1
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Choe J, Shin SH, Jeon K, Huh HJ, Park HD, Jeong BH. Features which discriminate between tuberculosis and haematologic malignancy as the cause of pleural effusions with high adenosine deaminase. Respir Res 2024; 25:17. [PMID: 38178065 PMCID: PMC10765929 DOI: 10.1186/s12931-023-02645-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 12/19/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Adenosine deaminase (ADA) is a useful biomarker for the diagnosis of tuberculous pleurisy (TBP). However, pleural effusions with high ADA can also be caused by other diseases, particularly hematologic malignant pleural effusion (hMPE). This study aimed to investigate the features that could differentiate TBP and hMPE in patients with pleural effusion ADA ≥ 40 IU/L. METHODS This was a retrospective observational study of patients with pleural effusion ADA ≥ 40 IU/L, conducted at a Korean tertiary referral hospital with an intermediate tuberculosis burden between January 2010 and December 2017. Multivariable logistic regression analyses were performed to investigate the features associated with TBP and hMPE, respectively. RESULTS Among 1134 patients with ADA ≥ 40 IU/L, 375 (33.1%) and 85 (7.5%) were diagnosed with TBP and hMPE, respectively. TBP and hMPE accounted for 59% (257/433) and 6% (27/433) in patients with ADA between 70 and 150 IU/L, respectively. However, in patients with ADA ≥ 150 IU/L, they accounted for 7% (9/123) and 19% (23/123), respectively. When ADA between 40 and 70 IU/L was the reference category, ADA between 70 and 150 IU/L was independently associated with TBP (adjusted odds ratio [aOR], 3.11; 95% confidence interval [CI], 1.95-4.95; P < 0.001). ADA ≥ 150 IU/L was negatively associated with TBP (aOR, 0.35; 95% CI, 0.14-0.90; P = 0.029) and positively associated with hMPE (aOR, 13.21; 95% CI, 5.67-30.79; P < 0.001). In addition, TBP was independently associated with lymphocytes ≥ 35% and a lactate dehydrogenase (LD)/ADA ratio < 18 in pleural effusion. hMPE was independently associated with pleural polymorphonuclear neutrophils < 50%, thrombocytopenia, and higher serum LD. A combination of lymphocytes ≥ 35%, LD/ADA < 18, and ADA < 150 IU/L demonstrated a sensitivity of 0.824 and specificity of 0.937 for predicting TBP. CONCLUSION In patients with very high levels of pleural effusion ADA, hMPE should be considered. Several features in pleural effusion and serum may help to more effectively differentiate TBP from hMPE.
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Affiliation(s)
- Junsu Choe
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Sun Hye Shin
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Kyeongman Jeon
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea
| | - Hee Jae Huh
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
- Department of Medical Device Management and Research, Samsung Advanced Institute for Health Sciences & Technology, Sungkyunkwan University, Seoul, Republic of Korea
| | - Hyung-Doo Park
- Department of Laboratory Medicine and Genetics, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea
| | - Byeong-Ho Jeong
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, 81 Irwon-ro, Gangnam-gu, Seoul, 06351, Republic of Korea.
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2
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Daboussi S, Saidane A, Mhamdi S, Kacem M, Essbaa S, Aichaouia C, Ghedira H, Gargouri F, Msakni I, Moatemri Z. Case Report: A very rare case of a Pleural Effusion revealing Multiple Myeloma. F1000Res 2023; 12:476. [PMID: 38774309 PMCID: PMC11106595 DOI: 10.12688/f1000research.133007.3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/01/2023] [Indexed: 05/24/2024] Open
Abstract
Multiple myeloma is a common malignant bone-based disease. Pleural effusions reported in these patients remain rare. It is commonly due to congestive heart disease, pulmonary embolism, nephrotic syndrome or a second neoplasia. The true myelomatous pleural effusion resulting from a direct tumoral invasion of the pleural are extremely rare. We report here the case of a massive pleural effusion revealing multiple myeloma in a 71-year-old patient. The chest ultrasound showed a massive pleural effusion in the left side with a multinodular thickening of the pleura. The medical thoracoscopy showed a grape-cluster appearance. The diagnosis was made by pleural guided biopsy revealing abnormal plasma cells with an intense positive CD 138 (plasma cell marker) and MUM1 (multiple myeloma oncogene1) staining with a light kappa chain in the protein electrophoresis associated with a myeloma. Unfortunately, our patient died one month after the initial diagnosis. We present also a review of the recent literature in order to highlight the clinical presentations of the myelomatous pleural effusion, the diagnostic tools, the therapeutic strategies as well as the outcomes.
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Affiliation(s)
- Selsabil Daboussi
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Department of Pneumology, Military Hospital, Tunis, 1008, Tunisia
| | - Asma Saidane
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Department of Pneumology, Military Hospital, Tunis, 1008, Tunisia
| | - Samira Mhamdi
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Department of Pneumology, Military Hospital, Tunis, 1008, Tunisia
| | - Marwa Kacem
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Department of Pneumology, Military Hospital, Tunis, 1008, Tunisia
| | - Samia Essbaa
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Department of Pneumology, Military Hospital, Tunis, 1008, Tunisia
| | - Chiraz Aichaouia
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Department of Pneumology, Military Hospital, Tunis, 1008, Tunisia
| | - Hela Ghedira
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Department of Hematology, Military Hospital, Tunis, 1008, Tunisia
| | - Faten Gargouri
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Pathology Departmeny, Military Hospital, Tunis, 1008, Tunisia
| | - Issam Msakni
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Pathology Departmeny, Military Hospital, Tunis, 1008, Tunisia
| | - Zied Moatemri
- Faculty of Medicine, University of Tunis El Manar, Tunis, 1007, Tunisia
- Department of Pneumology, Military Hospital, Tunis, 1008, Tunisia
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3
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Polski AG, Ramirez Marquez J, McQuiston S. Massive Myelomatous Pleural Effusion With Contralateral Mediastinal Shift: A Unique Presentation of Extramedullary Myeloma. Cureus 2023; 15:e43040. [PMID: 37680422 PMCID: PMC10480062 DOI: 10.7759/cureus.43040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/06/2023] [Indexed: 09/09/2023] Open
Abstract
Multiple myeloma (MM) is a relatively common malignancy that primarily affects the bone marrow, while extramedullary disease (EMD) occurs in the skin and muscle, lung pleura, lymph nodes, liver, and CNS. Myelomatous pleural effusion (MPE) is a rare extramedullary manifestation of MM in which pleural fluid is composed almost entirely of abnormal plasma cells. MPE and other types of EMD are associated with poor prognosis, and MPE can present emergently due to tension physiology. We report a case of a patient with massive MPE presenting with contralateral midline shift. There are exceedingly few such cases and this report highlights a unique presentation of this rare clinical entity. Epidemiology, radiographic features, diagnosis, treatment, and implications for the prognosis of the disease are discussed.
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4
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Maat Z, Al-Asa'd YTH, Subahi EA, Al-Ameen OAS, Elhiday AA. Myelomatous Pleural Effusion: A Rare Case Report and Literature Review. Case Rep Oncol 2022; 15:1049-1054. [PMID: 36636679 PMCID: PMC9830277 DOI: 10.1159/000527199] [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] [Received: 03/05/2022] [Accepted: 08/30/2022] [Indexed: 11/13/2022] Open
Abstract
Multiple myeloma (MM) is typically characterized by the neoplastic proliferation of plasma cells producing a monoclonal immunoglobulin. Pleural effusion in MM is uncommon and usually caused by heart failure, pulmonary embolus, and nephrotic syndrome [Arch Intern Med. 1978;138(5):727-30; Chest. 1994;105(2):622-4]. Here, we report a case of myelomatous pleural effusion as part of the initial presentation of MM in a patient with the IgG-lambda subtype, which is extremely uncommon.
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Affiliation(s)
- Zakaria Maat
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar,*Zakaria Maat,
| | | | - Eihab A. Subahi
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
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5
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Amjad MA, Hamid Z, Ramakrishna S, Frank R, Ochieng P. Myelomatous Pleural Effusion: A Rare Occurrence in Multiple Myeloma. Cureus 2022; 14:e26045. [PMID: 35859966 PMCID: PMC9288844 DOI: 10.7759/cureus.26045] [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] [Accepted: 06/17/2022] [Indexed: 11/16/2022] Open
Abstract
Various factors can cause pleural effusion in multiple myeloma patients. Myelomatous pleural effusion (MPE) is an uncommon but potentially life-threatening complication of multiple myeloma with a poor prognosis. After ruling out all other probable causes, the present case reports MPE in a patient with IgG kappa multiple myeloma.
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6
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Xu J, Gao L, Yan M, Wang B, Song Z, Liu H, Sun K, Nong L, Wang M, Cen X. Potential Role of Pleural Fluid Cytokine Profile in Myelomatous Pleural Effusions. Onco Targets Ther 2021; 14:4545-4550. [PMID: 34466000 PMCID: PMC8403078 DOI: 10.2147/ott.s324810] [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: 06/14/2021] [Accepted: 08/08/2021] [Indexed: 12/31/2022] Open
Abstract
Background Myelomatous pleural effusion (MPE), as a presentation of extramedullary infiltration of multiple myeloma (MM), is rare and currently associated with poor outcomes without effective therapy. The potential value of cytokine detection in pleural effusion to MPE has not been reported to date. Case Presentation We herein report a case of refractory and relapsed multiple myeloma that developed bilateral MPE due to disease progression caused by intolerance to various chemotherapy regimens. Cytomorphology and flow cytometry were adopted for diagnosis confirmation. Chemotherapy containing immunomodulators combined with thoracic catheterization drainage was applied to the patient, showing a certain therapeutic effect. During the course of disease, the change of cytokine profile in pleural effusion was monitored by cytometric bead array (CBA) technology, revealing that cytokines related to tumor load such as interleukin 6 (IL-6) and interleukin 10 (IL-10) in pleural effusion decreased with the improvement of disease, while other cytokines such as interleukin 2 (IL-2), interleukin 4 (IL-4), interleukin 17A (IL-17A), tumor necrosis factor α (TNF-α), interferon γ (IFN-γ), granzyme A, granzyme B, perforin and granulysin increased with the improvement of disease. Conclusion There is a prospect that cytokine level in pleural effusion may indicate treatment response of MPE, and in light of this case, immunomodulators may be utilized in treating patients suffering MPE. Due to limitations of our single case, we urge more groups to evaluate the potential role of cytokine profile in MPE.
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Affiliation(s)
- Junhui Xu
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China.,Xiamen Cardiovascular Hospital, Xiamen University, Xiamen, People's Republic of China
| | - Liang Gao
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Miao Yan
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Bingjie Wang
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Zhengyang Song
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Huihui Liu
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Kunyan Sun
- Department of Respiration, Peking University First Hospital, Beijing, People's Republic of China
| | - Lin Nong
- Department of Pathology, Peking University First Hospital, Beijing, People's Republic of China
| | - Mangju Wang
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
| | - Xinan Cen
- Department of Hematology, Peking University First Hospital, Beijing, People's Republic of China
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7
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Sameh Soliman D, Ali M, Akikki S, Ibrahim F, El-Omari H, Al-Sabbagh A, Okar L. Transient Pleural Fluid Infiltration by Clonal Plasma Cells Associated with Pulmonary Tuberculosis. Case Rep Oncol 2020; 13:883-891. [PMID: 32884535 PMCID: PMC7443684 DOI: 10.1159/000507984] [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] [Received: 04/17/2020] [Accepted: 04/17/2020] [Indexed: 11/19/2022] Open
Abstract
Pleural effusion is a rare presentation of plasma cell myeloma, occurring in around 6% of patients during the course of their disease, most commonly as a consequence of a concurrent disease process like heart failure secondary to amyloid deposition. Direct infiltration of the pleural fluid by malignant cells leading to myelomatous pleural effusion is a rare mechanism occurring in less than 1% of patients with plasma cell myeloma, and it is associated with a worse prognosis. There are few case reports of myelomatous pleural effusion as an initial presentation of multiple myeloma. Pleural fluid infiltration by monoclonal plasma cells in the absence of an underlying plasma cell myeloma was not reported before in the literature. Tuberculosis is a known cause of polyclonal gammaglobulinemia, however few case reports described the coexistence of monoclonal gammopathy of undetermined significance and tuberculosis. Here we present an interesting case of pleural fluid infiltration by an abnormal looking clonal plasma cells associated with active pulmonary tuberculosis and parapneumonic effusion in a patient with a background of acute myeloid leukemia. Interestingly, the clonal plasma cell proliferation was confined to the pleural fluid without any evidence of an underlying plasma cell neoplasms (including monoclonal gammopathy of undetermined significance and plasmacytomas). Since our patient had an underlying meyloid neoplasm, we though about the possibility of secondary malignancy. However, in almost all patients with coexisting myeloid and plasma cell neoplasms, myeloid neoplasms developed following chemotherapeutic treatment of plasma cell neoplasms not the other way around. Given that, one must conclude localized extramedullary (pleural) plasma cell proliferation probably represents a transient reactive process to pulmonary tuberculosis which is an extremely rare phenomenon and not described before.
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Affiliation(s)
- Dina Sameh Soliman
- Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.,Department of Clinical Pathology, National Cancer Institute, Cairo University, Cairo, Egypt.,Department of Laboratory Medicine and Pathology-Weill Cornell Medicine, Doha, Qatar
| | - Mohammad Ali
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
| | - Susanna Akikki
- Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.,Department of Laboratory Medicine and Pathology-Weill Cornell Medicine, Doha, Qatar
| | - Feryal Ibrahim
- Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Halima El-Omari
- Department of Hematology and Medical Oncology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar
| | - Ahmad Al-Sabbagh
- Department of Laboratory Medicine and Pathology, National Center for Cancer Care and Research, Hamad Medical Corporation, Doha, Qatar.,Department of Laboratory Medicine and Pathology-Weill Cornell Medicine, Doha, Qatar
| | - Lina Okar
- Department of Medical Education, Hamad Medical Corporation, Doha, Qatar
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8
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Millar JK, Benninger LA, Li Y, Ataya A. A 42-Year-Old Man With Shortness of Breath, Fever, and Pleural Effusions. Chest 2020; 155:e141-e144. [PMID: 31060711 DOI: 10.1016/j.chest.2018.10.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2018] [Revised: 10/19/2018] [Accepted: 10/26/2018] [Indexed: 10/26/2022] Open
Abstract
CASE PRESENTATION A 42-year-old man with a history of progressive multiple myeloma and chronic kidney disease presented with worsening shortness of breath and fever. He was scheduled for a planned admission for chemotherapy on the day of presentation and had developed these symptoms the night before. He had also developed worsening fatigue but denied any new cough, sputum production, or abdominal pain. The patient had been previously admitted 3 weeks prior for neutropenic fever and colitis during his first cycle of chemotherapy.
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Affiliation(s)
| | - Lauryn A Benninger
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL
| | - Ying Li
- Department of Pathology, Immunology and Laboratory Medicine, University of Florida, Gainesville, FL
| | - Ali Ataya
- Division of Pulmonary, Critical Care and Sleep Medicine, University of Florida, Gainesville, FL.
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9
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Yanamandra U, Deo P, Sahu KK, Nampoothiri RV, Gupta N, Prabhakaran A, Dhibhar DP, Khadwal A, Prakash G, Sachdeva MUS, Lad D, Varma N, Varma S, Malhotra P. Clinicopathological Profile of Myelomatous Pleural Effusion: Single-center Real-world Experience and Review of Literature. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2019; 19:183-189.e1. [DOI: 10.1016/j.clml.2018.12.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2018] [Revised: 11/25/2018] [Accepted: 12/12/2018] [Indexed: 12/16/2022]
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10
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Lin L, Han Q, Liu Z, Xu H, Wu Y, Zhang J, Liu X. Catch me if you can-How to make the best use of pleural effusion. J Thorac Dis 2017; 9:E664-E668. [PMID: 28932581 DOI: 10.21037/jtd.2017.06.65] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Etiology diagnosis of pleural effusion is a commonly encountered yet challenging problem. How to make the best use of pleural effusion evokes thinking. Myelomatous pleural effusion (MPE) is a rare condition and has been reported sporadically. We report an extremely rare case of multiple myeloma (MM) [IgD-lambda (λ) type, stage III B] with MPE as initial presentation and complicated with massive pericardial effusions during the progression of the disease. Cytological identification of malignant plasma cells in pleural effusion is the most direct method to diagnose MPE. What we learn from this case is that cell block can increase the sensitivity of detecting malignancies compared with conventional smear. Doctors should make best use of pleural effusion before further invasive procedure.
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Affiliation(s)
- Lianjun Lin
- The Geriatrics Department, Peking University First Hospital, Beijing 100034, China
| | - Qian Han
- The Geriatrics Department, Peking University First Hospital, Beijing 100034, China
| | - Zhonghui Liu
- The Geriatrics Department, Peking University First Hospital, Beijing 100034, China
| | - Huiying Xu
- The Geriatrics Department, Peking University First Hospital, Beijing 100034, China
| | - Yanping Wu
- The Geriatrics Department, Peking University First Hospital, Beijing 100034, China
| | - Jixin Zhang
- The Pathology Department, Peking University First Hospital, Beijing 100034, China
| | - Xinmin Liu
- The Geriatrics Department, Peking University First Hospital, Beijing 100034, China
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11
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Español I, Romera M, Gutiérrez-Meca MD, García MDC, Tejedor A, Martínez A, Ibáñez J, De Arriba F, Minguela A, Iturbe T, López MD. Carfilzomib and dexamethasone for extramedullary myeloma with pleuropericardial involvement. Clin Case Rep 2017; 5:1258-1260. [PMID: 28781837 PMCID: PMC5538069 DOI: 10.1002/ccr3.1015] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2016] [Revised: 04/15/2017] [Accepted: 04/18/2017] [Indexed: 12/20/2022] Open
Abstract
The dismal outcome of pleuropericardial extramedullary multiple myeloma (EMM) reflects both the selection of resistant disease and absence of useful drugs. Carfilzomib and dexamethasone should be explored in advanced EMM patients, even for bortezomib‐resistant patients, as may provide much longer overall survival than previously reported treatments.
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Affiliation(s)
- Ignacio Español
- Haematology Department Santa Lucía University General Hospital Cartagena Spain
| | - Marta Romera
- Haematology Department Santa Lucía University General Hospital Cartagena Spain
| | | | | | - Aurelia Tejedor
- Haematology Department Santa Lucía University General Hospital Cartagena Spain
| | - Antonio Martínez
- Haematology Department Santa Lucía University General Hospital Cartagena Spain
| | - Jerónima Ibáñez
- Haematology Department Santa Lucía University General Hospital Cartagena Spain
| | - Felipe De Arriba
- Hematology Department Morales Meseguer University General Hospital Murcia Spain
| | - Alfredo Minguela
- Immunology Department Virgen de la Arrixaca University General Hospital Murcia Spain
| | - Teodoro Iturbe
- Haematology Department Santa Lucía University General Hospital Cartagena Spain
| | - Maria Dolores López
- Haematology Department Santa Lucía University General Hospital Cartagena Spain
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12
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Harbhajanka A, Brickman A, Park JW, Reddy VB, Bitterman P, Gattuso P. Cytomorphology, clinicopathologic, and cytogenetics correlation of myelomatous effusion of serous cavities: A retrospective review. Diagn Cytopathol 2016; 44:742-7. [DOI: 10.1002/dc.23523] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Revised: 06/13/2016] [Accepted: 06/14/2016] [Indexed: 11/07/2022]
Affiliation(s)
- Aparna Harbhajanka
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Arlen Brickman
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Ji-Weon Park
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Vijaya B Reddy
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Pincas Bitterman
- Department of Pathology; Rush University Medical Center; Chicago Illinois
| | - Paolo Gattuso
- Department of Pathology; Rush University Medical Center; Chicago Illinois
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13
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Amaraneni A, Saeed U, Malik D, Brown M, Chandana SR. Bilateral myelomatous pleural effusion: presentation of two cases. Blood Res 2016; 51:142-4. [PMID: 27382562 PMCID: PMC4931935 DOI: 10.5045/br.2016.51.2.142] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2015] [Revised: 05/27/2015] [Accepted: 06/15/2015] [Indexed: 11/23/2022] Open
Affiliation(s)
- Akshay Amaraneni
- Department of Internal Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Usman Saeed
- Department of Internal Medicine-Pediatrics, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Devin Malik
- Department of Internal Medicine, Western Michigan University, Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
| | - Megan Brown
- Michigan State University, College of Human Medicine, East Lansing, MI, USA
| | - Sreenivasa R Chandana
- Division of Hematology and Oncology, West Michigan Cancer Center, Kalamazoo, MI, USA
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14
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Marron TU, Hanna MG, Ramanathan L, Chari A. Validation and Utility of the Free Light Chain Assay in Pleural Effusions of Patients With Multiple Myeloma. CLINICAL LYMPHOMA MYELOMA & LEUKEMIA 2016; 16:e113-7. [PMID: 27349767 DOI: 10.1016/j.clml.2016.04.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 04/06/2016] [Accepted: 04/26/2016] [Indexed: 10/21/2022]
Affiliation(s)
- Thomas U Marron
- Division of Hematology and Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Matthew G Hanna
- Department of Pathology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Lakshmi Ramanathan
- Department of Laboratory Medicine, Memorial Sloan-Kettering Cancer Center, New York, NY
| | - Ajai Chari
- Division of Hematology and Oncology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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15
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Abstract
OBJECTIVE Pleural effusion is rarely observed in patients with multiple myeloma (MM). Myeloma cell infiltration or invasion to the pleura is very rare. This study aimed to investigate the clinical characteristics of pleural effusion in patients with MM. METHODS We retrospectively reviewed the medical records of patients diagnosed with pleural effusion, MM, and pleural effusion with MM between 2004 and 2014 at Beijing Jishuitan Hospital. The present study included patients with pleural effusion who underwent cytological, bacteriological, biochemical and other testing. The cytopathology of abnormal pleural effusion cells was not diagnostic, thus flow cytometry was performed. MM was defined using the diagnosis standard of NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines) 2014 for MM. RESULTS This study included 3,480 pleural effusion patients and 319 MM patients. There were 34 patients with both MM and pleural effusion (17 men and 17 women). The average age was 63 years (range, 48-84 years). Pleural effusion with MM was caused by congestive heart disease, chronic renal failure, hypoalbuminemia, pulmonary infarctions, cirrhosis, pulmonary arterial hypertension, parapneumonic effusion, tuberculous pleural effusion, and myelomatous pleural effusion (MPE). The diagnosis of MPE was confirmed by the detection of myeloma cells in the pleural fluid using flow cytometric analyses. There were only 2 MPE cases in our study. The first MPE case was a woman. The first clinical manifestation was pleural effusion, and the diagnosis was non-secretory MM, DSS stage IIIA (Durie-Salmon staging system); ISS stage I (the International Staging System). The second MPE case was a man who was diagnosed with MM IgA-κ, DSS stage IIIA; ISS stage II. CONCLUSION The detection rate of MPE was very low. MPE tended to present with yellow exudates and the lack of physical and chemical characteristics. Furthermore, patients with MPE exhibited many yellow nodules on the pleura. These nodules were lobulated and had abundant blood supply. The routine pleural effusion pathological examination had low sensitivity. Flow cytometry may be more useful for improving the detection rate of MPE.
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Affiliation(s)
- Zhuo Wang
- Department of Respiratory Medicine, Beijing Jishuitan Hospital, China
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Babu KA, Sundararajan L, Prabu P, Parameswaran A. Disseminated plasma cell myeloma presenting as massive pleural effusion. Eur Clin Respir J 2015; 2:27028. [PMID: 26664659 PMCID: PMC4660938 DOI: 10.3402/ecrj.v2.27028] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2014] [Revised: 04/29/2015] [Accepted: 06/08/2015] [Indexed: 12/04/2022] Open
Abstract
Plasma cell myeloma (PCM) is a hematologic malignancy of plasma cell origin and usually associated with the presence of lytic bone lesions. Pleural effusions are rarely associated with PCM and most often signify a concurrent disease process. Malignant myelomatous pleural effusions are even more unusual and carry a poor prognosis. We report a unique case of unsuspected PCM with thoracic involvement in the form of massive left side pleural effusion. Pleural fluid cytology revealed numerous atypical plasma cells. Subsequently on further workup, urine Bence Jones protein was positive. Bone marrow aspiration and biopsy and computed tomography of the chest and abdomen revealed features consistent with multiple myeloma.
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Herrera DAA, Scott M, Varma M. Myelomatous Pleural Effusion Presenting with Extreme Hyperferritinemia and Severe Inflammatory Response. Case Rep Oncol 2015; 8:349-55. [PMID: 26464569 PMCID: PMC4592508 DOI: 10.1159/000438983] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
Abstract
Myelomatous involvement of pleural effusions developing in patients with multiple myeloma is extremely rare and only a few cases have been reported so far. It is thought to represent an aggressive clinical progression of disease and is usually associated with severe complications, poor prognosis and high mortality. Ferritin is a marker of inflammatory pathways that plays a significant role in plasma cell malignancies and has been studied as a prognostic factor for multiple myeloma. In severe inflammatory states such as septic shock or hemophagocytic lymphohistiocytosis, extreme levels of ferritin are thought to precipitate a cytokine storm associated with poor clinical outcomes. We present a case of myelomatous pleural effusion associated with extreme levels of ferritin and explore the possibility of a connection between this rare entity and other severe inflammatory states, which could account for its ominous outcomes and poor prognosis.
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Affiliation(s)
- Diego A Adrianzen Herrera
- Icahn School of Medicine at Mount Sinai, St. Luke's-Roosevelt Hospital Center Residency program, New York, N.Y., USA
| | - Matthew Scott
- Department of Medicine, Mount Sinai St. Luke's-Roosevelt Hospital, New York, N.Y., USA
| | - Mala Varma
- Division of Hematology/Oncology, Department of Medicine, Mount Sinai St. Luke's-Roosevelt Hospital, New York, N.Y., USA
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Arora P, Gupta SK, Mallik N, Mittal R, Sharma OD, Kumar L. Flow Cytometry in Diagnosis of Myelomatous Pleural Effusion: A Case Report. Indian J Hematol Blood Transfus 2015; 32:138-42. [PMID: 27408376 DOI: 10.1007/s12288-015-0589-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Accepted: 08/27/2015] [Indexed: 10/23/2022] Open
Abstract
Plasma cell myeloma is a multifocal plasma cell neoplasm associated with increased monoclonal protein in serum and/or urine. Pleural effusions in patients with myeloma are uncommon (6 %). However, effusions due to direct infiltration of the pleura by plasma cells (myelomatous pleural effusion) are extremely rare (<1 %) and usually seen with IgA myeloma. The diagnosis of such cases requires pleural fluid cytology, electrophoresis or pleural biopsy. We present a case of myelomatous pleural effusion diagnosed using flow cytometry immunophenotyping in addition to the pleural fluid cytology. A 45 year old female was diagnosed as plasma cell myeloma (IgG kappa) in 2007. She received multiple lines of therapy during the course of her treatment including thalidomide, dexamethasone, lenalidomide, bortezomib, and doxorubicin based regimens. However, the patient had progressive extramedullary disease and developed pleural effusion in 2014. Cytological examination of the pleural fluid showed degenerative changes. Few preserved areas showed mononuclear cells including morphologically abnormal plasma cells. Immunophenotyping of these cells by flow cytometry revealed a pattern indicating neoplastic plasma cells. There was expression of CD38, CD138, and CD56, with absence of CD19, CD10 and CD45. This confirmed the diagnosis of myelomatous pleural effusion. Subsequently, the patient was offered a dexamethasone, cyclophosphamide, etoposide and cisplatin based regimen but, she declined further treatment and succumbed to her disease 3 months later. Myelomatous pleural effusion is a rare complication of plasma cell myeloma. Flow cytometry can be used as an adjunctive technique in its diagnosis particularly in cases with equivocal cytology and electrophoresis findings.
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Affiliation(s)
- Parul Arora
- Department of Laboratory Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Sanjeev Kumar Gupta
- Department of Laboratory Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Nabhajit Mallik
- Department of Laboratory Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Reena Mittal
- Department of Laboratory Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Om Dutt Sharma
- Department of Laboratory Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
| | - Lalit Kumar
- Department of Medical Oncology, Dr BRA IRCH, All India Institute of Medical Sciences (AIIMS), New Delhi, India
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19
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Jiang AG, Yang YT, Gao XY, Lu HY. Bilateral pleural effusion as an initial manifestation of multiple myeloma: A case report and literature review. Exp Ther Med 2015; 9:1040-1042. [PMID: 25667674 PMCID: PMC4316953 DOI: 10.3892/etm.2015.2184] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 12/17/2014] [Indexed: 02/07/2023] Open
Abstract
Multiple myeloma (MM) is a rare type of malignant hematological neoplasm. Although primarily involving the bone marrow, MM has a significant risk of metastasizing to other organs and may present with various clinical symptoms. However, the involvement of the respiratory system in the course of MM is extremely uncommon, particularly presenting with bilateral pleural effusion as the sole initial manifestation, which may result in a delayed diagnosis of MM. The present study describes the extremely rare case of a patient with MM presenting with myelomatous pleural effusion (MPE). The 78-year-old patient was admitted to the Department of Respiratory Medicine, Taizhou People’s Hospital (Taizhou, China) in March 2014, complaining of persistent dyspnea. Following admission, chest computed tomography scans revealed bilateral pleural effusion and a small amount of pericardial effusion, but no evident mass lesion. Thoracentesis was performed and the resulting pleural effusion was exudative and slightly bloody. In the following cytological examination, myeloma cells were identified in the pleural effusion. The patient was diagnosed definitively with MM following a histopathological study of the bone marrow aspiration. Therefore, the observations of the present case report may promote the consideration of MM in the differential diagnosis of patients with unexplained and refractory pleural effusion. The present study also reviewed the literature with regard to the association between MM and pleural effusion.
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Affiliation(s)
- Ai-Gui Jiang
- Department of Respiratory Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Yu-Tian Yang
- Department of Respiratory Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Xiao-Yan Gao
- Department of Respiratory Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | - Hui-Yu Lu
- Department of Respiratory Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
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20
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Zhang LL, Li YY, Hu CP, Yang HP. Myelomatous pleural effusion as an initial sign of multiple myeloma-a case report and review of literature. J Thorac Dis 2014; 6:E152-9. [PMID: 25093103 DOI: 10.3978/j.issn.2072-1439.2014.06.48] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2014] [Accepted: 06/06/2014] [Indexed: 11/14/2022]
Abstract
OBJECTIVE Discuss and improve the understanding of the clinical characters and diagnostic methods of myelomatous pleurisy, particularly of the patients with pleural effusion as an initial manifestation. BACKGROUND A 53-year-old male, who had been misdiagnosed as tuberculous pleurisy in a local hospital, was diagnosed as multiple myeloma (MM) with pleural infiltration. We reviewed the literature on clinical manifestations, serum and pleural effusion characters, treatment and diagnostic options of this exceptionally rare presentation of MM. METHODS We conducted a search of the published medical literature since 2000 in MEDLINE and PubMed using search criteria [("pleural effusion" and "MM") or "myelomatous pleural effusions"]. The search led to 64 case reports, and 16 cases with pleural effusion as an initial manifestation were included in this review. We have also searched for recent advances in diagnosis. RESULTS AND CONCLUSIONS Myelomatous pleurisy is a rare complication of MM. Its clinical and laboratory findings are non-specific. Definitive diagnosis relies on the histopathology of pleural biopsy or pleural effusion. Thoracoscopic pleural biopsy is reliable, safe and effective. Chemotherapy is the mainstay of treatment for myelomatous pleural effusion. However, the response rate is low with an overall median survival time of 4 months.
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Affiliation(s)
- Li-Li Zhang
- Department of Respiratory & Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Yuan-Yuan Li
- Department of Respiratory & Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Cheng-Ping Hu
- Department of Respiratory & Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
| | - Hua-Ping Yang
- Department of Respiratory & Critical Care Medicine, Xiangya Hospital, Central South University, Changsha 410008, China
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21
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Suwatanapongched T, Pornsuriyasak P, Kanoksil W, Morasert T, Virayavanich W. A 76-year-old man with anemia, bone pain, and progressive dyspnea. Diagnosis: Bilateral myelomatous pleural effusions with extramedullary plasmacytomas. Chest 2014; 145:913-918. [PMID: 24687713 DOI: 10.1378/chest.13-1662] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Affiliation(s)
- Thitiporn Suwatanapongched
- Division of Diagnostic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand.
| | - Prapaporn Pornsuriyasak
- Department of Diagnostic and Therapeutic Radiology, Division of Pulmonary and Critical Care, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Wasana Kanoksil
- Department of Medicine, and Department of Pathology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Thotsaporn Morasert
- Department of Diagnostic and Therapeutic Radiology, Division of Pulmonary and Critical Care, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
| | - Warapat Virayavanich
- Division of Diagnostic Radiology, Faculty of Medicine, Ramathibodi Hospital, Mahidol University, Bangkok, Thailand
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22
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Gupta R, Hussain N, Rahman K, Nityanand S. Plasma cell myeloma with unusual morphology-A series of 6 cases. Eur J Haematol 2014; 93:165-70. [DOI: 10.1111/ejh.12310] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/07/2014] [Indexed: 11/28/2022]
Affiliation(s)
- Ruchi Gupta
- Department of Hematology; SGPGIMS; Lucknow India
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23
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Tsukamoto A, Yoshiki Y, Yamazaki S, Kumano K, Nakamura F, Kurokawa M. The significance of free light chain measurements in the diagnosis of myelomatous pleural effusion. Ann Hematol 2013; 93:507-8. [PMID: 23797638 DOI: 10.1007/s00277-013-1818-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 06/07/2013] [Indexed: 11/30/2022]
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Cho SY, Jeong JH, Lee WI, Lee J, Hong IK, Suh JT, Lee HJ, Yoon HJ, Park TS. Plasma cell myeloma initially presenting as lung cancer. Ann Lab Med 2013; 33:225-8. [PMID: 23667854 PMCID: PMC3646202 DOI: 10.3343/alm.2013.33.3.225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2012] [Revised: 11/23/2012] [Accepted: 01/24/2013] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sun Young Cho
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jae-Heon Jeong
- Department of Hematology-Oncology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Woo-In Lee
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Juhie Lee
- Department of Pathology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Il Ki Hong
- Department of Nuclear Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Jin-Tae Suh
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hee Joo Lee
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Hwi-Joong Yoon
- Department of Hematology-Oncology, School of Medicine, Kyung Hee University, Seoul, Korea
| | - Tae Sung Park
- Department of Laboratory Medicine, School of Medicine, Kyung Hee University, Seoul, Korea
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