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Stefanidis K, Yusuf G, Mulita F, Tsalikidis C, Mitsala A, Konstantelou E, Kotsopoulou M, Koletsis E, Pitiakoudis M, Dimopoulos P. Extraosseous Plasmacytomas: A Radiologist's Perspective-A Narrative Review of the Literature. Diagnostics (Basel) 2024; 14:1788. [PMID: 39202276 PMCID: PMC11353327 DOI: 10.3390/diagnostics14161788] [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] [Received: 06/20/2024] [Revised: 08/10/2024] [Accepted: 08/12/2024] [Indexed: 09/03/2024] Open
Abstract
Extraosseous plasmacytomas (EPs) are rare neoplasms originating from plasma cells, often associated with multiple myeloma. EPs are classified into three subtypes: extramedullary myeloma, solitary extramedullary plasmacytoma (SEP), and multiple solitary plasmacytomas. They can manifest in various anatomical sites, including the lung, mediastinum, breast, liver, pancreas, stomach, mesentery, kidney, small and large bowel, testis, and soft tissue. Despite their rarity, EPs present a diagnostic challenge due to their non-specific imaging appearances, which can mimic other neoplastic and inflammatory conditions. This review aims to describe the radiographic features of EPs in the chest, abdomen, and pelvis based on a thorough analysis of the existing literature. While imaging plays a crucial role in the detection and characterization of EPs, histological confirmation is necessary to differentiate them from other neoplastic entities. The review underscores the importance of considering EPs in the differential diagnosis, particularly in patients with a history of multiple myeloma. Understanding the imaging characteristics of EPs is essential for accurate diagnosis and appropriate management. Early imaging is crucial in these patients to exclude the possibility of EP, as timely diagnosis can significantly impact patient outcomes.
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Affiliation(s)
| | - Gibran Yusuf
- Radiology Department, King’s College Hospital NHS Foundation Trust, London SE5 9RS, UK;
| | - Francesk Mulita
- Department of Surgery, General University Hospital of Patras, 75000 Patras, Greece
| | - Christos Tsalikidis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.)
| | - Athanasia Mitsala
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.)
| | | | - Maria Kotsopoulou
- Haematology Department, Metaxa Cancer Hospital, 18537 Piraeus, Greece;
| | - Efstratios Koletsis
- Department of Cardiothoracic Surgery, General University Hospital of Patras, 75000 Patras, Greece;
| | - Michail Pitiakoudis
- Second Department of Surgery, University General Hospital of Alexandroupolis, Democritus University of Thrace Medical School, 68100 Alexandroupolis, Greece; (C.T.); (A.M.)
| | - Platon Dimopoulos
- Department of Radiology, General University of Patras, 61000 Patras, Greece;
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Holler A, Cicha I, Eckstein M, Haderlein M, Pöttler M, Rappl A, Iro H, Alexiou C. Extramedullary plasmacytoma: Tumor occurrence and therapeutic concepts-A follow-up. Cancer Med 2022; 11:4743-4755. [PMID: 35578404 PMCID: PMC9761078 DOI: 10.1002/cam4.4816] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/26/2022] [Accepted: 04/28/2022] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Extramedullary plasmacytoma (EMP) is a solitary tumor consisting of neoplastic plasma cells, with very little to no bone marrow involvement. EMPs are usually located in the head and neck region, but can also occur along the digestive tract, in lungs, or extremities. METHODS Following our publication on EMP, which appeared in 1999 (Cancer 85:2305-14), we conducted a literature search for EMP-related reports published between 1999 and 2021. The documented cases, as well as 14 of our own patients from the ENT Clinic Erlangen, were extensively analyzed. RESULTS Between 1998 and 2021, 1134 patients with EMP were reported, for whom information about the tumor localization was available. Among those, 62.4% had EMP in the head and neck area and 37.6% in other body regions. Data on therapy were reported in 897 patients, including 34.3% who received radiation, 28.1% surgery, 22.6% a combination of surgery and radiation, and 15.9% another therapy. In 76.9% patients no recurrence or transformation to multiple myeloma (MM) was reported, 12.8% showed local recurrence and 10.2% developed MM. Radiotherapy alone was associated with a tendency for increased occurrence of MM. In patients with EMP of head and neck area, combination therapy (surgery and radiation) resulted in a 5-year overall survival rate of 98.3%, surgery alone of 92.4%, and radiotherapy of 92.7%. CONCLUSIONS Collectively, our analyses indicate that surgical resection alone can achieve long-term tumor control in patients with EMP, if the tumor can be removed within safe limits without causing serious functional impairment. However, if this is not certain, either radiation or a combination of surgery and radiation therapy is suggested as an effective means of local tumor control.
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Affiliation(s)
- Adrian Holler
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversitätsklinikum Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany,Department of Otorhinolaryngology, Head & Neck Surgery, Section of Experimental Oncology & Nanomedicine (SEON), Else Kröner‐Fresenius‐Stiftung‐Professorship, Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Iwona Cicha
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversitätsklinikum Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany,Department of Otorhinolaryngology, Head & Neck Surgery, Section of Experimental Oncology & Nanomedicine (SEON), Else Kröner‐Fresenius‐Stiftung‐Professorship, Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Markus Eckstein
- Institute of PathologyUniversity Hospital Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Marlen Haderlein
- Department of Radiation OncologyUniversity Hospital, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Marina Pöttler
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversitätsklinikum Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Anja Rappl
- Institut für Medizininformatik, Biometrie und Epidemiologie (IMBE)Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Heinrich Iro
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversitätsklinikum Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
| | - Christoph Alexiou
- Department of Otorhinolaryngology, Head & Neck SurgeryUniversitätsklinikum Erlangen, Friedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany,Department of Otorhinolaryngology, Head & Neck Surgery, Section of Experimental Oncology & Nanomedicine (SEON), Else Kröner‐Fresenius‐Stiftung‐Professorship, Universitätsklinikum ErlangenFriedrich‐Alexander‐Universität Erlangen‐NürnbergErlangenGermany
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Sharma A, Binazir T, Sintow A, Lee CC, Shaharyar S, Tache J. An Extremely Rare Manifestation of Multiple Myeloma: An Immunoglobulin D Secreting Testicular Plasmacytoma. Cureus 2017; 9:e1400. [PMID: 28845377 PMCID: PMC5572044 DOI: 10.7759/cureus.1400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Multiple myelomas (MM) of the immunoglobulin D (IgD) subtype is rare amongst plasma cell malignancies. It can present a diagnostic challenge because of the low amount of immunoglobulin in the serum. The amount of monoclonal (M)-protein is often undetectable on electrophoresis. Historically, survival in these patients was typically shorter compared to the immunoglobulin A (IgA) and immunoglobulin G (IgG) subtypes due to advanced disease upon presentation. With the advent of better diagnostic techniques, the prognosis of this disease is changing. We describe a case of an extramedullary testicular plasmacytoma (EMP) of the IgD subtype as the primary feature of MM, which responded well to novel therapy. A 72-year-old White male presented to the emergency room with a right testicular mass for three months. He subsequently underwent right radical orchiectomy. Pathology of the specimen revealed plasmacytoid cells positive for cluster of differentiation (CD79a), lambda free light chain, IgD, and BCL-1 (Cyclin D1) on immunochemical stains. Urine and serum immunofixation were positive for monoclonal IgD with lambda light chain specificity and Bence Jones proteinuria. Bone marrow biopsy showed large sheets of plasma cells with greater than 90% cellularity. Flow cytometry displayed atypical plasma cells expressing cluster of differentiation (CD38, CD20, and CD56) with cytoplasm and lambda light chain, approximately 20%, consistent with a plasma cell dyscrasia. Stage 3 IgD lambda multiple myeloma was diagnosed. He received novel treatment with Bortezomib and dexamethasone for three months, followed by Lenalidomide. His performance status and lab data improved significantly. He had progression-free survival (PFS) of approximately three years and remained in complete remission low-dose dose of Lenalidomide daily. IgD myeloma was considered a diagnostic challenge due to undetectable M-protein levels on serum protein electrophoresis (SPEP). With the advent of serum free light chain assay and serum and cytologic examinations, diagnostic accuracy has significantly improved. The IgD subtype is commonly associated with poor clinical outcomes. However, the use of novel agents and autologous transplant has changed the prognosis of this disease.
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Affiliation(s)
- Ashish Sharma
- Internal Medicine, Aventura Hospital and Medical Center
| | - Tina Binazir
- Internal Medicine, Aventura Hospital and Medical Center
| | | | - Chi Chan Lee
- Internal Medicine, Aventura Hospital and Medical Center
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Narayanan G, Joseph R, Soman LV. Bilateral synchronous plasmacytoma of the testis. Proc (Bayl Univ Med Cent) 2016; 29:196-7. [PMID: 27034568 DOI: 10.1080/08998280.2016.11929415] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Extramedullary plasmacytoma (EMP) is usually seen in the head and neck regions and in the upper respiratory, gastrointestinal, and central nervous systems. Testis is a rare site for EMP, and bilateral synchronous testicular plasmacytoma occurring as an isolated event at initial presentation has been reported only once previously. We present herein the second such report in a 70-year-old man who underwent bilateral orchidectomy.
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Affiliation(s)
- Geetha Narayanan
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum, India
| | - Rona Joseph
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum, India
| | - Lali V Soman
- Department of Medical Oncology, Regional Cancer Centre, Trivandrum, India
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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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Cao D, Li L, Liu L, Xiao W, He X, Tang Z, Yuan J, Li X, Qiang W. Solitary extramedullary plasmacytoma of the adrenal gland: a rare case report with review of the literature. INTERNATIONAL JOURNAL OF CLINICAL AND EXPERIMENTAL PATHOLOGY 2014; 7:9072-9075. [PMID: 25674290 PMCID: PMC4313972] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 11/26/2014] [Indexed: 06/04/2023]
Abstract
Plasmacytomas are monoclonal plasma cells proliferations originating either in localized osseous tissue or in soft tissue (extramedullary plasmacytoma, EMP). Although many such lesions are found in the bone marrow, fewer arise in extramedullary tissue. A solitary EMP involving the adrenal gland is extremely rare, with only 7 cases having been reported in the literature thus far. Here, we describe a rare case of solitary EMP in the right adrenal gland of a 26-year-old man that was managed by retroperitoneal laparoscopic resection, with no recurrence during 6-year follow-up.
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Affiliation(s)
- Dehong Cao
- Department of Urology, West China Hospital, Sichuan UniversityChengdu, China
| | - Li Li
- Department of Laboratory of Pathology, West China Hospital, Sichuan UniversityChengdu, China
| | - Liangren Liu
- Department of Urology, West China Hospital, Sichuan UniversityChengdu, China
| | - Wei Xiao
- Department of Intensive Care Unit, Central South University Of The Third Xiangya HospitalChangsha, China
| | - Xin He
- Department of Laboratory of Pathology, West China Hospital, Sichuan UniversityChengdu, China
| | - Zhuang Tang
- Department of Urology, West China Hospital, Sichuan UniversityChengdu, China
| | - Jiuhong Yuan
- Department of Urology, West China Hospital, Sichuan UniversityChengdu, China
| | - Xiang Li
- Department of Urology, West China Hospital, Sichuan UniversityChengdu, China
| | - Wei Qiang
- Department of Urology, West China Hospital, Sichuan UniversityChengdu, China
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Successful treatment of intractable hiccups by oral application of lidocaine. Support Care Cancer 2012; 20:3009-11. [DOI: 10.1007/s00520-012-1533-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2012] [Accepted: 06/20/2012] [Indexed: 10/28/2022]
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