)
- Sho Shibata
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Sumie Tabata
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Hajime Morita
- Department of Nephrology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Tomomi Endo
- Department of Nephrology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Naoto Kawasaki
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Yoshio Okamoto
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Shojiro Inano
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Yoko Takiuchi
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Akiko Fukunaga
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
| | - Toshiyuki Kitano
- Department of Hematology, Tazuke Kofukai, Medical Research Institute, Kitano Hospital, Japan
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Ischemic stroke in patients with POEMS syndrome. Blood Adv 2021; 4:3427-3434. [PMID: 32722780 DOI: 10.1182/bloodadvances.2020001865] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2020] [Accepted: 06/12/2020] [Indexed: 12/28/2022] Open
Abstract
Polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes (POEMS) syndrome is associated with increased risk for ischemic stroke (IS). Because POEMS syndrome is rare, little is known regarding the underlying mechanism and prognosis for IS in patients in whom it occurs. The medical records of patients with POEMS syndrome were screened between January 2018 and January 2000 at Peking Union Medical College Hospital to identify those with IS. The baseline characteristics, IS features, and patient outcomes were analyzed. Forty-one (8.0%) of 510 POEMS patients were documented to have IS. Patients with IS were older, had a higher percentage of Overall Neuropathy Limitation Scale score >4, and had a higher level of fibrinogen compared with those who did not have IS. Ninety-three percent of IS events occurred before or within 3 months after a diagnosis of POEMS. Of 41 occurrences of IS, 29 (46.3%) were multifocal. Recurrent IS was observed in 13 (31.7%) of 41 patients, but not in patients with successful anti-plasma cell therapy. The 3-year overall survival rate in patients with IS was 71.0% and for those without IS, it was 88.5% (P = .002). We showed that 8.0% of POEMS patients had IS, and most IS events occurred in POEMS patients not being treated effectively. Having IS was a predictor of unfavorable prognosis. Early diagnosis, immediate initiation of treatment for POEMS, and control of POEMS syndrome is key to reducing the occurrence of IS, improving survival, and preventing recurrence of IS.
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Găman M, Vlădăreanu AM, Dobrea C, Onisâi M, Marinescu C, Cîşleanu D, Ciufu C, Vasile D, Bumbea H, Voican I. POEMS syndrome complicated with multiple ischemic vascular events: case report and review of literature. Onco Targets Ther 2018; 11:6271-6276. [PMID: 30310290 PMCID: PMC6166759 DOI: 10.2147/ott.s146221] [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: 11/19/2022] Open
Abstract
POEMS syndrome (acronym consisting of: polyneuropathy, organomegaly, endocrinopathy, M protein, and skin changes) is an uncommon disorder associated with an underlying plasma cell dyscrasia. There is no single specific test for POEMS, and due to its rarity and heterogeneity, patients are often mis- or underdiagnosed. Castleman disease (CD) is a rare lymphoproliferative disorder, closely related to POEMS syndrome; ~11%–30% of POEMS patients are associated with concomitant CD. In contrast to frequently published reports on vascular events in POEMS syndrome affecting coronary arteries or lower limbs, cases of cerebrovascular events are rarely mentioned in literature. We hereby report a patient with POEMS syndrome accompanied by CD who presented recurrent strokes and splenic infarction.
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Affiliation(s)
- Mihaela Găman
- Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania, .,Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania,
| | - Ana-Maria Vlădăreanu
- Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania, .,Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania,
| | - Camelia Dobrea
- Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania,
| | - Minodora Onisâi
- Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania, .,Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania,
| | - Cristina Marinescu
- Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania, .,Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania,
| | - Diana Cîşleanu
- Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania, .,Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania,
| | - Cristina Ciufu
- Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania, .,Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania,
| | - Daniela Vasile
- Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania, .,Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania,
| | - Horia Bumbea
- Department of Hematology, University of Medicine and Pharmacy Carol Davila Bucharest, Bucharest, Romania, .,Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania,
| | - Irina Voican
- Department of Hematology, University Emergency Hospital Bucharest, Bucharest, Romania,
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Fu FW, Rao J, Zheng YY, Wang HL, Yang JG, Zheng GQ. Ischemic stroke in patients with POEMS syndrome: a case report and comprehensive analysis of literature. Oncotarget 2017; 8:89406-89424. [PMID: 29179528 PMCID: PMC5687698 DOI: 10.18632/oncotarget.20131] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2017] [Accepted: 06/28/2017] [Indexed: 12/22/2022] Open
Abstract
Background POEMS syndrome is a rare multi-systemic disease characterized by polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes. Arterial or venous thrombosis is a less-common complication of POEMS syndrome. Ischemic stroke has also been reported sporadically. However, the association between POEMS syndrome and ischemic stroke has not been entirely understood. Methods A case of ischemic stroke caused by cerebral vasculitis in a patient with POEMS syndrome was presented. Then a comprehensive review and analysis of the literature were performed. Results A total of 28 patients were identified. The common clinical manifestations of POEMS syndrome were rather non-specific in patients with ischemic stroke compared with those of patients without ischemic stroke. Twenty patients were found with multiple ischemic lesions (71.5%). In the 25 patients who had undergone the evaluation of cerebral arteries, nineteen patients (76.0%) were found with cerebral vasculopathy. Twelve patients (48.0%) had more than one cerebral artery involved. Ischemic events were documented in 8 patients even when they were undergoing all the therapy for ischemic stroke. Ten (55.6%) of the 18 patients who had survival data died within two years after stroke events. Conclusion Comprehensive analysis of literature revealed several trends in patients with ischemic stroke and POEMS syndrome including a low survival rate and a preponderance of cerebral vasculopathy and multiple cerebral arteries affected. Ischemic stroke may be a poor outcome predictor in patients with POEMS syndrome. Further researches focusing on a larger cohort may help in better characterizing and treating this rare complication of POEMS syndrome.
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Affiliation(s)
- Fang-Wang Fu
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou city, China
| | - Jie Rao
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui Central Hospital, Lishui City, China
| | - Yuan-Yuan Zheng
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou city, China
| | - Hui-Lin Wang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou city, China
| | - Jian-Guang Yang
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou city, China
| | - Guo-Qing Zheng
- Department of Neurology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou city, China
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Yamaguchi I, Satomi J, Yamamoto N, Yoshioka S, Tada Y, Yagi K, Kanematsu Y, Nagahiro S. Coexistence of Quasi-moyamoya Disease and POEMS Syndrome in a Patient with Intracranial Hemorrhage: A Case Report and Literature Review. NMC Case Rep J 2016; 4:5-9. [PMID: 28664017 PMCID: PMC5364899 DOI: 10.2176/nmccrj.cr.2016-0106] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2016] [Accepted: 06/13/2016] [Indexed: 01/03/2023] Open
Abstract
POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome is a rare paraneoplastic syndrome elicited by plasma cell dyscrasia. Its clinical manifestations are multiple and stroke is not a recognized feature. A 44-year-old woman with a 3-month history of bilateral lower extremity sensorimotor disturbance was admitted to our hospital. Examinations revealed polyneuropathy, organomegaly, hypothyroidism, monoclonal gammopathy, pelvic plasmacytoma, and elevated serum vascular endothelial growth factor (VEGF) levels. A diagnosis of POEMS was made. Her condition was improved by radiation therapy of her pelvic plasmacytoma and she continued to be seen on an outpatient basis. Five years after her first admission she was re-admitted with sudden-onset right hemiparesis. A brain computed tomography (CT) scan revealed a left intracranial hemorrhage and magnetic resonance (MR) angiography and cerebral angiography showed occlusion of the proximal portion of the bilateral middle cerebral artery and narrowing of the bilateral internal carotid artery at the terminal portion; moyamoya vessels were seen. This is the first report of a patient whose intracranial hemorrhage was attributable to quasi-moyamoya disease associated with POEMS syndrome. We suggest that the POEMS syndrome be ruled out in the differential diagnosis of patients presenting with atypical stroke, multivessel stenotic lesions (moyamoya vessels), and polyneuropathy.
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Affiliation(s)
- Izumi Yamaguchi
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Junichiro Satomi
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Nobuaki Yamamoto
- Department of Clinical Neuroscience, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima Japan
| | - Shotaro Yoshioka
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yoshiteru Tada
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Kenji Yagi
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Yasuhisa Kanematsu
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
| | - Shinji Nagahiro
- Department of Neurosurgery, Institute of Biomedical Sciences, Tokushima University Graduate School, Tokushima, Japan
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Albertí M, Martinez-Yélamos S, Fernandez A, Vidaller A, Narváez J, Cano L, Gamez C, Martinez-Matos J. 18F-FDG PET/CT in the evaluation of POEMS syndrome. Eur J Radiol 2010; 76:180-2. [DOI: 10.1016/j.ejrad.2009.06.004] [Citation(s) in RCA: 48] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2009] [Revised: 06/02/2009] [Accepted: 06/03/2009] [Indexed: 11/25/2022]
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Dupont SA, Dispenzieri A, Mauermann ML, Rabinstein AA, Brown RD. Cerebral infarction in POEMS syndrome: incidence, risk factors, and imaging characteristics. Neurology 2009; 73:1308-12. [PMID: 19841383 DOI: 10.1212/wnl.0b013e3181bd136b] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
OBJECTIVES To determine the risk factors and incidence of cerebral infarction associated with POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes) syndrome. METHODS The Mayo Clinic dysproteinemia database was queried to identify patients with coded diagnosis of POEMS syndrome. Patients with cerebral infarction, occurring after the onset of POEMS-related symptoms, were selected. A retrospective observational study design was used to evaluate potential predictors of stroke in patients with POEMS syndrome. RESULTS A total of 9 patients (10%; 95% confidence interval 5.4-17.9) with cerebral infarction were identified (2 women, 22%). Traditional stroke risk factors were not significantly different between the stroke and nonstroke subgroups, but hematologic abnormalities such as elevated platelet count and bone marrow plasmacytosis differed between the 2 groups. Cerebral infarction occurrence after successful treatment of the underlying condition was not observed. CT and MRI data demonstrated a wide spectrum of infarct topography in these patients. Common stroke etiologies comprised suspected vascular structural abnormalities leading to vessel dissection and stenosis, in addition to embolism from a proximal source. CONCLUSIONS The 5-year risk of cerebral infarction in patients with POEMS syndrome is 13.4%. Evidence of plasma cell proliferation within the bone marrow and elevated serum platelet count led to increased risk of cerebral infarction in this population. We conclude that known modifiable stroke risk factors should be aggressively managed. Treatment of thrombocytosis should be considered in patients without a contraindication. Treatment of the syndrome may be the best approach to decreasing risk of cerebral infarction in these patients.
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Affiliation(s)
- S A Dupont
- Department of Neurology, Mayo Clinic, Rochester, MN 55905, USA.
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