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Han X, Li Q, Wang EH, Liu N. Clear cell sarcoma of soft tissue with plasmacytoid morphology: A rare case report. Medicine (Baltimore) 2022; 101:e31631. [PMID: 36343072 PMCID: PMC9646632 DOI: 10.1097/md.0000000000031631] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
RATIONALE Clear cell sarcoma of soft tissue (CCSST) is a rare malignant tumor that occurs in the extremities of young adults. CCSST has been documented to have atypical histopathological features, such as epidermotropism or myxoid differentiation, which may set pitfalls in the differential diagnosis. We report a case of CCSST with plasmacytoid morphology which has never been described. PATIENT CONCERNS A 15-year-old male, presented with a 5-cm mass in his left inguinal area. DIAGNOSIS Positron emission tomography-computed tomography examination showed nodules in the left groin and the lung, the latter was considered metastasis. A core needle biopsy with the diagnosis of CCSST with plasmacytoid morphology was made according to histology, immunostaining, and molecular analysis. INTERVENTIONS The patient received chemotherapy of doxorubicin and ifosfamide. OUTCOMES The patient failed to respond to the standard chemotherapy and deceased twelve months after diagnosis. LESSONS This special case of CCSST with plasmacytoid features demonstrated a morphological variation never been documented and may easily lead to misdiagnosis. For such cases, molecular analysis is essential to provide solid evidence for accurate diagnosis.
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Affiliation(s)
- Xu Han
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Qingchang Li
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - En-Hua Wang
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
| | - Nan Liu
- Department of Pathology, the First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang, China
- *Correspondence: Nan Liu, Department of Pathology, First Affiliated Hospital and College of Basic Medical Sciences, China Medical University, Shenyang 110001, China (e-mail: )
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2
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Stanborough RO, Garner HW. Multiple myeloma: a review of atypical imaging features and other distinct plasma cell disorders that demonstrate similar imaging features. Skeletal Radiol 2022; 51:135-144. [PMID: 34146119 DOI: 10.1007/s00256-021-03792-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 04/15/2021] [Accepted: 04/18/2021] [Indexed: 02/02/2023]
Abstract
Multiple osteolytic lesions are a well-recognized and typical imaging feature of multiple myeloma as well as several other plasma cell disorders. Given the high volume of imaging studies obtained of multiple myeloma patients, radiologists will likely encounter a subset of multiple myeloma patients with less common or "atypical" findings during their practice. These atypical findings include osteosclerotic lesions, extramedullary lesions, and amyloid deposition. Similar imaging findings that are considered atypical for multiple myeloma can also be detected in other plasma cell disorders that are distinct from multiple myeloma. For instance, POEMS syndrome is a distinct plasma cell disorder from multiple myeloma, but also can present with osteosclerotic lesions. This article reviews the atypical findings associated with multiple myeloma and also reviews other plasma cell disorders that can have a similar spectrum of imaging findings. Special attention is paid to the musculoskeletal imaging findings.
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Affiliation(s)
- Rupert O Stanborough
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Hillary W Garner
- Department of Radiology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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3
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Florindez JA, Alderuccio JP, Reis IM, Lossos IS. Survival analysis in treated plasmablastic lymphoma patients: a population-based study. Am J Hematol 2020; 95:1344-1351. [PMID: 32777103 DOI: 10.1002/ajh.25955] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 07/19/2020] [Accepted: 08/03/2020] [Indexed: 12/12/2022]
Abstract
Herein we analyzed survival outcomes in chemotherapy-treated patients with plasmablastic lymphoma (PBL) diagnosed between 2010 to 2016 (n = 248). Data was acquired from the Surveillance, Epidemiology, and End Results (SEER) 18 registries database (April 2019 release based on November 2018 submission). The majority of patients were male (81.9%) and younger than 60 years (71.0%). Oral and gastrointestinal (GI) sites were the most frequent primary extranodal locations (23% and 19.4%, respectively). Oral primary location was inversely associated with presence of B symptoms and advanced Ann-Arbor stage. The 3-year and 5-year overall survival (OS) rates of treated PBL patients were 54% (95% CI: 46.5%-60.8%) and 52.8% (95% CI: 45.2%-59.8%). Three-year conditional survival for 2-year and 3-year survivors were 90.3% and 97.8%, overlapping the survival of a general population matched by age, sex and calendar year. In a multivariable analysis, oral primary location was associated with not only better OS (HR 0.43; 95% CI: 0.21-0.88, P = .021) but also better lymphoma-specific survival (LSS) (SHR 0.36; 95% CI: 0.15-0.86, P = .022); age ≥60 years was associated with shorter LSS (SHR 1.73; 95% CI: 1.02-2.96, P = .043). Seven registries granted access to HIV status (n = 93) where HIV infection was detected in 52.7% of cases. The HIV status did not affect survival outcomes in unadjusted and adjusted analyses. We identified clinical characteristics associated with survival and showed that treated PBL patients may achieve long-term survival.
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Affiliation(s)
- Jorge A. Florindez
- Division of Hospital Medicine, Miller School of Medicine University of Miami Miami Florida
| | - Juan P. Alderuccio
- Divison of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
| | - Isildinha M. Reis
- Department of Public Health Science, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
- Biostatistics and Bioinformatics Core Resource, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
| | - Izidore S. Lossos
- Divison of Hematology, Department of Medicine, Sylvester Comprehensive Cancer Center, Miller School of Medicine University of Miami Miami Florida
- Department of Molecular and Cellular Pharmacology University of Miami Miami Florida
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4
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Rosado F, Guo L, Fuda F. Hematolymphoid neoplasms with a plasma cell phenotype. Semin Diagn Pathol 2020; 37:268-272. [PMID: 32564903 DOI: 10.1053/j.semdp.2020.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Revised: 05/18/2020] [Accepted: 05/18/2020] [Indexed: 12/20/2022]
Affiliation(s)
| | - Ling Guo
- Ohio State University Wexner Medical Center
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5
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Berno T, Riva M, Fedrigo M, Naso A, Anglani M, Briani C, Adami F. Immunomodulatory drugs in plasma cell diseases: everything has its price. Leuk Lymphoma 2019; 61:206-208. [PMID: 31502492 DOI: 10.1080/10428194.2019.1657574] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Affiliation(s)
- Tamara Berno
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova School of Medicine and Surgery, Padova, Italy
| | - Marcello Riva
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova School of Medicine and Surgery, Padova, Italy
| | - Marny Fedrigo
- Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiovascular Pathology and Pathological Anatomy Unit, University of Padova School of Medicine and Surgery, Padova, Italy
| | - Agostino Naso
- Department of Medicine, Nephrology Unit, Azienda Ospedaliera di Padova, Padova, Italy
| | - Mariagiulia Anglani
- Department of Neuroscience, Neuroradiology Unit, Padova University Hospital, Padova, Italy
| | - Chiara Briani
- Department of Neuroscience, Neurology Unit, University of Padova School of Medicine and Surgery, Padova, Italy
| | - Fausto Adami
- Department of Medicine, Hematology and Clinical Immunology Unit, University of Padova School of Medicine and Surgery, Padova, Italy
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Naymagon L, Abdul-Hay M. Primary extramedullary plasmacytoma with diffuse lymph node involvement: a case report and review of the literature. J Med Case Rep 2019; 13:153. [PMID: 31113466 PMCID: PMC6530079 DOI: 10.1186/s13256-019-2087-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2018] [Accepted: 04/15/2019] [Indexed: 12/25/2022] Open
Abstract
Background Primary plasmacytomas are localized proliferations of clonal plasma cells occurring in the absence of a systemic plasma cell dyscrasia such as multiple myeloma. Primary plasmacytomas most commonly manifest as solitary lesions of the bone or of the upper aerodigestive tract. Presentation in a lymph node is very uncommon and can often be initially mistaken for lymphoma. Because they are local phenomena, primary plasmacytomas are managed with local therapies such as radiation or, less commonly, excision. Multifocal presentations are rare and are often not amenable to local treatment modalities, thus requiring systemic therapies. Because of their rarity, standardized treatment guidelines are not established, and treatment paradigms borrow heavily from those employed in multiple myeloma. Multifocal presentation in lymph nodes is nearly unheard of with only seven such cases reported in the existing literature, only four of which were diffuse enough to require systemic therapy. Here we describe the most diffuse and widely distributed instance of primary lymph node plasmacytoma yet reported and present a description of its successful treatment with systemic therapy. Case presentation A 71-year-old Asian man presented with progressive fatigue in the setting of diffuse hypermetabolic lymphadenopathy throughout his chest, abdomen, and pelvis. A diagnosis of lymphoma was initially suspected; however, a lymph node biopsy was consistent with plasmacytoma. A bone marrow biopsy was unremarkable, and no monoclonal protein was identified, establishing a diagnosis of primary extramedullary plasmacytomas of the lymph nodes. He was treated with a myeloma-like regimen consisting of four cycles of bortezomib/dexamethasone followed by two cycles of thalidomide/prednisone with improvement in symptoms and near complete resolution of prior hypermetabolic lymphadenopathy. He remains in remission over 18 months following completion of therapy. Conclusion This case report and accompanying literature review highlight the exceedingly rare and easily misclassified entity of primary plasmacytoma of diffuse lymph nodes. Importantly, we demonstrate that this entity may be treated with, and demonstrate excellent response to, systemic therapies often employed in multiple myeloma.
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Affiliation(s)
- Leonard Naymagon
- New York University School of Medicine and Mount Sinai School of Medicine, New York, USA
| | - Maher Abdul-Hay
- New York University School of Medicine and New York University Perlmutter Cancer Center, 240 East 38th street, 19Floor, New York, NY, 10016, USA.
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Vertolli U, Berno T, Riva M, Adami F, Angelini A, Calò LA. A unique case of rapidly progressive glomerulonephritis following dexamethasone/bortezomib/thalidomide treatment for myeloma. Nephrology (Carlton) 2018; 23:1065-1067. [DOI: 10.1111/nep.13249] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/26/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Ugo Vertolli
- Department of Medicine, Nephrology; University of Padova; Padova Italy
| | - Tamara Berno
- Department of Medicine, Hematology; University of Padova; Padova Italy
| | - Marcello Riva
- Department of Medicine, Hematology; University of Padova; Padova Italy
| | - Fausto Adami
- Department of Medicine, Hematology; University of Padova; Padova Italy
| | - Annalisa Angelini
- Department of Cardiac; Thoracic and Vascular Sciences, University of Padova; Padova Italy
| | - Lorenzo A Calò
- Department of Medicine, Nephrology; University of Padova; Padova Italy
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Todorovic Z, Jovanovic M, Todorovic D, Ivosevic A, Markovic M, Radovanovic D, Jovanovic D, Cemerikic V, Djurdjevic P. Extramedullary Involvement of Lymph Nodes in Multiple Myeloma. SERBIAN JOURNAL OF EXPERIMENTAL AND CLINICAL RESEARCH 2017. [DOI: 10.1515/sjecr-2016-0081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
Myeloma multiplex is a malignant disease of bone marrow plasma cells. It is usually confined to the bone marrow, but in rare cases, patients can develop extramedullary disease. The involvement of lymph nodes is rare and can be a diagnostic challenge. Here, we describe a 36-year-old male patient who presented with abdominal pain and discomfort initially. An abdominal ultrasound followed by computed tomography (CT) revealed retroperitoneal and mesenteric lymph node enlargement. Biopsies of the abdominal lymph node and infiltrated colon showed a plasma cell infiltrate positive for CD79α, CD38, CD138, kappa light chain and VEGF2. Multiple myeloma with extramedullary localization was diagnosed. After six cycles of chemotherapy consisting of doxorubicin, dexamethasone and thalidomide followed by autologous haematopoietic cell transplantation, the patient achieved complete remission. Specifically, a CT scan after therapy showed enlarged lymph nodes in the abdomen, but PET CT scans did not detect any metabolically active foci. Thee years after the completion of therapy, the patient remains in remission. This case illustrates a rare presentation of extramedullary myeloma involving the abdominal lymph nodes, which could have been potentially mistaken for a lymphoid malignancy.
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Affiliation(s)
- Zeljko Todorovic
- Department of Internal medicine, Faculty of Medical Sciences, University of Kragujevac , Serbia
- Clinic for Haematology, Clinical Center “Kragujevac”, Kragujevac , Serbia
| | - Milena Jovanovic
- Center of Nephrology and Dialysis, Clinic for Urology and Nephrology, Clinical Center “Kragujevac”, Kragujevac , Serbia
| | - Dusan Todorovic
- Department of Ophthalmology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac , Serbia
| | - Anita Ivosevic
- Department of Internal medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac , Serbia
| | - Marina Markovic
- Department of Internal medicine, Faculty of Medical Sciences, University of Kragujevac, Kragujevac , Serbia
| | - Drakce Radovanovic
- Department of Surgery, Faculty of Medical Sciences, University of Kragujevac , Serbia
- Surgical Clinic, Clinical Center “Kragujevac”, Kragujevac , Serbia
| | - Danijela Jovanovic
- Department of Internal medicine, Faculty of Medical Sciences, University of Kragujevac , Serbia
- Clinic for Haematology, Clinical Center “Kragujevac”, Kragujevac , Serbia
| | | | - Predrag Djurdjevic
- Department of Internal medicine, Faculty of Medical Sciences, University of Kragujevac , Serbia
- Clinic for Haematology, Clinical Center “ Kragujevac ”, Serbia
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9
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Gorodetskiy VR, Probatova NA, Vasilyev VI. Unusual course of generalized lymph node primary plasmacytoma in a patient with Sjögren's syndrome: a case report. J Med Case Rep 2017; 11:116. [PMID: 28424097 PMCID: PMC5397765 DOI: 10.1186/s13256-017-1266-7] [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] [Received: 11/09/2016] [Accepted: 03/13/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Primary lymph node plasmacytoma is a rare disease that typically involves lymph nodes of the neck. In only 15% of cases is the disease generalized. Here, we present a case of generalized lymph node plasmacytoma in a patient with Sjögren's syndrome with an unusual course. CASE PRESENTATION A 48-year-old white woman presented to our hospital with enlargement of groups of lymph nodes, liver, and spleen. Her medical history was consistent with a 12-year course of Sjögren's syndrome. Blood and urine immunochemistry showed a massive (72 g/l) M-gradient formed from immunoglobulin Aκ in the serum and monoclonal free κ-type light chains in her urine. A skeletal X-ray revealed no bone destruction. Cytological and histological bone marrow assays showed no signs of plasma cell infiltration. The microarchitecture of her neck and inguinal lymph nodes was destroyed. Only small remnants of B cell follicles were found, while the interfollicular areas were expanded and infiltrated by CD138, MuM1, CD43, and IgAκ-positive plasma cells. After nine cycles of doxorubicin, cyclophosphamide, vincristine, and prednisolone chemotherapy, complete remission was achieved. However, the lymphoma relapsed 3 months later, with histological verification in her femoral lymph node. Despite the absence of subsequent adequate therapy, she gradually achieved complete remission of plasmacytoma with the disappearance of paraproteins. CONCLUSIONS Currently, primary lymph node plasmacytoma is generally considered a nodal marginal zone lymphoma with an extensive plasmacytic differentiation. In our case, despite the critical histological and immunohistochemical evaluation of three lymph node biopsies from different anatomical areas at different times, no signs of nodal marginal zone lymphoma were found. An 18-year follow-up of our patient with primary lymph node plasmacytoma demonstrated an extremely unusual clinical course. Initially, primary lymph node plasmacytoma was refractory to chemotherapy. However, subsequently, she underwent a complete spontaneous remission of plasmacytoma.
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Affiliation(s)
- Vadim R Gorodetskiy
- Department of Intensive Methods of Therapy, V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences, Kashirskoye shosse 34A, Moscow, 115522, Russia.
| | - Natalya A Probatova
- Department of Pathology, N.N. Blokhin Russian Cancer Research Center, Russian Academy of Medical Sciences, Kashirskoye shosse 24, Moscow, 115478, Russia
| | - Vladimir I Vasilyev
- Department of Intensive Methods of Therapy, V.A. Nasonova Research Institute of Rheumatology, Russian Academy of Medical Sciences, Kashirskoye shosse 34A, Moscow, 115522, Russia
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10
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Law MF, Chan HN, Leung C, Wong CK, Lai HK, Ha CY, Ng C, Yeung YM, Yip SF. Marginal zone B-cell lymphoma mimicking extramedullary plasmacytoma and the clinical outcome after treatment. Arch Med Sci 2017; 13:698-701. [PMID: 28507591 PMCID: PMC5420643 DOI: 10.5114/aoms.2017.67290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2015] [Accepted: 06/21/2015] [Indexed: 11/17/2022] Open
Affiliation(s)
- Man Fai Law
- Department of Medicine, Tuen Mun Hospital, Hong Kong
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Hong Kong
| | - Hay Nun Chan
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | | | | | - Ho Kei Lai
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Chung Yin Ha
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | - Celia Ng
- Department of Medicine, Tuen Mun Hospital, Hong Kong
| | | | - Sze Fai Yip
- Department of Medicine, Tuen Mun Hospital, Hong Kong
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Dayton VD, Williams SJ, McKenna RW, Linden MA. Unusual extramedullary hematopoietic neoplasms in lymph nodes. Hum Pathol 2017; 62:13-22. [DOI: 10.1016/j.humpath.2016.12.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2016] [Revised: 12/01/2016] [Accepted: 12/07/2016] [Indexed: 12/19/2022]
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12
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Ahn JS, Okal R, Vos JA, Smolkin M, Kanate AS, Rosado FG. Plasmablastic lymphoma versus plasmablastic myeloma: an ongoing diagnostic dilemma. J Clin Pathol 2017; 70:775-780. [DOI: 10.1136/jclinpath-2016-204294] [Citation(s) in RCA: 39] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2016] [Revised: 02/02/2017] [Accepted: 02/07/2017] [Indexed: 11/03/2022]
Abstract
AimsTo determine the utility of clinical, morphological and phenotypical features in the differential diagnosis of plasmablastic lymphoma and myeloma with plasmablastic features.MethodsAll plasmablastic neoplasms identified from a 15-year retrospective search were reviewed and classified into ‘lymphoma’, ‘myeloma’ or ‘indeterminate’. The classification was then compared with the previously established clinical diagnosis. Lessons learned from this review were used to design a diagnostic algorithm for pathologists to use in the absence of known clinical history.ResultsThe classification was possible in 10 of 11 cases, 8 lymphomas and 2 myelomas (n=2). No distinctive morphological or phenotypical features were identified. The most useful histopathological parameter was a positive Epstein-Barr virus in situ hybridisation. Presence of associated lymphadenopathy and/or oral mass in the absence of complete myeloma-defining signs was used to favour a diagnosis of lymphoma in 4 of 8 cases.ConclusionsThe distinction between plasmablastic lymphoma from plasmablastic myeloma warrants detailed knowledge of clinical, radiological and laboratorial findings. New studies identifying distinctive phenotypical or genetic features are needed to improve the histopathological differentiation of plasmablastic neoplasms.
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Salem KZ, Nishihori T, Kharfan-Dabaja MA, Horna P, Alsina M. Primary plasmacytoma involving mediastinal lymph nodes: A diagnostic mimicry of primary mediastinal lymphoma. Hematol Oncol Stem Cell Ther 2016; 9:26-9. [DOI: 10.1016/j.hemonc.2015.06.007] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Revised: 05/09/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022] Open
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Celotto K, Neppalli V, Holstein S. Remarkable Response to Methylprednisolone in a Multiple Myeloma Patient with Nodal Disease Refractory to High-Dose Chemotherapy. Cureus 2015; 7:e411. [PMID: 26824011 PMCID: PMC4725678 DOI: 10.7759/cureus.411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
Multiple myeloma is a disorder of malignant plasma cells, which is characterized by paraprotein production, lytic bone lesions, hypercalcemia, susceptibility to infections, and renal impairment. Here, we describe a patient with IgA myeloma with extensive nodal involvement who obtained significant benefit from high-dose methylprednisolone after failing aggressive induction chemotherapy and high-dose melphalan with autologous stem cell support.
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Pediatric Pharyngeal IgD-positive Monoclonal Plasmacytoid and Plasma Cell Neoplasm. J Pediatr Hematol Oncol 2015; 37:623-6. [PMID: 25851555 DOI: 10.1097/mph.0000000000000330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Pediatric neoplasm with monoclonal proliferation of lymphoplasmacytoid lymphocytes and plasma cells is exceedingly rare and has essentially never been reported in immunocompetent children. Here, we report a previously healthy 13-year-old girl with a pharyngeal mass and enlarged cervical lymph nodes. The pharyngeal mass was composed of CD138, CD79a, MUM-1, IgD, CD20, PAX-5, CD43, λ-restricted monoclonal plasmacytoid, and plasma cells. Scattered CD20, PAX-5 B cells were present in the background. The patient was treated as localized non-Hodgkin lymphoma (stage II) with cyclophosphamide, doxorubicin, vincristine, and prednisone and is in complete remission at 17 months from the last chemotherapy.
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Eszes N, Tamási L, Csekeő A, Csomor J, Szepesi A, Varga G, Balázs G, Losonczy G, Müller V. Unicentric mixed variant Castleman disease associated with intrabronchial plasmacytoma. Diagn Pathol 2014; 9:64. [PMID: 24649966 PMCID: PMC3994877 DOI: 10.1186/1746-1596-9-64] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Accepted: 03/07/2014] [Indexed: 11/10/2022] Open
Abstract
UNLABELLED Castleman disease (CD), described as a heterogeneous lymphoproliferative disorder, can be divided into different subtypes according to clinical appearance (unicentric and multicentric form) and histopathological features (hyaline vascular, plasma cell, mixed type, human herpesvirus 8-associated and multicentric not otherwise specified). Unicentric CD is known to be usually of the hyaline vascular variant, plasma cell and mixed type of this form are quite uncommon. Malignancies are mainly associated with the multicentric form. We report a rare case of unicentric mixed variant CD evolving into intrabronchial, extramedullary plasmacytoma.Intrabronchial mass with consequential obstruction of the left main bronchus, left lung atelectasis and mediastinal lymphadenomegaly was detected by chest CT in our patient suffering from cough and hemoptysis. Pulmonectomy was performed, histopathological and immunhistochemical analysis of lymph nodes revealed mixed type of CD with interfollicular monotypic plasma cell proliferation. The intrabronchial mass consisted of monotypic plasma cells confirming plasmacytoma. Systemic involvement was not confirmed by further tests.Although malignancies more often present in multicentric CD that usually belongs to the plasma cell subtype, this case confirms the neoplastic potential of the rarest, unicentric mixed variant of CD. VIRTUAL SLIDES The virtual slide(s) for this article can be found here: http://www.diagnosticpathology.diagnomx.eu/vs/2872096831190851.
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Affiliation(s)
- Noémi Eszes
- Department of Pulmonology, Semmelweis University, Diósárok u, 1/c, 1125 Budapest, Hungary.
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Butrym A, Prochorec-Sobieszek M, Dzietczenia J, Mazur G. Unclassifiable small B-cell lymphoma with marked plasmacytic differentiation and Mott cell formation. Leuk Lymphoma 2013; 55:1681-3. [PMID: 24083817 DOI: 10.3109/10428194.2013.848983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- Aleksandra Butrym
- Department of Hematology, Blood Neoplasms and Bone Marrow Transplantation
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Chen HF, Wu TQ, Li ZY, Shen HS, Tang JQ, Fu WJ, Yuan ZG, Hou J. Extramedullary plasmacytoma in the presence of multiple myeloma: clinical correlates and prognostic relevance. Onco Targets Ther 2012; 5:329-34. [PMID: 23152688 PMCID: PMC3496411 DOI: 10.2147/ott.s35348] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Objective We studied the clinical and laboratory features and outcomes of multiple myeloma (MM) with extramedullary plasmocytoma (EP) disease both at diagnosis and during the course of MM. Patients and methods Forty-two patients of 467 patients with MM were retrospectively analyzed from both the 100th Hospital of the People’s Liberation Army and Shanghai Changzheng Hospitals. The clinical characteristics, laboratory parameters, responses, risk factors, and outcomes were analyzed. Results The median age was 53 years with a male/female sex ratio of 34:8. Twenty-six patients had EP disease at the time of diagnosis, and 16 patients developed EP during the course of the disease. We found that the Durie–Salmon stage, serum lactate dehydrogenase level, beta-2-microglobulin, complete blood counts, albumin, and the type of immunoglobulin (Ig) were not associated with the development of EP disease. Patients who developed EP during the course of MM had a higher ratio of plasmocytes and premature plasmocytes in the bone marrow with lower C-reactive protein level and earlier stage of International Staging System for Lung Cancer at the diagnosis of MM compared with patients who presented with EP at diagnosis. Once the patients developed EP disease, they frequently showed resistance to chemotherapy. With a median follow-up of 30 months, 19 patients were alive. Log-rank univariate analysis showed that patients with EP who had normal C-reactive protein, higher hemoglobin, lower serum lactate dehydrogenase, and stage I of International Staging System for Lung Cancer had longer survival. However, cyclooxygenase multivariate analysis failed to show statistical significance for any factor. Conclusions EP disease is the MM end-phase and is not a rare manifestation of MM with a cumulative incidence of 9% of MM. The prognosis is very poor once the diagnosis of EP disease is concurrent with MM.
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Affiliation(s)
- Hai-Fei Chen
- Department of Hematology, 100th Hospital of People's Liberation Army, Medical Centre of Hematologic and Oncologic Diseases of Nanjing Military Command, Suzhou, China
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La Verde N, Moretti A, Bramati A, Bianchi F, Gherardi G, Piva S, Girelli S, Pedretti D, Farina G. Multiple myeloma with prostate involvement: a case report. J Clin Oncol 2012; 30:e306-8. [PMID: 22965957 DOI: 10.1200/jco.2012.42.7179] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Nicla La Verde
- Oncology Department, Azienda Ospedaliera Fatebenefratelli e Oftalmico, Corso di Porta Nuova 23, 20121 Milan.
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20
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Klimant E, Albu DM, Markman M. Synchronous presentation of a primary iliac lymph node plasmacytoma and a prostate adenocarcinoma. Case Rep Oncol 2011; 4:311-4. [PMID: 21734887 PMCID: PMC3128135 DOI: 10.1159/000329585] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Synchronous presentation of primary nodal plasmacytoma and prostate cancer is very rare and has not been described in the literature. Here, we report a case of a patient with nodal plasmacytoma whose clinical presentation was suggestive of metastatic prostate cancer in the setting of recently diagnosed prostate cancer. The workup and treatment of both malignancies as well as a possible underlying common pathologic mechanism (IL-6 gene mutation) are discussed.
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Affiliation(s)
- Eiko Klimant
- Departments of Medical Oncology, Cancer Treatment Centers of America, Eastern Regional Medical Center, Philadelphia, Pa., USA
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21
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Nodal and extranodal plasmacytomas expressing immunoglobulin a: an indolent lymphoproliferative disorder with a low risk of clinical progression. Am J Surg Pathol 2010; 34:1425-35. [PMID: 20871216 DOI: 10.1097/pas.0b013e3181f17d0d] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Plasmacytomas expressing immunoglobulin A are rare and not well characterized. In this study, 9 cases of IgA-positive plasmacytoma presenting in lymph node and 3 in extranodal sites were analyzed by morphology, immunohistochemistry, and polymerase chain reaction examination of immunoglobulin heavy and κ light chain genes. Laboratory features were correlated with clinical findings. There were 7 males and 5 females; age range was 10 to 66 years (median, 32 y). Six of the patients were younger than 30 years of age, 5 of whom had nodal disease. About 67% (6 of 9) of the patients with nodal disease had evidence of immune system dysfunction, including human immunodeficiency virus infection, T-cell deficiency, autoantibodies, arthritis, Sjögren syndrome, and decreased B cells. An IgA M-spike was detected in 6 of 11 cases, and the M-protein was nearly always less than 30 g/L. All patients had an indolent clinical course without progression to plasma cell myeloma. Histologically, nodal IgA plasmacytomas showed an interfollicular or diffuse pattern of plasma cell infiltration. The plasma cells were generally of mature Marschalko type with little or mild pleomorphism and exclusive expression of monotypic IgA. There was an equal expression of κ and λ light chains (ratio 6:6). Clonality was showed in 9 of 12 cases: by polymerase chain reaction in 7 cases, by cytogenetic analysis in 1 case, and by immunofixation in 1 case. Clonality did not correlate with pattern of lymph node infiltration. Our results suggest that IgA plasmacytomas may represent a distinct form of extramedullary plasmacytoma characterized by younger age at presentation, frequent lymph node involvement, and low risk of progression to plasma cell myeloma.
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22
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Parkins E, Boll M, O'Connor SJM, Rawstron AC, Owen RG. Extramedullary plasmacytoma with a t(11;14)(q13;q32) and aggressive clinical course. Leuk Lymphoma 2010; 51:1360-2. [DOI: 10.3109/10428194.2010.486454] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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23
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Rampisela D, Donner LR. An unusual self-limited clonal Mott cell proliferation with lymphoplasmacytic lymphoma-like features in a child with the Wiskott-Aldrich syndrome and Von Recklinghausen's neurofibromatosis. Pathol Res Pract 2009; 206:467-71. [PMID: 19713050 DOI: 10.1016/j.prp.2009.07.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2006] [Revised: 02/24/2009] [Accepted: 07/03/2009] [Indexed: 11/30/2022]
Abstract
Patients with the Wiskott-Aldrich syndrome are at high risk for development of lymphomas, which are predominantly extranodal and of the immunoblastic type. We present a case of a self-limited lymphoproliferation with features of lymphoplasmacytic lymphoma arising in a patient with the Wiskott-Aldrich syndrome. The patient also had stigmata of von Recklinghausen's neurofibromatosis. The tumor was composed of CD138+, IgGkappa+, CD20-, PAX-5- Mott cells and CD5-, CD10-, CD19+, CD20+, CD43- small lymphoid B-cells that partially expressed CD23. The lymphadenopathy spontaneously resolved after a period of less than a year, and the patient had remained free of detectable lymphoproliferation for almost 4 years. He then developed Burkitt's lymphoma of the left parapharyngeal space. It is remarkable that both known lymphoproliferations with features of lymphoplasmatic lymphoma arising in patients with the Wiskott-Aldrich syndrome, this one and the previously described one, have spontaneously resolved. This observation is truly intriguing and requires further clinico-pathologic studies.
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Affiliation(s)
- Debby Rampisela
- Department of Pathology, Scott and White Memorial Hospital and Clinic, 2401 South 31st Street, Temple, TX 76508, USA
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Abstract
Extramedullary plasmacytoma may originate in any organ, either as a primary tumor or as a facet of systemic multiple myeloma. These solid lesions most commonly affect the upper respiratory tract, gastrointestinal and urogenital tract, skin, and lung. Primary plasmacytoma of the lymph node is a rare hematologic neoplasm, which usually manifests as an enlargement of the cervical lymph nodes with no evidence of any other plasma cell dyscrasia. A 56-year-old man was admitted, due to the presence of multiple palpable masses in the right cervical and submandibular areas. Surgical resection revealed plasmacytoma of the lymph nodes. According to our full work-up, no evidence of the systemic involvement of plasma cell dyscrasia was discovered and thus, the diagnosis of primary plasmacytoma of the lymph node was made. Radiotherapy was administered, and the remnant mass was reduced substantially, to 1x2 cm in size. The patient was scheduled to be monitored by a PET CT scan, as well as by a neck CT scan.
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Affiliation(s)
- Young Hyo Lim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Su Kyoung Park
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Ho Suk Oh
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Jung Hye Choi
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Myung Ju Ahn
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - Young Yul Lee
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
| | - In Soon Kim
- Department of Internal Medicine, Hanyang University College of Medicine, Seoul, Korea
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Damaj G, Mohty M, Vey N, Dincan E, Bouabdallah R, Faucher C, Stoppa AM, Gastaut JA. Features of extramedullary and extraosseous multiple myeloma: a report of 19 patients from a single center. Eur J Haematol 2005; 73:402-6. [PMID: 15522061 DOI: 10.1111/j.1600-0609.2004.00331.x] [Citation(s) in RCA: 99] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
Extramedullary (EM) localizations at diagnosis or during the course of multiple myeloma (MM) are rare. We conducted a large retrospective study to more accurately describe the clinical and laboratory features of this entity, and the outcome of these manifestations. The charts of 19 eligible patients out of 432 patients with MM were retrieved from the hematology department of the Institut Paoli-Calmettes Cancer Center. Median age was 61 (range: 39-79) with a female/male sex ratio of 8/11. Ten patients were found to have EM and extraosseous tumor at the time of MM diagnosis, and nine patients developed EM tumor during the course of the disease. Neither the stage of the disease, the LDH level, or the type of immunoglobulin (Ig) was found to be associated with the development of EM disease. Patients who developed EM tumor during the course of MM had a lower serum Ig and a higher monoclonal Bence-Jones proteinuria at the diagnosis of MM than patients who presented with EM tumor at diagnosis. Multiple sites were usually involved. Resistance to chemotherapy was frequent and response to thalidomide was poor. Eight out of the 19 patients responded to high-dose chemotherapy. The remaining 11 patients progressed while on therapy. With a median follow-up of 13 months (range: 2-65), six patients are alive, four patients are in partial remission and two patients in present progressive disease. In conclusion, EM tumors are a rare manifestation of MM, with a cumulative incidence of 4.6% of MM. Multiple sites are usually involved. The response to chemotherapy is very poor with a very low response rate to thalidomide. The prognosis is very poor, especially when the diagnosis of EM tumor is concurrent with the diagnosis of MM.
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Affiliation(s)
- G Damaj
- Department of Hematology, Institut Paoli Calmettes and Université de la Méditerranée, Marseille, France.
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Lee LA, Fang TJ, Li HY. Solitary plasmacytosis of the larynx in a patient with non-Hodgkin's lymphoma. Am J Otolaryngol 2002; 23:316-20. [PMID: 12239702 DOI: 10.1053/ajot.2002.124196] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Solitary plasmacytosis of the larynx is a clinically unusual event. It may cause hoarseness or airway obstruction and usually needs surgical excision. Plasmacytosis is distinguished from extramedullary plasmacytoma (EMP) in that the latter primarily involves the head and neck and needs more intensive therapy such as radiotherapy. Many reports have described the histopathology and immunohistochemistry of EMP of the larynx; however, no literature in English has described solitary plasmacytosis of the larynx. We report a 44-year-old female patient with non-Hodgkin's lymphoma and systemic lupus erythromatosus with Sjögren's syndrome. She complained of 1-year period of hoarseness that became exacerbated in the most recent 3 weeks. A wide-base and smooth-surface mass at the left supraglottic area was noted by direct laryngoscope. Computed tomography scan revealed a well-defined radiopaque mass. The histopathology of a specimen excised by carbon dioxide laser-assisted laryngomicrosurgery was interpreted initially as plasmacytoma. Immunohistochemical staining for kappa and lambda light chains demonstrated polyclonal plasma cells, and the definitive diagnosis was plasmacytosis. After 6 months follow-up, the subjective quality of her voice improved. Laryngoscopic examination revealed no evidence of recurrence.
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Affiliation(s)
- Li-Ang Lee
- Department of Otolaryngology, Chang Gung Memorial Hospital, and Chang Gung University, Taoyuan, Taiwan
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