EXTENSIVE OSSIFICATION IN A PULMONARY PLASMACYTOMA

Pulmonary plasmacytomas: a clinicopathologic and immunohistochemical study of five cases

Five cases of primary plasmacytoma of the lung are presented. The patients were four men and one woman between the ages of 50 and 79 years (mean age, 57 years; median age, 54 years). Two patients presented with symptoms related to their tumor; these included cough, dyspnea, and hemoptysis. In two patients, the tumor presented as a hilar mass, whereas in the remaining three patients, the tumor was located intraparenchymally. Clinically, only one patient had a reported monoclonal gammopathy (IgG, kappa). Because of the proximal location of these tumors, three patients underwent pneumonectomy; one other underwent a lobectomy, and one had a segmental resection. Grossly, the tumors ranged from 2.5 to 8 cm in maximum diameter (mean, 4.4 cm); they were either peribronchial or involved a major bronchus. Histologically, they were characterized by sheets of plasma cells that were well differentiated in two cases and moderately differentiated in three. Amyloid was present in two cases. In four tumors, there was a monoclonal population of lambda light chain-bearing plasma cells, whereas in one, the plasma cells expressed a monoclonal kappa light chain. The tumor cells predominantly expressed IgG heavy chains in two cases. Peribronchial and mediastinal lymph nodes were involved in three cases. Follow-up information ranged from 4 days to 262 months (average, 115 months; median, 36 months). Two patients survived more than 20 years before dying of non-tumor-related causes. Two patients died 28 months and 4 days after surgery with concurrent tumor in liver and mediastinal and para-aortic lymph nodes. Comparing the present cases and those reported in the literature, we noted that the patients herein presented are, on average, older than those published previously. Combining our cases with 14 other verifiable, previously published cases, the overall 2- and 5-year survivals of pulmonary plasmacytomas are 66% and 40%, respectively. Patients with pulmonary plasmacytomas can have a long-term survival, as evidenced by two of our patients who survived 20 or more years.

Primary pulmonary plasmacytoma

BACKGROUND

A patient was diagnosed with an extramedullary plasmacytoma of the lung after complete resection of the mass at thoracotomy. Immunoperoxidase staining of the mass revealed monoclonal lambda chains. Screening for multiple myeloma identified a small amount of M-protein in the blood, but no other evidence of multiple myeloma was found.

METHODS

A literature search was conducted to determine the prognosis and the best way to manage the patient.

RESULTS

Nineteen cases of primary pulmonary plasmacytoma were found in the literature. The age range was 3-79 years. Most of these cases were diagnosed at thoracotomy and treated by surgical excision. Immunohistochemical evaluation of the lesion is essential for diagnosis but was done in only three cases.

CONCLUSIONS

Surgery and radiation therapy seem to be equally effective forms of treatment. The role of adjuvant chemotherapy is unknown. Local recurrences are rare. Follow-up data were inadequate to determine disease-free survival, progression to multiple myeloma, and overall survival in primary pulmonary plasmacytoma. Close follow-up is needed to detect progression.

The radiological appearances of plasma cell granuloma of the lung

The clinical, radiological and pathological features of plasma cell granuloma in 4 patients are presented. The natural history of the condition is benign. 30% of cases occur in children. The radiological appearances are not specific and consist of an intrapulmonary mass which is not accompanied by pleural effusion. Tomography is helpful in demonstrating calcification and cavitation, but these features are unusual. Successful treatment requires surgical removal.

Bone structures in avian and mammalian lungs

Ectopic bone was found in the interstitium of lungs of birds, guinea pigs and minks. There was no evidence of a relation between the ectopic bone and the occurrence of disease.

The relation between chronic polyneuropathy and osteosclerotic myeloma

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