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Mousavizadeh Ahmadabadi SM, Banar S, Parvas E, Shahbazi N, Biranvand H. Uncommon manifestation of multiple myeloma: A case report of intracardiac plasmacytoma presenting with severe heart failure and bilateral pleural effusion. Int J Surg Case Rep 2024; 114:109187. [PMID: 38160518 PMCID: PMC10800586 DOI: 10.1016/j.ijscr.2023.109187] [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: 11/01/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Extramedullary intracardiac plasmacytoma is a rare type of plasma cell neoplasm that involves the heart. This article presents a case report of a patient with this condition and describes the surgical management of the disease. CASE PRESENTATION The patient was a 65-year-old male with a history of multiple myeloma in remission for two years who presented with shortness of breath and chest pain. Imaging studies revealed a mass in the right atrium of the heart, which was confirmed to be extramedullary intracardiac plasmacytoma on biopsy. The patient underwent surgical resection of the mass. CLINICAL DISCUSSION Extramedullary intracardiac plasmacytoma is a rare condition that can occur in patients with multiple myeloma. Early diagnosis and prompt treatment are crucial for improving the prognosis of affected individuals. Surgical resection may be a viable treatment option for some patients. CONCLUSION This case report highlights the potential risks and complications associated with surgical intervention in patients with extramedullary intracardiac plasmacytoma. Further research is needed to determine the best treatment approach for this rare condition and to improve patient outcomes.
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Affiliation(s)
- Seyed Mohammadali Mousavizadeh Ahmadabadi
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Shahid Rajaei Research & Training Hospital, Next to Mellat Park, Vali-Asr Ave, Tehran Postal code: 1995614331, Iran
| | - Sepideh Banar
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Shahid Rajaei Research & Training Hospital, Next to Mellat Park, Vali-Asr Ave, Tehran Postal code: 1995614331, Iran
| | - Ehsan Parvas
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran
| | - Narges Shahbazi
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran
| | - Hamidreza Biranvand
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran.
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Choudhuri J, Janmey V, Ding J, Dailey D, Shi Y, Wang Y. Cardiovascular Involvement of a CD138-Negative Anaplastic Myeloma: A Diagnostic Dilemma. Hematol Rep 2023; 15:66-72. [PMID: 36810550 PMCID: PMC9944938 DOI: 10.3390/hematolrep15010007] [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: 08/26/2022] [Revised: 09/01/2022] [Accepted: 01/04/2023] [Indexed: 01/20/2023] Open
Abstract
Anaplastic myeloma (AM) is an extremely rare and aggressive histological variant of myeloma. It is characterized by extramedullary presentation in the young and has a poor prognosis. It can be a diagnostic challenge when myeloma is not suspected and even more when the immunophenotype is unexpected. We present a rare presentation of anaplastic myeloma with cardiovascular involvement. Though the patient did not have the typical clinical features of myeloma, except lytic lesion in the femur, the cardiac biopsy showed sheets of anaplastic cells, and some with multinucleation. There were also some areas with a more plasmacytoid appearance. The initial immunohistochemical panel was negative for CD3, CD20, CD138, AE1/3, and kappa. It was positive for lambda. This led to an extended panel which showed positivity for CD79a and MUM1 and negative for LMP-1, HHV-8, CD43, CD117, CD56, and CD30. Even the flow cytometry on the bone marrow showed a small population of atypical cells positive for CD38 and negative for CD138 with lambda restriction. This is an unusual case of anaplastic myeloma with cardiovascular involvement and CD138 negativity. This case highlights the need to add a panel of plasma cell markers when myeloma is suspected, and it is pertinent to read flow cytometry with caution to avoid missing atypical plasma cells which maybe CD38+/CD138-.
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Affiliation(s)
- Jui Choudhuri
- Department of Pathology, Montefiore Medical Center, 111 E 210th Street, New York, NY 10467, USA
| | - Victor Janmey
- Department of Radiology, Montefiore Medical Center, 111 E 210th Street, New York, NY 10467, USA
| | - Juan Ding
- Department of Pathology, Montefiore Medical Center, 111 E 210th Street, New York, NY 10467, USA
| | - Denise Dailey
- Department of Pathology, Montefiore Medical Center, 111 E 210th Street, New York, NY 10467, USA
| | - Yang Shi
- Department of Pathology, Montefiore Medical Center, 111 E 210th Street, New York, NY 10467, USA
| | - Yanhua Wang
- Department of Pathology, Montefiore Medical Center, 111 E 210th Street, New York, NY 10467, USA
- Correspondence:
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Extramedullary intracardiac multiple myeloma misdiagnosed as a thrombus: a case report. BMC Surg 2021; 21:375. [PMID: 34689771 PMCID: PMC8543969 DOI: 10.1186/s12893-021-01377-y] [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: 05/31/2021] [Accepted: 10/15/2021] [Indexed: 02/08/2023] Open
Abstract
Background Extramedullary intracardiac multiple myeloma (MM) is extremely rare. Patients with extramedullary intracardiac MM may suffer from a poor prognosis. Experience in the diagnosis and therapy of cardiac involvement in MM is limited. Herein, we describe a 67-year-old male with extramedullary intracardiac MM who was initially misdiagnosed with a thrombus. Case presentation A 67-year-old male was admitted for exertional dyspnea and fatigue. The patient was diagnosed with MM one year earlier and had complete remission after chemotherapy. He was implanted with a permanent pacemaker two months prior due to sick sinus syndrome. After this admission, transthoracic echocardiography (TTE) and computed tomography (CT) confirmed the existence of a large right atrial mass extending to the superior and inferior vena cava. We initially considered the right atrial mass as a thrombus and performed surgical treatment for the patient. The surgical intervention partially relieved the obstruction of the superior and inferior vena cava and improved hemodynamics. Postoperative pathological examination of the right atrial mass suggested malignant plasmacytoma associated with MM. After recovery from the surgery, the patient received one cycle of chemotherapy. A follow-up of seven months revealed that our patient was still alive with a good general condition. Conclusions Increasing the awareness of extramedullary intracardiac lesions in patients with MM is warranted. Our case confirmed that surgical intervention followed by adjuvant chemotherapy could improve the patient’s hemodynamics and achieve remission of cardiac symptoms.
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Wang S, Zhao R, Tan K, Liu C, Zhang L, Xu M, Xiong F. Multiple myeloma with cardiac involvement accompanied by partial superior vena cava obstruction: A case report and literature review. Echocardiography 2021; 38:1652-1656. [PMID: 34346524 DOI: 10.1111/echo.15169] [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: 05/11/2021] [Revised: 07/04/2021] [Accepted: 07/19/2021] [Indexed: 11/29/2022] Open
Abstract
Multiple myeloma is a malignant proliferative disorder of plasma cells. Extramedullary involvement of the endocardium is rare in multiple myeloma. Here, we reported a 57-year-old male, once was diagnosed with multiple myeloma. The echocardiography reveled multiple solid masses in the right atrium, along with partial obstruction of superior vena cava. The mass resection alleviated the edema of upper limbs and identified the mass as extramedullary plasmablastic transformation and endocardial involvement. We also conducted a literature review and summary analysis of space-occupying lesions in the heart in 12 patients with multiple myeloma (including the current case) in the last 10 years. Echocardiography is the preferred radiologic examination method for diagnosis and follow-up in multiple myeloma with cardiac involvement, and surgical resection is effective for alleviating symptoms.
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Affiliation(s)
- Shuzhen Wang
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Ruohan Zhao
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Kunyue Tan
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Chunxia Liu
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Lijuan Zhang
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Min Xu
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
| | - Feng Xiong
- Department of Cardiology, Cardiovascular Institute of Chengdu, Chengdu Third People's Hospital, The Affiliated Hospital of Southwest Jiaotong, Chengdu, China
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Iyer AM, Levenson JE, Follansbee WP, Schelbert EB, Chen T. Atypical Case of Epicardial Amyloid Mass without Classical Features of Myocardial Infiltration. CASE 2020; 4:160-165. [PMID: 32577598 PMCID: PMC7303247 DOI: 10.1016/j.case.2019.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Epicardial amyloid deposition without typical features of cardiac amyloid can occur. Multimodality imaging enables diagnosis and management of systemic amyloid. Novel antibody therapies for AL amyloidosis can alleviate symptoms.
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Guan X, Jalil A, Khanal K, Liu B, Jain AG. Extramedullary Plasmacytoma Involving the Heart: A Case Report and Focused Literature Review. Cureus 2020; 12:e7418. [PMID: 32337142 PMCID: PMC7182159 DOI: 10.7759/cureus.7418] [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] [Indexed: 12/24/2022] Open
Abstract
Cardiac tumors are extremely rare. Here, we report an unusual case of cardiac plasmacytoma that occurred 11 years after complete remission of the original multiple myeloma (MM). The tumor primarily manifested as a solitary extramedullary plasmacytoma (SEP) with extensive infiltration into the heart and large vessels. There was no evidence of systemic involvement. The relapsing tumor assumed a unique immunophenotype from CD138+/CD38+/CD56- to CD138-/CD38+/CD56-. The patient responded to chemotherapy consisting of carfilzomib, cyclophosphamide, and dexamethasone. This case highlights the importance of multimodal imaging evaluation and tissue diagnosis for accurately characterizing this rare disorder.
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Affiliation(s)
- Xuan Guan
- Internal Medicine, AdventHealth, Orlando, USA
| | - Anum Jalil
- Internal Medicine, AdventHealth, Orlando, USA
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Skipina TM, Sane DC, Cui C, Song S, Phillips SG, Jarrett RW. A plasma cell-based pericardial effusion leading to tamponade in a patient with multiple myeloma - a case report and review of the literature. Cardiovasc Pathol 2019; 40:41-46. [PMID: 30852296 DOI: 10.1016/j.carpath.2019.02.002] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 02/06/2019] [Accepted: 02/06/2019] [Indexed: 12/25/2022] Open
Abstract
A rare case of extramedullary multiple myeloma causing cardiac tamponade secondary to a plasma cell-based pericardial effusion is described. A systematic search using PubMed (National Library of Medicine) was used to identify a further 27 cases dating back to 1970. Case characteristics, treatment strategies, and survival time following tamponade are discussed. Linear regression demonstrated a weak but statistically significant correlation between survival time following tamponade and treatment with systemic chemotherapy and steroids (β=16.8 weeks, P=.009). However, this manifestation of extramedullary multiple myeloma still conveys a dismal prognosis with a median survival following tamponade of only 6 weeks based on our review.
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Affiliation(s)
| | - David C Sane
- Division of Cardiovascular Disease, Department of Medicine, Carilion Clinic, Roanoke, VA
| | - Charles Cui
- Division of Cardiovascular Disease, Department of Medicine, Carilion Clinic, Roanoke, VA
| | - Steven Song
- Division of Cardiovascular Disease, Department of Medicine, Carilion Clinic, Roanoke, VA
| | - Stephen G Phillips
- Division of Cardiovascular Disease, Department of Medicine, Carilion Clinic, Roanoke, VA
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Coakley M, Yeneneh B, Rosenthal A, Fonseca R, Mookadam F. Extramedullary Cardiac Multiple Myeloma—A Case Report and Contemporary Review of the Literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:246-52. [DOI: 10.1016/j.clml.2016.02.003] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2015] [Revised: 02/05/2016] [Accepted: 02/10/2016] [Indexed: 12/12/2022]
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Kevane B, Crowley MP, Bolster M, Gilligan O. Myeloma relapse involving the heart and presenting as acute cardiac failure. J Clin Oncol 2014; 32:e67-8. [PMID: 24493727 DOI: 10.1200/jco.2012.47.6713] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Behzadnia N, Sheybani-Afshar F, Hossein-Ahmadi Z, Ansari-Asl Z, Sharif-Kashani B, Dorudinia A. Late relapse of multiple myeloma presenting as a right atrial mass. Asian Cardiovasc Thorac Ann 2013; 22:1106-8. [DOI: 10.1177/0218492313495402] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Intracardiac involvement is a rare presentation of relapsed multiple myeloma. We present a case of lobulated mass in the wall of the right atrium, with extension to the inferior vena cava and obliteration and encasement of the interatrial septum in a 57-year-old man, a known case of multiple myeloma, with progressive exertional dyspnea and anasarca.
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Affiliation(s)
- Neda Behzadnia
- Chronic Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Faezeh Sheybani-Afshar
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zargam Hossein-Ahmadi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zahra Ansari-Asl
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Babak Sharif-Kashani
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Atosa Dorudinia
- Pediatric Respiratory Diseases Research Center, National Research Institute of Tuberculosis and Lung Disease, Shahid Beheshti University of Medical Sciences, Tehran, Iran
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