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Mohamed I, Haji M, Hassan N, Qasim H, Rajab R, Rajab R, Ibrahim A, Zulqarnain M, Sadeddin EZ, Ghoz H, Mohammed S. A Rare Case of Primary Duodenal Plasmacytoma: An Incidental Finding. Cureus 2023; 15:e37342. [PMID: 37182040 PMCID: PMC10169253 DOI: 10.7759/cureus.37342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/09/2023] [Indexed: 05/16/2023] Open
Abstract
Solitary extramedullary plasmacytoma (SEP) is a rare tumor due to the monoclonal proliferation of plasma cells without bone marrow involvement. Plasmacytomas are frequently encountered in bone or soft tissue but rarely occur in the gastrointestinal (GI) tract. They can present with a multitude of symptoms depending on their site. This report describes a case of SEP diagnosed as a duodenal ulcer (DU) during esophagogastroduodenoscopy (EGD) for iron deficiency anemia.
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Affiliation(s)
- Islam Mohamed
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mariam Haji
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Noor Hassan
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Hana Qasim
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Rawan Rajab
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Rami Rajab
- Biology, Saint Louis University, Saint Louis, USA
| | - Ali Ibrahim
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Mir Zulqarnain
- Gastroenterology and Hepatology, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Esmat Z Sadeddin
- Gastroenterology and Hepatology, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Hassan Ghoz
- Gastroenterology and Hepatology, University of Missouri Kansas City School of Medicine, Kansas City, USA
| | - Sobrina Mohammed
- Internal Medicine, University of Missouri Kansas City School of Medicine, Kansas City, USA
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2
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Mao M, Liang N, Ren R, Zhao Y, Ma D, Liu H. A Nomogram Model for Predicting the Postoperative Recurrence of Localized Laryngeal Amyloidosis. Ann Otol Rhinol Laryngol 2023; 132:259-265. [PMID: 35403442 DOI: 10.1177/00034894221086990] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To analyze the factors related to postoperative recurrence in patients with localized laryngeal amyloidosis (LocLA) and to construct a nomogram prediction model (NPM). METHODS We collected the data for LocLA patients diagnosed from March 2000 to May 2019 and clinical characteristics data were extracted. Factors related to recurrence were analyzed using multivariate logistic regression. The NPM was constructed for predicting the recurrence risk of LocLA. The receiver operating characteristic (ROC) curve evaluated the distinguishing ability using the area under curve (AUC). The calibration curve was created to evaluate the consistency of the NPM. RESULTS A total of 226 confirmed LocLA cases were included. One hundred seventy-five cases (77.4%) had localized single nodule, and 51 cases had more than one lesions. Sixty-three (27.9%) cases had no multinucleated giant cell (MGC) around amyloid, and 163 (72.1%) cases had MGC around amyloid. Multivariate logistic regression analysis showed that more than one lesions (odds ratio [OR] = 3.206 and 95% confidence interval [CI]: 1.492-6.888; P value: .003), subglottic involvement (OR = 2.926 and 95% CI: 1.300-6.585; P = .010), and no multinucleated giant cell (MGC) around amyloid (OR = 2.503 and 95% CI: 1.173-5.342; P = .018) had a statistically significant effect on postoperative LocLA recurrence (P < .05). The AUC of the ROC curve was 0.753 (95% CI: 0.667-0.832). The bias-corrected curve approached the ideal curve, with an average absolute error of 0.037. CONCLUSIONS More than one lesions, subglottic involvement, and no MGC around amyloid are risk factors for postoperative recurrence of LocLA. The NPM constructed has good applicability.
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Affiliation(s)
- Meiling Mao
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Na Liang
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Ran Ren
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Yihua Zhao
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Donglin Ma
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
| | - Honggang Liu
- Department of Pathology, Beijing Tongren Hospital, Capital Medical University; Beijing Key Laboratory of Head and Neck Molecular Diagnostic Pathology, Beijing, China
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3
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Evenhuis JV, Oates A, Hoyer N, Vilander AC, Thamm DH, Worley DR. A retrospective study of canine oral extramedullary plasmacytoma over a 15-year period (July 2004-July 2019): Treatment, histologic parameters and clinical outcomes. Vet Comp Oncol 2023; 21:302-314. [PMID: 36808816 DOI: 10.1111/vco.12888] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 01/20/2023] [Accepted: 02/13/2023] [Indexed: 02/23/2023]
Abstract
A total of 45 cases of canine oral extramedullary plasmacytomas (EMPs) presented to a tertiary referral institution over a 15-year period were examined. Histologic sections of 33 of these cases were examined for histopathologic prognostic indicators. Patients underwent variable treatment including surgical intervention, chemotherapy and/or radiation therapy. Long term survival was observed in the majority of dogs with a median survival time of 973 days (2-4315 days). However, almost 1/3 of dogs had progression of plasma cell disease, including two cases with myeloma-like progression. Histologic characterization of these tumours did not reveal criteria to predict tumour malignancy. However, cases without tumour progression did not exceed 28 mitotic figures in ten 400× fields (2.37 mm2 ). All cases with tumour related death showed at least moderate nuclear atypia. Oral EMPs may represent a local manifestation of systemic plasma cell disease or singular focal neoplasia.
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Affiliation(s)
- Janny V Evenhuis
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, Colorado, USA
| | - Andrew Oates
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Naomi Hoyer
- James L. Voss Veterinary Teaching Hospital, Colorado State University, Fort Collins, Colorado, USA.,Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA
| | - Allison C Vilander
- Department of Microbiology, Immunology, and Pathology, Colorado State University, Fort Collins, Colorado, USA
| | - Douglass H Thamm
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA.,Flint Animal Cancer Center, Colorado State University, Fort Collins, Colorado, USA
| | - Deanna R Worley
- Department of Clinical Sciences, Colorado State University, Fort Collins, Colorado, USA.,Flint Animal Cancer Center, Colorado State University, Fort Collins, Colorado, USA
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4
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Kosydar S, Gulhane A, Libby E, Cowan AJ, Kwok M, Lee SS, Green DJ, Coffey D, Holmberg LA, Chen DL, Tseng YD. Radiographic Response of Solitary Plasmacytomas After Conformal Radiotherapy May Be Delayed: Outcomes in the 3D Era. Am J Clin Oncol 2022; 45:443-449. [PMID: 36346953 DOI: 10.1097/coc.0000000000000948] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
OBJECTIVE Although recurrence rates after radiotherapy for solitary plasmacytoma (SP) are well established, little is known about how SP responds radiographically, as most historical patients were treated in the 2D era. We evaluated the response to radiotherapy among SP patients staged and treated with 3D techniques, including proton therapy, which has not yet been previously reported. METHODS AND MATERIALS Between 2007 and 2021, 15 SP patients (4 extramedullary, 11 bone) staged with 3D imaging and bone marrow evaluation were consecutively treated with definitive radiotherapy. The best response was categorized in 9 evaluable patients according to response evaluation criteria in solid tumors (RECIST) and positron emission tomography response criteria in solid tumors (PERCIST). RESULTS With a median follow-up of 34 months, 4 patients relapsed. The median time to the best response was ~2 years (26.6 mo RECIST, 25.4 mo PERCIST). Response rates differed based on response assessment criteria. PERCIST was associated with higher rates of complete (85.7%) or partial response (14.3%) compared with RECIST (16.7% complete, 33.3% partial). Two-year and 4-year PFS for extramedullary SP were 100% and 75%, compared with 91% and 55% for bone ( P =0.75). Patients treated with proton therapy (n=5) did not appear to have different patterns of relapse (1 marginal, 1 distant) compared with those treated with photons or electrons (n=10; 2 distant). CONCLUSIONS More conformal dose distribution with proton therapy does not appear to alter patterns of recurrence. Although response rates differ based on criteria by both RECIST and PERCIST assessments, the radiographic response may be slow and requires validation in other cohorts.
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Affiliation(s)
| | - Avanti Gulhane
- University of Washington School of Medicine
- Department of Radiology, University of Washington, Seattle, WA
| | - Edward Libby
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - Andrew J Cowan
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - Mary Kwok
- University of Washington School of Medicine
- Division of Hematology, University of Washington
| | - Sarah S Lee
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - Damian J Green
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - David Coffey
- Sylvester Comprehensive Cancer Center, University of Miami, Miami, FL
| | - Leona A Holmberg
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Division of Medical Oncology
| | - Delphine L Chen
- University of Washington School of Medicine
- Department of Radiology, University of Washington, Seattle, WA
| | - Yolanda D Tseng
- University of Washington School of Medicine
- Clinical Research Division, Fred Hutchinson Cancer Center
- Department of Radiation Oncology
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5
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Gao J, Tseng CC, Barinsky GL, Fang CH, Grube JG, Hsueh WD, Baredes S, Eloy JA. Analysis of the Treatment and Survival of Sinonasal Extramedullary Plasmacytoma. Am J Rhinol Allergy 2022; 36:591-598. [PMID: 35440217 DOI: 10.1177/19458924221092529] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND While extramedullary plasmacytomas are infrequently encountered plasma cell malignancies, most cases occur in the head and neck, with a predilection for the sinonasal cavity. Due to the rarity of this disease, the majority of studies on sinonasal extramedullary plasmacytoma (SN-EMP) are case reports or small retrospective case series. OBJECTIVE To investigate the impact of patient, disease, and treatment factors on the survival of patients with SN-EMP. METHODS The National Cancer Database was queried for all patients with SN-EMP between 2004-2016 (N = 381 cases). Univariate and multivariate analyses were used to examine patient demographics, tumor characteristics, and survival. RESULTS The majority of SN-EMP patients were over 60 years old (57.0%), male (69.8%), and white (86.2%). The most common treatment modality was radiotherapy alone (38.6%), followed by surgery plus radiotherapy (37.8%). Five-year overall survival was 74.0% and median survival was 9.1 years. Accounting for patient demographics and tumor characteristics in a multivariate model, the following groups had worse prognosis: 60 and older (HR 1.99, p = 0.031) and frontal sinus primary site (HR 11.56, p = 0.001). Patients who received no treatment (HR 3.89, p = 0.013), chemotherapy alone (HR 5.57, p = 0.008) or radiotherapy plus chemotherapy (HR 2.82, p = 0.005) had significantly lower survival than patients who received radiotherapy alone. Patients who received surgery with radiotherapy (HR 0.57, p = 0.039) had significantly higher survival than patients who received radiotherapy alone. CONCLUSION In patients with SN-EMP five-year overall survival was found to be 74.0% with decreased survival associated with a frontal sinus primary site and being aged 60 or older. Patients receiving no treatment, chemotherapy alone, or radiotherapy with chemotherapy was associated with lower survival. Receiving surgery plus radiotherapy was associated with the highest five-year overall survival.
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Affiliation(s)
- Jeff Gao
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christopher C Tseng
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Gregory L Barinsky
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Christina H Fang
- Department of Otorhinolaryngology - Head and Neck Surgery, 2013Montefiore Medical Center, The University Hospital of Albert Einstein College of Medicine, Bronx, New York, USA
| | - Jordon G Grube
- Division of Otolaryngology/ Head and Neck Surgery, Department of Surgery, 138207Albany Medical Center, Albany, New York, USA
| | - Wayne D Hsueh
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Soly Baredes
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA
| | - Jean Anderson Eloy
- Department of Otolaryngology - Head and Neck Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Center for Skull Base and Pituitary Surgery, Neurological Institute of New Jersey, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Neurological Surgery, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Ophthalmology and Visual Science, 12286Rutgers New Jersey Medical School, Newark, New Jersey, USA.,Department of Otolaryngology and Facial Plastic Surgery, Saint Barnabas Medical Center - RWJBarnabas Health, Livingston, New Jersey, USA
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6
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Su W, Zeng L, Zhao D, Fu Y, Tang J. Case Report: Plasmacytoma of External Urethral Meatus. Front Endocrinol (Lausanne) 2022; 13:783855. [PMID: 35250855 PMCID: PMC8888426 DOI: 10.3389/fendo.2022.783855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2021] [Accepted: 01/18/2022] [Indexed: 11/29/2022] Open
Abstract
RATIONALE Extramedullary plasmacytoma (EMP) can occur in various parts of the body. It is generally accepted that the highest site of occurrence is the head and neck region (80% to 90%), followed by the gastrointestinal tract and the skin. It is worth mentioning that the site of disease, in this case, was the urethral meatus, which is extremely rare in clinical practice. PATIENT CONCERNS A 50-year-old female complained of an episode of painless gross hematuria without symptoms of frequent urination, urgency, abdominal pain, abdominal distension, fever, or oliguria. The patient has no history of smoking or drinking and denied any family history of solid malignancy or hematological disease. DIAGNOSIS AND INTERVENTIONS Urethrocystoscopy revealed urethral polypoid hyperplasia, which we initially thought could be a urethral caruncle. The patient was asked to undergo caruncle resection after 1 week of potassium permanganate sitz bath, and postoperative pathology revealed plasmacytoma. After that, a whole-body MRI showed no other lesions. She received postoperative radiotherapy. OUTCOMES During radiotherapy, the patient's condition and appetite were fair, and the skin mucositis was I°. Pelvic contrast-enhanced MRI and whole-body PET-CT 6 months after urethral meatus lumpectomy and radiotherapy showed changes without obvious abnormal signs. No recurrence or metastasis was detected after one year of follow-up. LESSONS Urinary EMP is a rare disease. It is not easy to diagnose due to its rare site of occurrence and non-specific symptoms. The diagnosis of EMP requires a combination of imaging studies and pathological findings. Currently, surgery combined with radiotherapy or radiotherapy alone is the mainstay treatment and usually results in an acceptable local control rate. At the same time, chemotherapy cannot be ignored.
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Affiliation(s)
- Wen Su
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Liang Zeng
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Dongsheng Zhao
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
| | - Ying Fu
- Department of Nuclear Medicine, Hunan Cancer Hospital Affiliated to Central South University, Changsha, China
| | - Jin Tang
- Department of Urology, The Third Xiangya Hospital, Central South University, Changsha, China
- *Correspondence: Jin Tang,
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7
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Mukkamalla SKR, Malipeddi D. Myeloma Bone Disease: A Comprehensive Review. Int J Mol Sci 2021; 22:6208. [PMID: 34201396 PMCID: PMC8227693 DOI: 10.3390/ijms22126208] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 05/17/2021] [Accepted: 06/03/2021] [Indexed: 12/11/2022] Open
Abstract
Multiple myeloma (MM) is a neoplastic clonal proliferation of plasma cells in the bone marrow microenvironment, characterized by overproduction of heavy- and light-chain monoclonal proteins (M-protein). These proteins are mainly found in the serum and/or urine. Reduction in normal gammaglobulins (immunoparesis) leads to an increased risk of infection. The primary site of origin is the bone marrow for nearly all patients affected by MM with disseminated marrow involvement in most cases. MM is known to involve bones and result in myeloma bone disease. Osteolytic lesions are seen in 80% of patients with MM which are complicated frequently by skeletal-related events (SRE) such as hypercalcemia, bone pain, pathological fractures, vertebral collapse, and spinal cord compression. These deteriorate the patient's quality of life and affect the overall survival of the patient. The underlying pathogenesis of myeloma bone disease involves uncoupling of the bone remodeling processes. Interaction of myeloma cells with the bone marrow microenvironment promotes the release of many biochemical markers including osteoclast activating factors and osteoblast inhibitory factors. Elevated levels of osteoclast activating factors such as RANK/RANKL/OPG, MIP-1-α., TNF-α, IL-3, IL-6, and IL-11 increase bone resorption by osteoclast stimulation, differentiation, and maturation, whereas osteoblast inhibitory factors such as the Wnt/DKK1 pathway, secreted frizzle related protein-2, and runt-related transcription factor 2 inhibit osteoblast differentiation and formation leading to decreased bone formation. These biochemical factors also help in development and utilization of appropriate anti-myeloma treatments in myeloma patients. This review article summarizes the pathophysiology and the recent developments of abnormal bone remodeling in MM, while reviewing various approved and potential treatments for myeloma bone disease.
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Affiliation(s)
| | - Dhatri Malipeddi
- Internal Medicine, Canton Medical Education Foundation/NEOMED, Canton, OH 44710, USA;
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8
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Kumar SK, Callander NS, Adekola K, Anderson L, Baljevic M, Campagnaro E, Castillo JJ, Chandler JC, Costello C, Efebera Y, Faiman M, Garfall A, Godby K, Hillengass J, Holmberg L, Htut M, Huff CA, Kang Y, Hultcrantz M, Larson S, Liedtke M, Martin T, Omel J, Shain K, Sborov D, Stockerl-Goldstein K, Weber D, Keller J, Kumar R. Multiple Myeloma, Version 3.2021, NCCN Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2020; 18:1685-1717. [PMID: 33285522 DOI: 10.6004/jnccn.2020.0057] [Citation(s) in RCA: 114] [Impact Index Per Article: 28.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Multiple myeloma is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. This manuscript discusses the management of patients with solitary plasmacytoma, smoldering multiple myeloma, and newly diagnosed multiple myeloma.
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Affiliation(s)
| | | | - Kehinde Adekola
- 3Robert H. Lurie Comprehensive Cancer of Center Northwestern University
| | | | | | | | - Jorge J Castillo
- 7Dana-Farber/Brigham and Women's Cancer Center
- Massachusetts General Hospital Cancer Center
| | - Jason C Chandler
- 8St. Jude Children's Research Hospital/The University of Tennessee Health Science Center
| | | | - Yvonne Efebera
- 10The Ohio State University Comprehensive Cancer Center - James Cancer Hospital and Solove Research Institute
| | - Matthew Faiman
- 11Case Comprehensive Cancer Center/University Hospitals Seidman Cancer Center and Cleveland Clinic Taussig Cancer Institute
| | - Alfred Garfall
- 12Abramson Cancer Center at the University of Pennsylvania
| | | | | | - Leona Holmberg
- 15Fred Hutchinson Cancer Research Center/Seattle Cancer Care Alliance
| | - Myo Htut
- 16City of Hope National Medical Center
| | - Carol Ann Huff
- 17The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins
| | | | | | | | | | - Thomas Martin
- 22UCSF Helen Diller Family Comprehensive Cancer Center
| | | | | | | | | | - Donna Weber
- 27The University of Texas MD Anderson Cancer Center; and
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Extramedullary Solitary Plasmacytoma with Anaplastic Features of the Nasopharynx. Case Rep Hematol 2020; 2020:8845546. [PMID: 32774947 PMCID: PMC7396063 DOI: 10.1155/2020/8845546] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 07/13/2020] [Indexed: 11/18/2022] Open
Abstract
Extramedullary plasmacytomas (ESPs) are rare forms of plasma cell dyscrasias and usually are seen in the upper aerodigestive tract. ESPs with anaplastic features are extremely rare, and no treatment guidelines exist. We present a 75-year-old gentleman presented with left nasal blockage, and on examination, a polypoid left nasal mass was seen. He was, then, referred to ENT after a CT scan revealed a mass in the left nasopharynx for a biopsy. The preliminary reports suggested a high-grade lymphoma; however, after further testing, it was revealed to be an anaplastic plasma cell neoplasm. PET scan, bone marrow biopsy, serum and urine protein electropheresis, serum immunofixation and light chains were all unremarkable for systemic disease. Differential diagnosis included plasmablastic lymphoma, NK/T cell lymphoma-nasal type, and squamous cell cancers of the head and neck. He was treated with radiation alone given his comorbidities. Given there are no treatment guidelines, we would like to highlight this rare case and discuss different potential management options such as radiation, chemotherapy, surgery, or a combination of different modalities.
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10
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Di Stadio A, Gambacorta V, de Crescenzo S, Sidoni A, Cristi MC, Di Giovanni A, Maranzano M, Ricci G. Extramedullary nasal plasmacytoma arising after polyp excision and the role of the inflammation in tumor development: A case report. Mol Clin Oncol 2020; 12:451-455. [PMID: 32257202 PMCID: PMC7087468 DOI: 10.3892/mco.2020.2007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2019] [Accepted: 12/06/2019] [Indexed: 11/30/2022] Open
Abstract
A correlation between inflammation and cancer has been identified in the case of nasal cancer, however a specific connection between nasal inflammation and extramedullary nasal plasmacytoma (ENP), to the best of our knowledge, has not yet been determined. The present case report describes a patient affected by ENP, in who the tumor arose in the same area, from which a nasal polyp was previously surgically removed, five months after the polyp excision. The patient underwent surgical endoscopic tumor asportation without being treated with radio-chemotherapy. ENP was totally removed via surgery and no signs of recurrence were identified by endoscopy or magnetic resonance imaging during the last check-up 1 year after tumor asportation. It was hypothesized that in this elderly patient, who was exposed to viral infections and pollution for several years, ENP may be correlated to the inflammatory process that occurred after surgery, and this likely contributed to a neoplastic mutation in B-cells.
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Affiliation(s)
- Arianna Di Stadio
- Department of Otolaryngology, University of Perugia, I-65121 Perugia, Italy
| | - Valeria Gambacorta
- Department of Otolaryngology, University of Perugia, I-65121 Perugia, Italy
| | | | - Angelo Sidoni
- Department of Anatomic Pathology, University of Perugia, I-65121 Perugia, Italy
| | | | | | - Massimo Maranzano
- Department of Oral Maxillo-Facial and Facial Plastic Surgery, University of Manchester, Manchester M13 9PL, UK
| | - Giampietro Ricci
- Department of Otolaryngology, University of Perugia, I-65121 Perugia, Italy
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11
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Extramedullary multiple myeloma. Leukemia 2019; 34:1-20. [DOI: 10.1038/s41375-019-0660-0] [Citation(s) in RCA: 81] [Impact Index Per Article: 16.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 07/31/2019] [Accepted: 08/12/2019] [Indexed: 01/07/2023]
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12
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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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13
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Multifocal Extramedullary and Multiple Solitary Bone Plasmacytoma: A Case Report and Review of the Literature. INTERNATIONAL JOURNAL OF CANCER MANAGEMENT 2019. [DOI: 10.5812/ijcm.91498] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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14
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How J, Johnson PC, Corrales CE, Wright K, Justicz N, Chen JX, Sperling AS, Connell NT. Plasmacytoma presenting as jugular foramen tumor in a young woman with multiple myeloma. Am J Hematol 2019; 94:728-732. [PMID: 30916796 DOI: 10.1002/ajh.25477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2019] [Revised: 02/24/2019] [Accepted: 03/25/2019] [Indexed: 11/11/2022]
Affiliation(s)
- Joan How
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
- Department of MedicineHarvard Medical School Boston Massachusetts
| | - Patrick Connor Johnson
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
- Department of MedicineHarvard Medical School Boston Massachusetts
| | | | - Kyle Wright
- Department of PathologyHarvard Medical School Boston Massachusetts
| | - Natalie Justicz
- Department of Orolaryngology Head and Neck SurgeryHarvard Medical School Boston Massachusetts
| | - Jenny X. Chen
- Department of Orolaryngology Head and Neck SurgeryHarvard Medical School Boston Massachusetts
| | - Adam S. Sperling
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
- Department of MedicineHarvard Medical School Boston Massachusetts
| | - Nathan T. Connell
- Department of MedicineHarvard Medical School Boston Massachusetts
- Hematology Division, Department of MedicineBrigham and Women's Hospital Boston Massachusetts
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15
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Naymagon L, Abdul-Hay M. Primary extramedullary plasmacytoma with diffuse lymph node involvement: a case report and review of the literature. J Med Case Rep 2019; 13:153. [PMID: 31113466 PMCID: PMC6530079 DOI: 10.1186/s13256-019-2087-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background Primary plasmacytomas are localized proliferations of clonal plasma cells occurring in the absence of a systemic plasma cell dyscrasia such as multiple myeloma. Primary plasmacytomas most commonly manifest as solitary lesions of the bone or of the upper aerodigestive tract. Presentation in a lymph node is very uncommon and can often be initially mistaken for lymphoma. Because they are local phenomena, primary plasmacytomas are managed with local therapies such as radiation or, less commonly, excision. Multifocal presentations are rare and are often not amenable to local treatment modalities, thus requiring systemic therapies. Because of their rarity, standardized treatment guidelines are not established, and treatment paradigms borrow heavily from those employed in multiple myeloma. Multifocal presentation in lymph nodes is nearly unheard of with only seven such cases reported in the existing literature, only four of which were diffuse enough to require systemic therapy. Here we describe the most diffuse and widely distributed instance of primary lymph node plasmacytoma yet reported and present a description of its successful treatment with systemic therapy. Case presentation A 71-year-old Asian man presented with progressive fatigue in the setting of diffuse hypermetabolic lymphadenopathy throughout his chest, abdomen, and pelvis. A diagnosis of lymphoma was initially suspected; however, a lymph node biopsy was consistent with plasmacytoma. A bone marrow biopsy was unremarkable, and no monoclonal protein was identified, establishing a diagnosis of primary extramedullary plasmacytomas of the lymph nodes. He was treated with a myeloma-like regimen consisting of four cycles of bortezomib/dexamethasone followed by two cycles of thalidomide/prednisone with improvement in symptoms and near complete resolution of prior hypermetabolic lymphadenopathy. He remains in remission over 18 months following completion of therapy. Conclusion This case report and accompanying literature review highlight the exceedingly rare and easily misclassified entity of primary plasmacytoma of diffuse lymph nodes. Importantly, we demonstrate that this entity may be treated with, and demonstrate excellent response to, systemic therapies often employed in multiple myeloma.
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Affiliation(s)
- Leonard Naymagon
- New York University School of Medicine and Mount Sinai School of Medicine, New York, USA
| | - Maher Abdul-Hay
- New York University School of Medicine and New York University Perlmutter Cancer Center, 240 East 38th street, 19Floor, New York, NY, 10016, USA.
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16
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Liu S, Li X, Li Y, Li D, Wang Y, Tian C. Multiple myeloma with dural mater involvement. Onco Targets Ther 2019; 12:3373-3375. [PMID: 31118689 PMCID: PMC6506830 DOI: 10.2147/ott.s202662] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2019] [Accepted: 03/12/2019] [Indexed: 11/23/2022] Open
Abstract
Multiple myeloma is an incurable clonal B-cell malignancy which may present with neoplastic monoclonal plasma cells in either bone or soft tissues. Central nervous system (CNS) involvement such as dural myeloma or intraparenchymal infiltration, or with diffuse leptomeningeal involvement, is uncommon. Dural involvement of myeloma without parenchymal or leptomeningeal disease is an even rarer occurrence; therefore there are no established treatment guidelines for CNS myelomatosis. Here we reported a refractory MM patient progressed to dura mater involvement after the induction therapy but showed good response to lenalidomide treatment.
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Affiliation(s)
- Su Liu
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - Xubin Li
- Imaging Department, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - Yueyang Li
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - Dongying Li
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - Yafei Wang
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
| | - Chen Tian
- Department of Hematology, Tianjin Medical University Cancer Institute and Hospital, National Clinical Research Center for Cancer, Key Laboratory of Cancer Prevention and Therapy, Tianjin 300060, People's Republic of China
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17
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Oertel M, Elsayad K, Kroeger KJ, Haverkamp U, Rudack C, Lenz G, Eich HT. Impact of radiation dose on local control and survival in extramedullary head and neck plasmacytoma. Radiat Oncol 2019; 14:63. [PMID: 30987659 PMCID: PMC6466654 DOI: 10.1186/s13014-019-1265-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2018] [Accepted: 03/28/2019] [Indexed: 12/11/2022] Open
Abstract
Background Patients with plasma-cell neoplasia usually suffer from systemic disease, although a minority (< 5%) may present with solitary involvement of bone or soft tissue (extramedullary plasmacytoma (EMP)). Radiotherapy (RT) is a state-of-the-art treatment for these tumors offering long term curation. Methods and materials Between January 2005 and January 2017, twenty-seven patients underwent RT at our institution. The aim of this study was to analyse the effectiveness of various RT doses for different forms of EMP. Results A total of 33 radiation courses were administered to 27 patients with a median age of 56 years. The median RT dose was 45 Gy (range: 12–55.8). The local control rate was 76% (93% for primary EMP vs. 61% for the secondary EMP lesions; P < 0.05). A complete response (CR) rate to local RT was achieved for 42% lesions (67% for primary EMP vs. 22% for the secondary EMP lesions; P < 0.01). The overall response rate (ORR) for the EMP lesions treated with high-dose regimens (> 45 Gy) versus low-dose regimens (≤ 45 Gy) was 87% versus 67%, respectively (P = 0.2). The median survival with high-dose RT group was significantly longer (P = 0.02). In subgroups analysis, primary EMP patients treated with high-dose RT had a non-significant higher ORR (100% vs. 80%, respectively; P = 0.3,) longer duration of LC (P = 0.3) with a longer survival (P = 0.05) than patients in low-dose group. No significant difference has been detected in secondary EMP patients treated with high-dose RT regarding ORR (60% vs. 62%, respectively; P = 1), and survival (P = 0.4). Conclusion RT is an efficacious treatment modality in the treatment of EMP. A radiation dose ≤45 Gy confer a comparable CR rate to high-dose regimens and appears to be an effective treatment for controlling local EMP progression. Radiation dose-escalation may be beneficial for particular subgroups of patients.
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Affiliation(s)
- Michael Oertel
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Khaled Elsayad
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany.
| | - Kai Jannes Kroeger
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Uwe Haverkamp
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
| | - Claudia Rudack
- Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital of Muenster, Muenster, Germany
| | - Georg Lenz
- Department of Internal Medicine-A (Hematology, Oncology, Hemostaseology and Pulmonology), University Hospital Muenster, Muenster, Germany
| | - Hans Theodor Eich
- Department of Radiation Oncology, University Hospital of Muenster, Albert-Schweitzer-Campus 1, Building A1, 48149, Muenster, Germany
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Čunović N, Košec A, Stevanović S, Bedeković V. A Case Report of Solitary Extramedullary Plasmacytoma of the Cricoid Cartilage Diagnosed After Total Thyroidectomy. EAR, NOSE & THROAT JOURNAL 2019; 99:130-131. [PMID: 30966804 DOI: 10.1177/0145561319839634] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Affiliation(s)
- Nikolina Čunović
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Andro Košec
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
| | - Siniša Stevanović
- Department of Otorhinolaryngology and Head and Neck Surgery, University Hospital Center Sestre Milosrdnice, Zagreb, Croatia
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Solitary Extramedullary Plasmacytoma Mimicking Acute Subdural Hematoma. World Neurosurg 2018; 120:521-524. [DOI: 10.1016/j.wneu.2018.09.151] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Revised: 09/18/2018] [Accepted: 09/19/2018] [Indexed: 11/20/2022]
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20
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Lawrence BJ, Petersen EL, Riches WG, Pfeiffer DC. Clinical Course of a Patient With Kidney Failure Due to Isolated Bilateral Renal Extramedullary Plasmacytomas. Am J Kidney Dis 2018; 72:752-755. [DOI: 10.1053/j.ajkd.2018.03.029] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 03/27/2018] [Indexed: 11/11/2022]
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21
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Clark A, Tharmalingam S, Manduch M, Hollins R, Houlden RL, Lakoff J. Solitary Extramedullary Plasmacytoma of the Thyroid Gland Following Head and Neck External Beam Radiotherapy. AACE Clin Case Rep 2018. [DOI: 10.4158/accr-2017-0194] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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22
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Sunkara T, Sharma SR, Ofosu A, Gaduputi V, Reddy M, Shahzad G. A Case of Concurrent Gastric and Pancreatic Plasmacytomas in a Patient With Multiple Myeloma: An Extremely Rare Entity. J Investig Med High Impact Case Rep 2018; 6:2324709618777003. [PMID: 29854857 PMCID: PMC5971378 DOI: 10.1177/2324709618777003] [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: 03/07/2018] [Revised: 04/07/2018] [Accepted: 04/21/2018] [Indexed: 11/15/2022] Open
Abstract
Multiple myeloma (MM), a plasma cell tumor, is primarily a disease of the bone marrow. Extramedullary plasmacytoma, also a plasma cell tumor, is very rare in the gastrointestinal tract and the pancreas, and only a handful cases have been documented till now. Gastric and pancreatic plasmacytomas are usually seen in elderly patients; however, cases in patients as young as 32 years of age have been reported. Commonly, patients with gastric plasmacytoma present with nonspecific symptoms like epigastric pain, abdominal fullness, anorexia, and weight loss, or serious conditions like massive upper gastrointestinal bleeding and gastric outlet obstruction. Patients with pancreatic plasmacytoma commonly present with obstructive jaundice. In this article, we present the case of a 79-year-old man with a history of MM for 3 years, diagnosed with gastric and pancreatic masses, which turned out to be plasmacytomas. To our knowledge, simultaneous occurrence of gastric and pancreatic plasmacytomas is extremely uncommon with less than 5 cases reported in the literature. We also compiled all the individual cases of gastric and pancreatic MM that have been reported in literature till now.
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Affiliation(s)
- Tagore Sunkara
- The Brooklyn Hospital Center, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
| | - Santosh R Sharma
- The Brooklyn Hospital Center, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
| | - Andrew Ofosu
- The Brooklyn Hospital Center, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
| | | | - Madhavi Reddy
- The Brooklyn Hospital Center, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
| | - Ghulamullah Shahzad
- The Brooklyn Hospital Center, Clinical Affiliate of the Mount Sinai Hospital, Brooklyn, NY, USA
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23
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Dural Plasmacytoma with Meningeal Myelomatosis in a Patient with Multiple Myeloma. Case Rep Hematol 2018; 2018:6730567. [PMID: 29651350 PMCID: PMC5831945 DOI: 10.1155/2018/6730567] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2017] [Revised: 12/28/2017] [Accepted: 01/14/2018] [Indexed: 11/21/2022] Open
Abstract
Here, we describe the case of a 66-year-old male diagnosed with multiple myeloma who presented with generalized tonic-clonic seizures. Magnetic resonance imaging demonstrated a right solid extra-axial parieto-occipital lesion with typical characteristics of meningeal myelomatosis. Biopsy was performed, which diagnosed a dural plasmacytoma. Because of this, we started concomitant therapy with radiotherapy and lenalidomide, but the patient has a poor response to treatment and died few weeks after its initiation. Myelomatous involvement of the dura mater is a rare occurrence, given that only few cases were reported in the English literature. This presentation confers an ominous prognosis and must be a suspect diagnosis in patients diagnosed with multiple myeloma presenting neurological symptoms.
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24
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Abrar S, Ali N, Qureshi BM, Abbasi AN. Extramedullary plasmacytoma: rare neoplasm of parotid gland. BMJ Case Rep 2018; 2018:bcr-2017-222367. [PMID: 29301803 DOI: 10.1136/bcr-2017-222367] [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] [Indexed: 11/04/2022] Open
Abstract
A 45-year-old man presented with left-sided facial swelling. Initial excisional biopsy was done somewhere else without prior imaging and it came out to be pleomorphic adenoma; local imaging after biopsy showed mass over the left parotid gland with ipsilateral lymphadenopathy. On examination, there was a well-circumscribed mass with signs of left facial nerve palsy. He underwent left radical parotidectomy with ipsilateral modified radical neck dissection, and per operatively, it came out to be neoplastic lesion. Final histopathology was plasma cell neoplasm of the parotid gland. After surgery, the patient received radiation therapy to the left parotid region on account of uncertain surgical margins. It has been 3 years down the road that there is no evidence of local recurrence or transformation into multiple myeloma. Available evidence reveals that mere surgery for extramedullary plasmacytoma is not enough for local control whenever there is doubt of residual disease consider radiation therapy.
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Affiliation(s)
- Sehrish Abrar
- Department of Oncology, Section of Radiation Oncology, Aga Khan University Hospital, Karachi, Pakistan
| | - Nasir Ali
- Radiation Oncology, Aga Khan University Hospital, Karachi, Sindh, Pakistan
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25
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El-Fattah MA. Second cancers in survivors of plasmacytoma of bone in the U.S.A: a SEER database analysis. Leuk Lymphoma 2017; 58:2952-2956. [DOI: 10.1080/10428194.2017.1312386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mohamed Abd El-Fattah
- Department of Internal Medicine, Faculty of Medicine, Suez Canal University, Ismailia City, Ismailia, Egypt
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26
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Gilder H, Murphy ME, Alvi MA, Kerezoudis P, Shepherd D, Maloney PR, Yaszemski MJ, Morris JM, Dispenzieri A, Matsumoto JM, Bydon M. Skull base plasmacytoma: A unique case of POEMS syndrome with a plasmacytoma causing craniocervical instability. J Clin Neurosci 2017; 47:254-257. [PMID: 29100675 DOI: 10.1016/j.jocn.2017.10.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2017] [Accepted: 10/11/2017] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Plasmacytomas, considered to be the solitary counterparts of multiple myeloma, are neoplastic monoclonal plasma cell proliferations within soft tissue or bone. Plasmacytomas often present as a collection of findings known as POEMS-syndrome (Polyneuropathy, Organomegaly, Endocrinopathy, M-Protein spike, and Skin changes). CASE DESCRIPTION We present a report of a 47 yo male diagnosed with POEMS-syndrome secondary to a skull base plasmacytoma. The mass resulted in marked instability of the cranio-cervical junction due to bony erosion. Following an induction course of chemotherapy, he showed clinical improvement with a marked reduction in tumor size and underwent an autologous peripheral blood stem cell transplant for systemic treatment of his POEMS-syndrome. Following completion of systemic treatment, he then underwent a definitive occipital-cervical fusion without complications. His neurologic exam upon dismissal was stable with subjective improvement in left upper extremity strength. Postoperative radiographs confirmed spinal alignment and pathological examination of a small biopsy from C1 revealed benign fibrous tissue. CONCLUSION To the best of our knowledge, this is the first report of a skull-base plasmacytoma associated with POEMS-syndrome, causing cranio-cervical instability. The approach of systemic therapy combined with temporary external fixation, followed by definitive occipital cervical fusion resulted in a good outcome for this patient.
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Affiliation(s)
- Hannah Gilder
- Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Meghan E Murphy
- Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Mohammed Ali Alvi
- Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Panagiotis Kerezoudis
- Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Daniel Shepherd
- Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Patrick R Maloney
- Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Mohamad Bydon
- Mayo Clinic Neuro-Informatics Laboratory, Rochester, MN, USA; Department of Neurologic Surgery, Mayo Clinic, Rochester, MN, USA.
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Abstract
Solitary plasmacytoma is a rare disease characterized by a localized proliferation of neoplastic monoclonal plasma cells, without evidence of systemic disease. It can be subdivided into solitary bone plasmacytoma if the lesion originates in bone, or solitary extramedullary plasmacytoma if the lesion involves a soft tissue. The incidence of solitary bone plasmacytoma is higher than solitary extramedullary plasmacytoma. Also, the prognosis is different: even if both forms respond well to treatment, overall survival and progression-free survival of solitary bone plasmacytoma are poorer than solitary extramedullary plasmacytoma due to its higher rate of evolution in multiple myeloma. However, the recent advances in the diagnosis of multiple myeloma can better refine also the diagnosis of plasmacytoma. Flow cytometry studies and molecular analysis may reveal clonal plasma cells in the bone marrow; magnetic resonance imaging or 18 Fluorodeoxyglucose positron emission tomography could better define osteolytic bone lesions. A more explicit exclusion of possible occult systemic involvement can avoid cases of misdiagnosed multiple myeloma patients, which were previously considered solitary plasmacytoma and less treated, with an unavoidable poor prognosis. Due to the rarity of the disease, there is no uniform consensus about prognostic factors and treatment. Radiotherapy is the treatment of choice; however, some authors debate about the radiotherapy dose and the relationship with the response rate. Moreover, the role of surgery and chemotherapy is still under debate. Nevertheless, we must consider that the majority of studies include a small number of patients and analyze the efficacy of conventional chemotherapy; few cases are reported concerning the efficacy of novel agents.
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28
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Nalbandyan K, Benharroch D, Rouvio O, Gurevitch A. Composite Nasopharyngeal plasmacytoma with nodal paraimmunoblastic variant of small lymphocytic lymphoma: A case report. Oncol Lett 2017; 14:1745-1747. [PMID: 28789404 DOI: 10.3892/ol.2017.6308] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2016] [Accepted: 01/19/2017] [Indexed: 11/06/2022] Open
Abstract
A 78-year-old male who presented with severe shortness of breath and bilateral nasal congestion was shown to exhibit ta mass localized in the nasopharynx. The tumor was diagnosed as an extramedullary plasmacytoma. Peripheral blood eosinophilia had been persistently noted in the preceding 12 years. The plasmacytoma exhibited a predominance of κ-light chain monotypic Mott cells and was admixed with numerous eosinophils. No history of allergic rhinitis, asthma or aspirin sensitivity was elicited. An axillary lymph node was excised two weeks after the nasopharyngeal biopsy, and it exhibited a paraimmunoblastic transformation of small lymphocytic lymphoma. A review of the literature identified few occurrences of such simultaneous tumors in individual patients.
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Affiliation(s)
- Karen Nalbandyan
- Department of Pathology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva 84101, Israel
| | - Daniel Benharroch
- Department of Pathology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva 84101, Israel
| | - Ory Rouvio
- Department of Hematology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva 84101, Israel
| | - Anna Gurevitch
- Department of Hematology, Soroka University Medical Center and Faculty of Health Sciences, Ben Gurion University of The Negev, Beer-Sheva 84101, Israel
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29
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Helman SN, Filip P, Iacob C, Colley P. Bilateral sinonasal extramedulary plasmacytoma treated with radiotherapy and a medial maxillectomy with a Denker's procedure. Am J Otolaryngol 2017; 38:360-362. [PMID: 28302379 DOI: 10.1016/j.amjoto.2017.02.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2017] [Accepted: 02/10/2017] [Indexed: 10/20/2022]
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Barzenje DA, Kolstad A, Ghanima W, Holte H. Long-term outcome of patients with solitary plasmacytoma treated with radiotherapy: A population-based, single-center study with median follow-up of 13.7 years. Hematol Oncol 2017; 36:217-223. [PMID: 28393375 DOI: 10.1002/hon.2415] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Revised: 01/26/2017] [Accepted: 03/06/2017] [Indexed: 01/18/2023]
Abstract
In this single-center, population-based, and retrospective study, we analyzed the outcome of 49 patients with solitary bone plasmacytoma (SBP) and 28 patients with solitary extramedullary plasmacytoma (SEP), all treated with radiotherapy. Laminectomy was performed in 18/30 SBP patients with vertebral involvement and tumour resection in 10 SEP patients. Overall survival and cause of death for each patient were compared to 5 sex-, age-, and residency-matched individuals from the normal population. Response (complete and partial) was achieved in 94% of SBP and 96% of SEP patients. Relapse rates were higher in SBP (65%) compared to patients with SEP (18%) (P < .01). Only one in-field relapse was identified for the whole series. Ten- and 15-year overall survival, progression free survival (PFS) and multiple myeloma free survival (MMFS) for patients with SBP were 60%/41%, 25%/17%, and 33%/33%. Corresponding values for patients with SEP were 67%/54%, 57%/44%, and 91%/91%. SBP patients had significantly shorter PFS and MMFS compared to SEP patients (P < .01 for both). Only two of the SEP patients developed multiple myeloma and no patient in the whole series progressed to multiple myeloma later than 10 years after diagnosis. Unlike for SEP, the major cause of death among SBP patients was multiple myeloma (49%). Compared to matched normal population, no increased risk of death from secondary malignancies or cardiovascular disease was observed. Positive predictors in SBP patients were for overall survival age <60 years, combined laminectomy and radiotherapy and radiotherapy dose >40 gray, for PFS tumour size <6 cm and combined laminectomy and radiotherapy and for MMFS tumour size <6 cm. Radiotherapy confers excellent local control in both SEP and SBP patients; however, the challenge is to prevent development of multiple myeloma in patients with SBP.
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Affiliation(s)
| | - Arne Kolstad
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Waleed Ghanima
- Department of Medicine, Ostfold Hospital Trust, Grålum, Norway
| | - Harald Holte
- Department of Oncology, Oslo University Hospital, Oslo, Norway
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31
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Wen G, Wang W, Zhang Y, Niu S, Li Q, Li Y. Management of extramedullary plasmacytoma: Role of radiotherapy and prognostic factor analysis in 55 patients. Chin J Cancer Res 2017; 29:438-446. [PMID: 29142463 DOI: 10.21147/j.issn.1000-9604.2017.05.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
Objective To investigate potential prognostic factors affecting patient outcomes and to evaluate the optimal methods and effects of radiotherapy (RT) in the management of extramedullary plasmacytoma (EMP). Methods Data from 55 patients with EMP between November 1999 and August 2015 were collected. The median age was 51 (range, 22-77) years. The median tumor size was 3.5 (range, 1.0-15.0) cm. The median applied dose was 50.0 (range, 30.0-70.0) Gy. Thirty-nine patients (70.9%) presented with disease in the head or neck region. Twelve patients received RT alone, 9 received surgery (S) alone, 3 received chemotherapy (CT) alone, and 3 patients did not receive any treatment. Combination therapies were applied in 28 patients. Results The median follow-up duration was 56 months. The 5-year local recurrence-free survival (LRFS), multiple myeloma-free survival (MMFS), progression-free survival (PFS) and overall survival (OS) rates were 79.8%, 78.6%, 65.2% and 76.0%, respectively. Univariate analysis revealed that RT was a favourable factor for all examined endpoints. Furthermore, head and neck EMPs were associated with superior LRFS, MMFS and PFS. Tumor size <4 cm was associated with superior MMFS, PFS and OS; serum M protein negativity was associated with superior MMFS and PFS; age ≥50 years and local recurrence were associated with poor MMFS. The dose ≥45 Gy group exhibited superior 5-year LRFS, MMFS and PFS rates (94.7%, 94.4%, 90.0%, respectively), while the corresponding values for the dose <45 Gy group were 62.5% (P=0.008), 53.3% (P=0.036) and 41.7% (P<0.001). Conclusions Involved-site RT of at least 45 Gy should be considered for EMP. Furthermore, patients with head and neck EMP, tumor size <4 cm, age <50 years and serum M protein negativity had better outcomes.
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Affiliation(s)
- Ge Wen
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China.,Department of Radiation Oncology, the Third Affiliated Hospital of Guangzhou Medical University, Guangzhou 510150, China
| | - Weihu Wang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yujing Zhang
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Shaoqing Niu
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Qiwen Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
| | - Yexiong Li
- Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education/Beijing), Department of Radiation Oncology, Peking University Cancer Hospital & Institute, Beijing 100142, China
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Nochikattil SK, Iype EM, Ramrao SK, Nair P, Thomas S. A Case of Multiple Myeloma: Mimicking Carcinoma Larynx. Indian J Otolaryngol Head Neck Surg 2016; 68:534-536. [PMID: 27833884 DOI: 10.1007/s12070-016-0987-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2015] [Accepted: 05/02/2016] [Indexed: 11/28/2022] Open
Affiliation(s)
| | | | | | - Preethi Nair
- Department of Pathology, Regional Cancer Centre, Trivandrum, Kerala India
| | - Shaji Thomas
- Department of Surgical Oncology, Regional Cancer Centre, Trivandrum, Kerala India
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Intensity-modulated radiotherapy for localized nasopharyngeal amyloidosis. Strahlenther Onkol 2016; 192:944-950. [DOI: 10.1007/s00066-016-0996-6] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Accepted: 05/02/2016] [Indexed: 10/21/2022]
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Extramedullary Plasmacytoma of the Paranasal Sinuses: Combining Surgery with External Radiotherapy. Indian J Otolaryngol Head Neck Surg 2016; 68:34-8. [PMID: 27066407 DOI: 10.1007/s12070-015-0826-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2014] [Accepted: 01/15/2015] [Indexed: 10/24/2022] Open
Abstract
Extramedullary plasmacytomas (EMP) are rare neoplasms characterized by the proliferation of a single B-lymphoid cell clone, arising primarily in the head and neck region. The purpose of this study is to report our experience in the management of EMPs arising in the paranasal sinuses. We retrospectively reviewed clinical records of 7 patients (4 men and 3 women), admitted between 1995 and 2010 for EMPs of the paranasal sinuses-5 within the ethmoid and 2 in the maxillary sinus. Treatment consisted in endoscopic resection followed by external RT. The mean follow-up period is 50 months (range 9-67 months). Local recurrences developed in 2 out of 7 cases. Both recurrences occurred in maxillary EMPs and they underwent salvage treatment-combination of RT and surgery. At the time of analyzing these data 5 patients (70 %) were alive and two (30 %) have died of their disease. A single patient, presenting local relapse at 6 months, died due to the disease at 9 months. One patient progressed to multiple myeloma. Larger controlled clinical trials are necessary to establish an optimal treatment of choice that implies an individualized management of these patients.
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18F-FDG PET/CT Metabolic Activity in a Patient With Solitary Extramedullary Plasmacytoma of the Lung. Clin Nucl Med 2016; 41:232-4. [DOI: 10.1097/rlu.0000000000001030] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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36
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Li QW, Niu SQ, Wang HY, Wen G, Li YY, Xia YF, Zhang YJ. Radiotherapy Alone is Associated with Improved Outcomes Over Surgery in the Management of Solitary Plasmacytoma. Asian Pac J Cancer Prev 2016; 16:3741-5. [PMID: 25987031 DOI: 10.7314/apjcp.2015.16.9.3741] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND A moderate dose of radiation is the recommended treatment for solitary plasmacytoma (SP), but there is controversy over the role of surgery. Our study aimed at comparing different treatment modalities in the management of SP. MATERIALS AND METHODS Data from 38 consecutive patients with solitary plasmacytoma, including 16 with bone plasmacytoma and 22 with extramedullary plasmacytoma, were retrospectively reviewed. 15 patients received radiotherapy alone; 11 received surgery alone, and 12 received both. The median radiation dose was 50Gy. All operations were performed as radical resections. Local progression-free survival (LPFS), multiple myeloma-free survival (MMFS), progression-free survival (PFS) and overall survival (OS) were calculated and outcomes of different therapies were compared. RESULTS The median follow-up time was 55 months. 5-year LPFS, MMFS, PFS and OS were 87.0%, 80.9%, 69.8% and 87.4%, respectively. Univariate analysis revealed, compared with surgery alone, radiotherapy alone was associated with significantly higher 5-year LPFS (100% vs 69.3%, p=0.016), MMFS (100% vs 51.4%, p=0.006), PFS (100% vs 33.7%, p=0.0004) and OS (100% vs 70%, p=0.041). CONCLUSIONS Radiotherapy alone can be considered as a more effective treatment for SP over surgery. Whether a combination of radiotherapy and surgery improves outcomes requires further study.
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Affiliation(s)
- Qi-Wen Li
- Department of Radiation Oncology, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, China E-mail :
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He J, Zhang Y, Shen Q, Li Y, Liu Z, Peng X, Shen Y, Yin R, Chen N. Irradiation combined with surgery for function preservation in the treatment of extramedullary plasmacytoma of the left labia majora during pregnancy: A case report. Oncol Lett 2016; 10:3238-3242. [PMID: 26722319 DOI: 10.3892/ol.2015.3648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2014] [Accepted: 07/28/2015] [Indexed: 02/05/2023] Open
Abstract
Extramedullary plasmacytoma (EMP) in the vulva is extremely rare. The current study presents, for the first time, a case of EMP in the left labia majora in a 36-year-old patient during pregnancy. A painful 7×4×2-cm mass with ulceration, pus and blood scabs, previously misdiagnosed as vulvar ulcer in a local hosipital, was proven to be an EMP by biopsy. Upon magnetic resonance imaging, the tumor was shown to occur in the left labia majora without lymphadenopathy. A complete multiple myeloma (MM) workup excluded coexistence with MM. The goal of treatment was to eradicate the tumor while synchronously preserving the vulva. Therefore, following the termination of the pregnancy, radiotherapy with a total dose of 4,500 cGy markedly reduced the size of the tumor. An extended local excision of the residual tumor, and anaplasty of the vulva preserved the appearance and function of the vulva to the utmost. No post-operative radiation was administered, as the resection margins were not microscopically involved. There was no relapse, metastasis or progression to MM in a 9-month post-operative follow-up period, but close follow-up and long-term surveillance are required.
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Affiliation(s)
- Jinlan He
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yulong Zhang
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Qin Shen
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yan Li
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Zhe Liu
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Xingchen Peng
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Yali Shen
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Rui Yin
- Department of Pathology, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
| | - Nianyong Chen
- Department of Radiation Oncology, Cancer Center and State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P.R. China
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Khan M, Rajarubendra N, Azer S, Skene A, Harrison SJ, Campbell B, Lawrentschuk N. Plasmacytoma of the testis in a patient with relapsed and refractory multiple myeloma: Case report and review of the literature. Urol Ann 2015; 7:530-3. [PMID: 26692682 PMCID: PMC4660713 DOI: 10.4103/0974-7796.164844] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Testicular plasmacytoma, whether occurring as a primary lesion or as a reflection of underlying multiple myeloma (MM), is a rare disease. We report the case of a 38-year-old male with multiply relapsed MM, who was found to have a testicular plasmacytoma. He presented with a gradually enlarging scrotal mass. Following orchidectomy, pathologic examination of the specimen demonstrated a plasmacytoma. In the context of active MM, the specimen was also sent for cytogenetic analysis but this was unhelpful in guiding a chemotherapy regime, which still continues at time of reporting. Although a rare lesion, there remains no definitive treatment protocol for the management of testicular plasmacytoma representing an extramedullary manifestation of MM.
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Affiliation(s)
- Munad Khan
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | | | - Sarah Azer
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia
| | - Alison Skene
- Department of Pathology, Austin Hospital, Melbourne, Australia
| | - Simon J Harrison
- Department of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia ; Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia
| | - Belinda Campbell
- Department of Oncology, Sir Peter MacCallum, University of Melbourne, Melbourne, Australia ; Department of Radiation Oncology and Cancer Imaging, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Nathan Lawrentschuk
- Department of Surgery, University of Melbourne, Austin Hospital, Melbourne, Australia ; Olivia Newton-John Cancer Research Department, Austin Hospital, Melbourne, Australia ; Department of Cancer Surgery, Peter MacCallum Cancer Centre, Melbourne, Australia
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Anderson KC, Alsina M, Atanackovic D, Biermann JS, Chandler JC, Costello C, Djulbegovic B, Fung HC, Gasparetto C, Godby K, Hofmeister C, Holmberg L, Holstein S, Huff CA, Kassim A, Krishnan AY, Kumar SK, Liedtke M, Lunning M, Raje N, Singhal S, Smith C, Somlo G, Stockerl-Goldstein K, Treon SP, Weber D, Yahalom J, Shead DA, Kumar R. Multiple Myeloma, Version 2.2016: Clinical Practice Guidelines in Oncology. J Natl Compr Canc Netw 2015; 13:1398-435. [PMID: 26553768 PMCID: PMC4891187 DOI: 10.6004/jnccn.2015.0167] [Citation(s) in RCA: 52] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Multiple myeloma (MM) is a malignant neoplasm of plasma cells that accumulate in bone marrow, leading to bone destruction and marrow failure. Recent statistics from the American Cancer Society indicate that the incidence of MM is increasing. The NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) included in this issue address management of patients with solitary plasmacytoma and newly diagnosed MM.
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Skóra T, Pudełek K, Nowak-Sadzikowska J, Pietrasz M, Szyszka-Charewicz B, Jakubowicz J. Effect of definitive radiotherapy on the long-term outcome in patients with solitary extramedullary plasmacytoma. Hematol Oncol 2015; 35:317-322. [DOI: 10.1002/hon.2261] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Revised: 08/18/2015] [Accepted: 08/25/2015] [Indexed: 11/09/2022]
Affiliation(s)
- Tomasz Skóra
- Oncology Department; Maria Skłodowska-Curie Memorial Institute of Oncology; Kraków Poland
| | | | | | - Mariusz Pietrasz
- Oncology Department; Maria Skłodowska-Curie Memorial Institute of Oncology; Kraków Poland
| | | | - Jerzy Jakubowicz
- Oncology Department; Maria Skłodowska-Curie Memorial Institute of Oncology; Kraków Poland
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Pinto JA, Sônego TB, Artico MS, Leal CDFA, Bellotto S. Extramedullary plasmacytoma of the larynx. Int Arch Otorhinolaryngol 2015; 16:410-3. [PMID: 25991967 PMCID: PMC4432537 DOI: 10.7162/s1809-97772012000300019] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 08/01/2010] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION The extramedullary plasmocytoma is one of the localized forms of malignancy of the plasma cells, which has multiple myeloma main diagnosis. Its main site to the head and neck, but with a rare presentation in the larynx. OBJECTIVE To describe a case of extramedullary plasmocytoma of the larynx, with literature review. CASE REPORT Patient female, 49, referring to intermittent dysphonia for 01 years with progressive worsening associated with vocal fatigue and vocal effort, with reddish lesion, smooth edges fold left ventricular endoscopy. Being subjected to excisional biopsy diagnosed with extramedullary histopathological plasmocytoma. CONCLUSION Extramedullary Plasmocytoma must be considered in the differential diagnosis of rare tumors of the larynx. It is essential after the diagnosis of multiple myeloma research and a "follow up" appropriate.
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Affiliation(s)
- José Antônio Pinto
- President of the Brazilian Society of Laryngology and Voice (2001-2003). Director of the Center for Otolaryngology and Head and Neck Surgery of São Paulo
| | - Thiago Branco Sônego
- Resident Doctor of the Center for Otolaryngology and Head and Neck Surgery of São Paulo
| | - Marina Spadari Artico
- Resident Doctor of the Center for Otolaryngology and Head and Neck Surgery of São Paulo
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Abstract
A 75-year-old woman presented with a 1-year history of an enlarging mass in the left parotid gland. Biopsy revealed a parotid plasmacytoma, and the patient was referred for a staging F-FDG PET/CT to evaluate the presence of multiple myeloma bone involvement. The PET/CT scan showed intense FDG uptake in the neck mass but no FDG-avid lymphadenopathy or distant metastases. Plasmacytoma involving the parotid gland is extremely rare. We present the F-FDG PET/CT imaging of solitary parotid plasmacytoma.
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44
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Webb M, Barrett C, Barrett S, van Rensburg JJ, Louw V. Cranial plasmacytoma: a case series and review of the literature. Indian J Hematol Blood Transfus 2014; 29:43-7. [PMID: 24426333 DOI: 10.1007/s12288-011-0126-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 10/21/2011] [Indexed: 01/16/2023] Open
Abstract
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.
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Affiliation(s)
- Michael Webb
- Division Clinical Haematology, Department of Internal Medicine (G73), Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300 South Africa
| | - Claire Barrett
- Division Clinical Haematology, Department of Internal Medicine (G73), Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300 South Africa
| | - Shelley Barrett
- Department of Ophthalmology, Faculty of Health Sciences, University of the Free State, Bloemfontein, South Africa
| | - Jacques Janse van Rensburg
- Division Clinical Haematology, Department of Internal Medicine (G73), Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300 South Africa
| | - Vernon Louw
- Division Clinical Haematology, Department of Internal Medicine (G73), Faculty of Health Sciences, University of the Free State, PO Box 339, Bloemfontein, 9300 South Africa
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Nam KU, Ahn J, Hong J. Occurrence of multiple myeloma in the head and neck: a report of two cases. J Korean Assoc Oral Maxillofac Surg 2013; 39:139-43. [PMID: 24471032 PMCID: PMC3858165 DOI: 10.5125/jkaoms.2013.39.3.139] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Revised: 06/14/2013] [Accepted: 06/14/2013] [Indexed: 12/25/2022] Open
Abstract
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.
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Affiliation(s)
- Ki-Uk Nam
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jaemyung Ahn
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
| | - Jongrak Hong
- Department of Oral and Maxillofacial Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea
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46
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Ashraf MJ, Azarpira N, Khademi B, Abedi E, Hakimzadeh A, Valibeigi B. Extramedullary plasmacytoma of the nasal cavity report of three cases with review of the literature. IRANIAN RED CRESCENT MEDICAL JOURNAL 2013; 15:363-6. [PMID: 24083014 PMCID: PMC3785915 DOI: 10.5812/ircmj.2209] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Revised: 01/04/2012] [Accepted: 01/11/2012] [Indexed: 11/16/2022]
Abstract
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.
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Affiliation(s)
| | - Negar Azarpira
- Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran
- Corresponding author: Negar Azarpira, Transplant Research Center, Shiraz University of Medical Sciences, Shiraz, IR Iran. Tel: +98- 7116474331, Fax: +98-711 6474331, E-mail:
| | - Bighan Khademi
- Otolaryngology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Elham Abedi
- Pathology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Afsoon Hakimzadeh
- Pathology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran
| | - Bita Valibeigi
- Pathology Department, Shiraz University of Medical Sciences, Shiraz, IR Iran
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Gerry D, Lentsch EJ. Epidemiologic evidence of superior outcomes for extramedullary plasmacytoma of the head and neck. Otolaryngol Head Neck Surg 2013; 148:974-81. [PMID: 23482476 DOI: 10.1177/0194599813481334] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare clinicopathologic data, epidemiologic factors, and survival outcomes between extramedullary plasmacytomas of the head and neck vs other body sites. STUDY DESIGN Analysis of a national database. SETTING Extramedullary plasmacytoma (EMP) is a rare B-cell neoplasm with a tendency to occur in the head and neck. Due to limited clinical data, few studies have conducted a thorough comparison between head and neck EMPs and those arising at other body sites. SUBJECTS AND METHODS We compared 690 EMPs of the head and neck with 495 non-head and neck EMPs, evaluating disease-specific survival (DSS) and overall survival (OS) based on tumor type, location, grade, stage, and treatment. RESULTS Head and neck EMPs more often affected men (P > .001) and were typically located in the pharynx (21.5%), nasal cavity (19.3%), oral cavity (14.7%), and paranasal sinuses (13.0%). Non-head and neck EMPs were more often limited to only local disease at presentation (94.8% vs 82.1%-86.7%, P < .001). Patients with non-head and neck EMP more often received surgery alone, whereas those with head and neck EMP were more often treated with combination therapy or radiation alone (P < .001). Head and neck EMPs had a significantly higher 5-year DSS and OS than other plasmacytomas (P < .001), and they had a higher 10-year OS when treated with surgery or combination therapy than with radiation alone (P = .003). CONCLUSION Extramedullary plasmacytoma of the head and neck represents a type of tumor unique from other plasmacytomas, with distinct epidemiologic characteristics and a superior prognosis. Evidence suggests that surgically based treatments may offer improved outcomes.
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Affiliation(s)
- Daniel Gerry
- Mercer University School of Medicine, Savannah, Georgia, USA
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48
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Kyle RA, Dispenzieri A. Monoclonal gammopathies. Clin Immunol 2013. [DOI: 10.1016/b978-0-7234-3691-1.00094-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Abstract
The diagnosis of a sellar plasmacytoma is often missed and is mistaken for a non functioning pituitary adenoma. We reviewed the literature on reported cases of sellar plasmacytoma in order to identify its clinical presentation, laboratory, radiological and pathological characteristics. We describe the management of these cases after the correct diagnosis was made and provide insight to preoperative diagnosis of this entity. Preoperative diagnosis may help avoid unnecessary surgical resection of an otherwise radiosensitive tumor. We also report and describe in detail a new case of sellar plasmacytoma that we have recently evaluated.
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Affiliation(s)
- Rene Joukhadar
- Department of Diabetes, Endocrinology, and Metabolism, City of Hope National Medical Center, Duarte, CA 91010, USA.
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50
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Tan J, Lade S, Harrison S, Opat S, Mac Manus MP. Complete remission of localised gastric plasmacytomas following definitive radiotherapy. J Med Imaging Radiat Oncol 2012; 56:328-31. [PMID: 22697332 DOI: 10.1111/j.1754-9485.2012.02369.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
AIMS Primary gastric extramedullary plasmacytoma is an extremely rare condition and there is scant information in the literature concerning its natural history or therapy. There have been anecdotal reports of surgical resection, with or without Helicobacter pylori eradication, but there are no useful reports of the role of radiotherapy. We report the clinicopathologic outcome of radical radiotherapy as a primary treatment modality. METHODS We identified two patients with biopsy-proven primary gastric extramedullary plasmacytoma. Routine staging investigations were performed and H. pylori status was determined. Radical radiotherapy to 41.4 Gy in 23 fractions was delivered using conformal techniques. The target volume was the stomach with a 1-cm margin. Prophylactic anti-emetic was administered prior to each fraction. Post-treatment endoscopies and biopsies were performed at 3-monthly intervals to assess clinicopathological response. Treatment-related toxicities were documented. RESULTS Both patients achieved durable (>12 months) pathologically confirmed complete remissions without significant toxicities. CONCLUSION Radical radiotherapy offers the potential for cure and organ preservation with low toxicity. It should be considered a favourable alternative to surgery in the management of this rare disease entity.
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Affiliation(s)
- Jennifer Tan
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
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