Relapsed multiple myeloma manifesting as extramedullary plasmacytoma of the breast: Imaging findings

Bilateral Breast Involvement in Multiple Myeloma: A Report of a Rare Case

Breast plasmacytoma is an uncommon extramedullary manifestation of multiple myeloma (MM). This case presents a primary extramedullary plasmacytoma and progression to MM with breast involvement after 12 years of discovering the disease. The patient is a 54-year-old woman who initially presented with a right humerus pathological fracture that turned out to be a primary extramedullary plasmacytoma. She received chemotherapy and achieved remission. Six years later, the disease recurred as a mass in the sternum, which was treated with radiation and chemotherapy but without improvement. The disease then progressed to MM with lesions in various bones. Following the first radiation treatment, the patient developed a new-onset cough, leading to a high-resolution CT, which incidentally revealed multiple bilateral breast lesions suggestive of malignancy. Mammography and sonography indicated multiple nodular densities warranting biopsy. Tru-cut biopsy confirmed plasmacytic neoplasm consistent with MM. Subsequent imaging showed the progression of breast lesions with increasingly aggressive features. Biopsies consistently indicated refractory progressive MM. This case highlights the aggressive, multisystemic nature of MM and the challenge of managing refractory disease with extensive systemic involvement, including rare bilateral breast lesions.

A Rare Case of Extra-Medullary Portacaval Plasmacytoma in a Patient With Relapsed Multiple Myeloma

Multiple myeloma (Kahler disease) is a monoclonal plasma cell immunoproliferative neoplasm originating within the bone marrow that involves the production of monoclonal immunoglobulins, mostly IgG and IgA. Extramedullary plasmacytoma (EMP) is a subset of plasma cell neoplasms that can develop in patients at the time of diagnosis with multiple myeloma, or relapse of the disease. Symptoms related to plasmacytomas depend on the primary location. Here in, we present a rare case of extramedullary plasmacytoma involving the portacaval space in an 83-year-old African American female with relapsed multiple myeloma. She was treated successfully with radiation therapy with complete resolution of the mass. In this case report, we aim to discuss the clinical features along with diagnostic methods and treatment for extramedullary plasmacytomas with emphasis on utilizing a multidisciplinary approach in managing these rare cases.

Extramedullary relapse of multiple myeloma presenting as a breast lump

Multiple myeloma (MM) involving the breast tissue is rare. We report the case of a 70-year-old woman with a background of previously treated MM in remission presenting with a breast lump. Histology showed a plasma cell neoplasm and subsequent staging investigations showed widespread extramedullary relapse of MM. Despite its rarity, this diagnosis should be considered within the differential diagnosis of breast masses as it can arise de novo or may be the first presenting feature of myeloma. The importance of the multidisciplinary team approach with triple assessment of the breast, as well as recent advances in knowledge regarding extramedullary disease in myeloma and novel treatment approaches in MM are discussed.

A Rare Case of Extramedullary Multiple Myeloma Presenting as Masses on the Breast and Chest Wall Complicated with Sjogren's Syndrome

Multiple myeloma (MM) in the breast has been rarely documented. However, there are no reports on concurrent masses of chest wall soft tissue and breast as the primary symptoms for MM. Herein, we report a case of a 68-year-old woman presented with masses in her right breast and chest wall for 1 month. She recalled having xerophthalmia and xerostomia for 2 years without taking any test to search for the cause of these symptoms. Ultrasonography (US) and computed tomography (CT) examination revealed masses in the right breast and chest wall. Both lesions of the breast and chest wall were confirmed to be plasma cell tumors by ultrasound-guided puncture biopsy and MM was confirmed by bone marrow examination. Meanwhile, Sjogren's syndrome (SS) was diagnosed by the positive expression of antibodies against antinuclear, Ro/SSA and La/SSB. After three courses of chemotherapy for MM, the symptoms of SS were significantly alleviated and the masses in the chest wall and breast disappeared.

Extramedullary Plasmacytoma of the breast in a patient with Multiple Myeloma

Extramedullary plasmacytoma of the breast is rare. It is important to recognize the imaging findings and include it as a differential consideration in multiple myeloma patients with a breast mass. A 74-year-old woman undergoing chemotherapy for relapsed multiple myeloma presented with a palpable mass in her right breast. A screening mammogram four months prior was unremarkable. She underwent a diagnostic right mammogram which showed two well-circumscribed hyperdense masses. An ultrasound of the right breast showed mixed echogenic masses with indistinct margins and increased vascularity. Ultrasound guided biopsy confirmed the presence of an extramedullary plasmacytoma. A follow-up whole body PET/CT demonstrated an FDG-avid right breast mass with extensive osseous metastases.

Multiple Myeloma Breast Involvement: A Case Report

Multiple Myeloma involving the breast is very rare and the diagnosis is challenging because the clinical and radiological features of breast multiple myeloma are indistinguishable to other forms of breast disease whether primary or metastatic. In this article the authors report a case presented with breast masses, which were found to be extra osseous Multiple Myeloma. The patient was managed for multiple spinal lesions that were primarily thought to be metastasis from primary breast cancer.