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Sanchez EG, Ramos C, Ratnarajah K, Bravo FP, Del Solar MA, Le M, Netchiporouk E. Adenopathy and extensive skin patch overlying plasmacytoma syndrome—the clue to early diagnosis of polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes: A case series and literature review. SAGE Open Med Case Rep 2022; 10:2050313X221091602. [PMID: 35495293 PMCID: PMC9052825 DOI: 10.1177/2050313x221091602] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Importance: Adenopathy and extensive skin patch overlying plasmacytoma syndrome is a
paraneoplastic syndrome characterized by a cutaneous vascular patch
overlying a plasmacytoma and systemic manifestations. It is thought to be an
early stage of polyneuropathy, organomegaly, endocrinopathy, monoclonal
gammopathy, and skin changes syndrome, which is a rare, but potentially
fatal multisystemic disease that is associated with plasma cell dyscrasia.
Thus, a high index of suspicion is required to identify patients with
adenopathy and extensive skin patch overlying plasmacytoma as they may
present with early polyneuropathy, organomegaly, endocrinopathy, monoclonal
gammopathy, and skin changes, which is curable if detected early. Objective: To report additional cases of adenopathy and extensive skin patch overlying
plasmacytoma syndrome, describe dermatoscopic and histologic findings of the
cutaneous patch and review all up to date literature on adenopathy and
extensive skin patch overlying plasmacytoma syndrome. Design: Case series from a single tertiary care center. Participants: Here, we present the second case series of three patients with adenopathy and
extensive skin patch overlying plasmacytoma syndrome who all meet the
diagnostic criteria for polyneuropathy, organomegaly, endocrinopathy,
monoclonal gammopathy, and skin changes. The diagnosis was suspected based
on the presence of the violaceous cutaneous patch along with symptoms of
systemic involvement (fatigue, weight loss, weakness). Dermoscopy revealing
regular dilated parallel capillaries was suggestive of a benign/reactive
vascular process. Histopathology in all three cases showed reactive vascular
proliferation with a characteristic 90° branching. To date only 20 cases of
adenopathy and extensive skin patch overlying plasmacytoma have been
published, including ours. All patients presented with cutaneous lesions
(violaceous patch and others) and most, at least 15/20, met the diagnostic
criteria for polyneuropathy, organomegaly, endocrinopathy, monoclonal
gammopathy, and skin changes. When clinical follow-up was reported, most
patients had a favorable prognosis with partial or complete symptom
resolution following treatment of the underlying plasmocytoma.
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Affiliation(s)
| | - César Ramos
- Division of Dermatology, Department of Medicine, Universidad Cayetano Heredia, Lima, Peru
| | | | - Francisco P Bravo
- Division of Dermatology, Department of Medicine, Universidad Cayetano Heredia, Lima, Peru
| | - Manuel A Del Solar
- Division of Dermatology, Department of Medicine, Universidad Cayetano Heredia, Lima, Peru
| | - Michelle Le
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal General Hospital Montreal, QC, Canada
| | - Elena Netchiporouk
- Division of Dermatology, Department of Medicine, McGill University Health Centre, Montreal General Hospital Montreal, QC, Canada
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Abstract
Adenopathy and an extensive skin patch overlying a plasmacytoma (AESOP) syndrome, first described 16 years ago, is characterized by a slowly expanding red or brown patch (classic variant) or plaque (morphea-like variant) overlying a solitary plasmacytoma of the bone. Early recognition can be life-saving, as it is an early presentation of polyneuropathy, organomegaly, endocrinopathy, M-protein, skin changes (POEMS) syndrome, which may be fatal. There are two forms: the classic variant, which presents as a smooth, shiny macule with abnormal visibility of skin vessels, and the morphea-like variant, which presents as a plaque where the skin is folded, giving a "peau d'orange" appearance. The locations are frequently above the rib cage, above the sternum, or the scalp. Seventy-five percent of the patients develop regional lymphadenopathy within a few months. Histopathologic study reveals a capillary proliferation in the dermis. The diagnosis relies on subsequent identification of the plasmacytoma. At the time of a presumptive diagnosis, only 40% of patients have fulfilled the diagnostic criteria of POEMS. Treatment depends on the final hematologic diagnosis, but radiation of the plasmacytoma is required.
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Dagrosa AT, Cowdrey MCE, LeBlanc RE, Lansigan F, Kaur P, Carter JB. Adenopathy and extensive skin patch overlying a plasmacytoma with unusual histologic findings in a patient with polyneuropathy, organomegaly, endocrinopathy, monoclonal protein and skin changes syndrome and Castleman disease. J Cutan Pathol 2019; 46:784-789. [DOI: 10.1111/cup.13514] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Revised: 05/15/2019] [Accepted: 05/17/2019] [Indexed: 12/14/2022]
Affiliation(s)
- Alicia T. Dagrosa
- Department of Surgery, Section of DermatologyDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Molly C. E. Cowdrey
- Department of DermatologyLahey Hospital & Medical Center Burlington Massachusetts
| | - Robert E. LeBlanc
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Frederick Lansigan
- Section of Hematology/OncologyDartmouth‐Hitchcock Norris Cotton Cancer Center Lebanon New Hampshire
| | - Prabhjot Kaur
- Department of Pathology and Laboratory MedicineDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
| | - Joi B. Carter
- Department of Surgery, Section of DermatologyDartmouth‐Hitchcock Medical Center Lebanon New Hampshire
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Abstract
The interaction between hair and malignancy is complicated. Various hair abnormalities can manifest in oncology patients as a clinical manifestation, the result of cancer therapy, or due to a paraneoplastic condition. The mechanisms of these changes remain unclear. Alopecia is one of the common clinical presentations occurring in oncology patients that affects their quality of life. The condition can concomitantly develop during the course of malignancy or when patients undergo cancer treatment. It is important for physicians to understand alopecia in association with malignancy as it may be an important associated finding or provide the clues to aid diagnosis. The aim of this review is to summarize the clinical characteristics of alopecia that occur in cancer patients and their relationship with the type of malignancy and its treatment.
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Kutlubay Z, Engin B, Uzuncakmak TK, Demirkesen C, Altiti MM, Karter Y, Tuzun Y. POEMS syndrome (polyneuropathy organomegaly endocrinopathy M-protein skin changes) with xanthoma--a case report. J Eur Acad Dermatol Venereol 2014; 30:353-5. [PMID: 25296893 DOI: 10.1111/jdv.12766] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Affiliation(s)
- Z Kutlubay
- Department of Dermatology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - B Engin
- Department of Dermatology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - T K Uzuncakmak
- Department of Dermatology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - C Demirkesen
- Department of Pathology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - M M Altiti
- Department of Internal Medicine, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Y Karter
- Department of Internal Medicine, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
| | - Y Tuzun
- Department of Dermatology, Istanbul University, Cerrahpasa Medical Faculty, Istanbul, Turkey
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Plata Bello J, Garcia-Marin V. POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, multiple myeloma and skin changes) with cranial vault plasmocytoma and the role of surgery in its management: a case report. J Med Case Rep 2013; 7:245. [PMID: 24139142 PMCID: PMC4016595 DOI: 10.1186/1752-1947-7-245] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2013] [Accepted: 08/29/2013] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION POEMS syndrome (an acronym of polyneuropathy, organomegaly, endocrinopathy, multiple myeloma and skin changes) is a paraneoplastic disorder related to an underlying plasma cell dyscrasia. The development of such a syndrome is rare and its association with calvarial plasmocytoma is even less common, with only two previous reported cases. We describe, in detail, an unusual presentation of cranial plasmocytoma associated with POEMS syndrome and briefly discuss the possible role of surgery in the management of this disease. CASE PRESENTATION We present the case of a 45-year-old Caucasian man who was admitted to our department presenting with progressive weakness in his lower limbs, enlarged lymph nodes and a large mass on the scalp with intense bone erosion. POEMS criteria were present and pathological studies confirmed a Castleman's variant plasmocytoma. Clinical status improved noticeably after the excision of the plasmocytoma and the treatment was completed with radiotherapy and steroid pulse therapy. CONCLUSION Cranial vault plasmocytoma and its association with POEMS syndrome are rare conditions with few previously reported cases. Although the role of surgery is not clearly defined in POEMS syndrome guidelines, the fact that there seems to be a better prognosis and clinical outcome when surgery is used as a part of the management in POEMS syndrome with cranial vault plasmocytoma is worth discussing.
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Affiliation(s)
- Julio Plata Bello
- Neuroscience Department, Hospital Universitario de Canarias, C/Ofra s/n, La Laguna, 38320, Santa Cruz de Tenerife, Spain.
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Castleman's disease of the mesorectum: report of a case. Surg Today 2011; 41:271-5. [PMID: 21264768 DOI: 10.1007/s00595-009-4206-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2009] [Accepted: 08/20/2009] [Indexed: 12/28/2022]
Abstract
Castleman's disease is a benign lymphoid proliferative disorder, which most commonly presents as a solitary mass in the mediastinum, although extrathoracic sites have been reported in the neck, axilla, pelvis, mesentery, pancreas, and retroperitoneum. We report a case of asymptomatic, isolated Castleman's disease in the mesorectum, which is extremely rare. The patient was a 34-year-old woman who underwent investigations for vaginal spotting. A presacral mass was located on the left side of the rectum, 10 cm from the anal verge. Contrast-enhanced computed tomography showed a large, well-demarcated, strongly enhancing mass with internal radiating septa in the mesorectum. The mass was well circumscribed and isointense to muscle on T1-weighted magnetic resonance imaging, appearing as a slightly hyperintense mass on T2-weighted imaging. We performed laparoscopic mesorectal mass excision, and histological examination revealed features typical of the hyaline-vascular type of Castleman's disease. Thus, when a mesorectal mass is being investigated, Castleman's disease should be considered in the differential diagnosis.
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Mlczoch L, Attarbaschi A, Dworzak M, Gadner H, Mann G. Alopecia areata and multifocal bone involvement in a young adult with Hodgkin's disease. Leuk Lymphoma 2009; 46:623-7. [PMID: 16019495 DOI: 10.1080/10428190500032570] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
A 17-year-old girl presented with a 3 month history of alopecia areata, a generalized scaling skin, enlargement of the inguinal lymph nodes and severe back pain. Staging procedures revealed multifocal bone disease and generalized lymphadenopathy. The diagnosis of nodular sclerosing Hodgkin's disease was established by biopsies of the os ileum and a left inguinal lymph node. Complete clinical remission was achieved after 2 OPPA (vincristine, prednisone, procarbazine, and doxorubicin) and 4 COPP (cyclophosphamide, vincristine, prednisone, and procarbazine) cycles and treatment completed with involved-field irradiation. After the completion of therapy, skeletal lesions had mostly resolved or become sclerotic and the patient had normal hair regrowth and skin appearance. Conclusively, this case illustrates that alopecia areata may occur as a paraneoplastic phenomenon or an autoimmune process related to the deranged cellular immune system in children and adolescents with Hodgkin's disease.
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Inflammation cutanée de contiguïté. Ann Dermatol Venereol 2008; 135:127-30. [DOI: 10.1016/j.annder.2007.02.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2006] [Accepted: 02/09/2007] [Indexed: 01/27/2023]
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Hinds G, Thomas VD. Malignancy and Cancer Treatment-Related Hair and Nail Changes. Dermatol Clin 2008; 26:59-68, viii. [DOI: 10.1016/j.det.2007.08.003] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
UNLABELLED The cicatricial alopecias encompass a diverse group of disorders characterized by permanent destruction of the hair follicle and irreversible hair loss. Destruction of the hair follicle can result from primary, folliculocentric disease or as a secondary result. This article focuses on the former, or primary cicatricial alopecias. The cause and pathogenesis of many of these disorders are largely unknown. Although unique clinicopathologic features allow for accurate diagnosis in some cases, diagnostic certainty is often elusive and reflects the limits of present understanding. Classification of the primary cicatricial alopecias on the basis of pathology provides a diagnostic and investigational framework and, it is hoped, will facilitate future enlightenment. Details of classification, etiopathogenesis, clinicopathologic features, differential diagnosis, and practical management of the primary cicatricial alopecias will be discussed. LEARNING OBJECTIVES Upon completion of this learning activity, participants should be familiar with the following aspects of the primary cicatricial alopecias: (1) the new, consensus-issued classification scheme, (2) current understanding about etiopathogenesis, (3) salient clinicopathologic features, (4) differential diagnosis, and (5) therapeutic management.
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Affiliation(s)
- Elizabeth K Ross
- Department of Medicine, University of British Columbia, Vancouver Coastal Health Research Insitute, Vancouver, British Columbia, Canada
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Muhsein KA, Liew NC, Shaker ARH, Shahrin IAW. Localized Castleman's Disease Presenting as a Vascular Right Iliac Fossa Mass. Asian J Surg 2004; 27:54-7. [PMID: 14719517 DOI: 10.1016/s1015-9584(09)60246-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Castleman's disease is a rare lymphoproliferative disorder of unknown aetiology. The presentation is varied, diagnosis is difficult, and optimum management is still unknown. We report our experience with a case of Castleman's disease in a 34-year old woman who presented with pallor, hepatosplenomegaly, and a right iliac fossa mass that was 5 cm in diameter. this was initially diagnosed as a soft tissue sarcoma and preoperative tumour embolization was planned before excision. Mesenteric arteriogram revealed that the feeder arteries arose from the superior mesenteric artery and embolization was aborted for fear of causing bowel ischaemia. On laparotomy, lymphoid enlargement was found between the leaves of the jejunal mesentery. The tumour was relatively avascular and the overlying mesenteric vessels contributed to teh duplex ultrasound and computerized tomography appearance of hypervascularity. The tumour with the mesentery and the overlying segment of jejunum was excised completely. Histopathology confirmed Castleman's disease. The purpose of this report is to present this rare case that caused a diagnostic dilemma and to review the management of this disorder.
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Affiliation(s)
- Khairul Abdullah Muhsein
- Department of Surgery, University Putra Malaysia, Jalan Masjid, Hospital Kuala Lumpur, 50586 Kuala Lumpur.
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Abstract
BACKGROUND Multiple myeloma (MM) is a plasma cell dyscrasia characterized by a clonal proliferation of plasma cells that produces a monoclonal protein. There are dermatologic disorders that have been associated with MM, such as amyloidosis, cryoglobulinemia, POEMS syndrome, normolipemic plane xanthoma, and plasmacytoma. The high volume of patients with MM seen at our institution presents an opportunity to define more extensively the spectrum of cutaneous diseases seen in concert with MM. DESIGN We reviewed 2357 pathology reports of all patients with a diagnosis of MM to find those who had undergone a skin biopsy. Files were searched for bone-marrow diagnosis, and for type and number of transplants. RESULTS In all, 284 patients yielded 472 skin biopsy specimens (average 1.7/patient). Skin biopsy specimen diagnoses included neoplastic lesions, (111; 73 malignant, 38 benign), graft-versus-host disease (120), drug-related lesions (46), cutaneous eruption of lymphocyte recovery (3), thrombocytopenia-related lesions (9), normolipemic plane xanthoma (1), amyloidosis (1), Sweet's syndrome (7), panniculitis (1), papulosquamous lesions (18), bullous diseases (17), vasculitis (11), infectious lesions (41), granulomatous dermatitis (6), alopecia cicatrisata (1), nonspecific lesions (77), and unrelated lesions (2). CONCLUSIONS Skin biopsy specimens from patients with MM less than 60 days from transplant most commonly show sequelae of the transplant such as graft-versus-host disease, Grover's disease (as a result of leukocytopenia and fever, waiting for engraftment), drug eruptions, chemotherapy effect, thrombocytopenic effect, cutaneous eruption of lymphocyte recovery, and Sweet's syndrome (possibly as a result of granulocyte-macrophage colony-stimulating factor). Biopsy specimens taken more than 60 days from transplant most commonly show graft-versus-host disease, drug eruptions, and Sweet's syndrome but also show unrelated conditions such as neoplastic lesions, nevi, papulosquamous lesions, vasculitis, infections, and nonspecific changes.
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Affiliation(s)
- Ilene B Bayer-Garner
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock 72205, USA
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Lipsker D, Rondeau M, Massard G, Grosshans E. The AESOP (adenopathy and extensive skin patch overlying a plasmacytoma) syndrome: report of 4 cases of a new syndrome revealing POEMS (polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes) syndrome at a curable stage. Medicine (Baltimore) 2003; 82:51-9. [PMID: 12544710 DOI: 10.1097/00005792-200301000-00005] [Citation(s) in RCA: 37] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
We describe an easily recognizable and previously not individualized clinical syndrome that can reveal solitary plasmacytoma of bone. We report 4 patients with a slowly extending violaceous skin patch overlying a solitary plasmacytoma of bone, associated with enlarged regional lymph nodes. Biopsies of the cutaneous lesion and the lymph nodes were not specific, although increased dermal mucin deposition and vascular proliferation were present in all skin specimens. Three patients had associated polyneuropathy. One patient had POEMS (Polyneuropathy, Organomegaly, Endocrinopathy, Monoclonal protein, and Skin changes) syndrome at the time the plasmacytoma was diagnosed. Another patient developed POEMS syndrome, from which he died, 4 years after excision of the plasmacytoma. The 3 other patients were treated either with irradiation or with a combination of irradiation and surgery, and recovered completely, including from the associated neuropathy and/or POEMS syndrome. We suggest calling this unique and distinctive clinical presentation the for
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Affiliation(s)
- Dan Lipsker
- Clinique Dermatologique, Sevice de Médecine Interne, Hôpitaux Universitaires Strasbourg, France.
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Abstract
Benign hyperplastic lymphoid infiltrates of the skin (pseudolymphoma, older term) simulate lymphoma clinically and histologically. They can be divided into B-cell predominant (typical cutaneous lymphoid hyperplasia (CLH), angiolymphoid hyperplasia, Kimura's disease, and Castleman's disease) and T-cell predominant (T-cell CLH, lymphomatoid contact dermatitis, and lymphomatoid drug eruption). Both types may represent exaggerated reactions to diverse external antigens (insect bite, tattoo, zoster, trauma, among others). A composite assessment of clinical presentation and behavior, routine histology, immunophenotyping, and molecular studies is essential for the diagnosis of benign cutaneous lymphoid infiltrates. Treatment includes antibiotics, intralesional and systemic corticosteroids, excision, radiotherapy, and immunosuppressants. Treatment depends on the assessment and biologic behavior, which is usually benign. Molecular biologic analysis has shown that a significant proportion of cases harbor occult B- or T-cell clones (clonal CLH). Progression to overt cutaneous lymphoma has been observed in a minority of cases. Patients with clonal populations of B or T cells and persistent lesions should be closely observed for emergence of a lymphoma.
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Affiliation(s)
- A C Gilliam
- Department of Dermatology, Case Western Reserve University, University Hospitals of Cleveland, OH, USA
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