Treatment and outcomes for primary cutaneous extramedullary plasmacytoma: a case series

Dermatologic manifestations of hematologic disorders

Distinguishing key morphologic features and understanding the pathophysiology of common cutaneous manifestations of hematologic disorders is essential to ensure prompt and appropriate treatment. In fact, classic cutaneous signs may provide the first clue to the diagnosis of an underlying hematologic disease. Disorders of coagulation, vascular abnormalities, or cutaneous infiltration and deposition are responsible for the underlying pathophysiology of cutaneous manifestations in the majority of cases. Hematologists often feel ill-equipped in identifying morphologic changes in the skin. Thus, the purpose of this review is to provide a comprehensive overview of classic cutaneous manifestations and diagnostic considerations of the associated hematologic conditions. Though there is a specific focus on non-malignant disorders, those straddling the spectrum of malignancy are also discussed. In many disease states, the skin may serve as an important marker of an emerging hematologic disorder, so close collaboration and multidisciplinary input remain essential to provide optimal and timely care for these patients.

A Rare Case of Unresectable Solitary Extramedullary Plasmacytoma at the Shoulder Region: Case Report

INTRODUCTION: Plasmacytoma is a solitary neoplastic lesion marked by a localized accumulation of monoclonal plasma cells without an evidence of a systemic proliferation. Plasmacytoma may arise in intramedullar (bone) or extramedullar (soft tissue). Extramedullary plasmacytoma is rare, with the most frequent locations in the nasal cavity and nasopharynx. Here, we describe a case of solitary extramedullary plasmacytoma of the shoulder region. CASE REPORT: A 49-year-old male patient presented with right shoulder mass that was solid, fixed, ulcerated, and poorly circumscribed, with size 20 × 15 × 10 cm. Shoulder X-ray and MRI results revealed a soft-tissue mass on the right shoulder with the destruction of lateral part of the right clavicle. Biopsy results suggested Non-Hodgkin Lymphoma; however, first panel of immunohistochemical (IHC) analysis showed negative staining of LCA, CK, CD20, and CD3, with high Ki67. Second panel of IHC revealed negative staining of ALK, TdT, and CD79a; meanwhile, CD138 was strongly expressed. Further hematological, biochemical, and radiological examinations that revealed no systemic involvement supported the diagnosis of solitary extramedullary plasmacytoma. Patient received radiotherapy treatment 60 Gy in 30 fractions and zometa within 4 weeks interval and showed remarkable response of the therapy. DISCUSSION: Solitary extramedullary (soft tissue) plasmacytomas (SEP) are less common than solitary bone plasmacytoma (SBP), yet it has a better prognosis since the majority can be cured by local radiotherapy. CONCLUSION: We report a case of SEP of the shoulder that showed remarkable response of therapy. In this case report, radiotherapy was shown to be a highly effective modality to treat a patient with solitary extramedullary plasmacytoma.

Cutaneous manifestations of monoclonal gammopathy

Monoclonal gammopathy associated with dermatological manifestations are a well-recognized complication. These skin disorders can be associated with infiltration and proliferation of a malignant plasma cells or by a deposition of the monoclonal immunoglobulin in a nonmalignant monoclonal gammopathy. These disorders include POEMS syndrome, light chain amyloidosis, Schnitzler syndrome, scleromyxedema and TEMPI syndrome. This article provides a review of clinical manifestations, diagnostics criteria, natural evolution, pathogenesis, and treatment of these cutaneous manifestations.

IgM Plasma Cells Reside in Healthy Skin and Accumulate with Chronic Inflammation

Antibodies are key to cutaneous host defense and inflammation. Despite their importance, the mechanisms by which skin antibodies are sustained are poorly described. Here, we identified that, in addition to antibody production in lymphoid tissues, plasma cells reside in healthy mouse and human skin. In naïve mice, IgM was the predominant isotype produced in skin. Skin plasma cells developed independently of T cells and microbiota. Importantly, chronic skin inflammation promoted the massive accumulation of IgM-secreting cells, and cutaneous immunization directed both T cell-dependent and -independent antigen-specific IgM-secreting cells into skin. Unlike their counterparts in lymphoid tissues, cutaneous IgM-secreting cells were completely dependent on survival factors such as a proliferation-inducing ligand or B cell-activating factor, which were constitutively expressed and upregulated during inflammation in skin. Our data support a model in which skin plasma cells supply natural and adaptive IgM to the cutaneous environment, thereby supporting homeostatic skin barrier functions and providing defense against pathogen intrusion. Our results are also of potential relevance for manipulation of cutaneous plasma cells in inflammatory skin diseases or cutaneous plasma cell malignancies.

Solitary Plasmacytoma of the Mesentery: A Systematic Clinician's Diagnosis

INTRODUCTION

Plasmacytoma is an uncommon plasma cell neoplasm and its localized form is solitary plasmacytoma of the bone and solitary extramedullary plasmacytoma. Solitary plasmacytoma of the mesentery is extremely rare, reported only in a handful of cases.

CASE PRESENTATION

A 47-year-old man with nonspecific abdominal complains was found to have an ill-defined mass on his mesenteric root. Laparoscopic biopsy and stepwise histopathological examination revealed a mesenteric plasmacytoma, and extensive imaging and laboratory investigations led to the diagnosis of the solitary mesenteric plasmacytoma. The patient underwent definitive radiotherapy and remains under remission one year later.

DISCUSSION

Plasma cell dyscrasias include a variant of proliferative disease, characterized by clonal expansion of bone marrow plasma cells, producing a massive quantity of monoclonal immunoglobulin called paraprotein or M-protein. Solitary extramedullary plasmacytoma accounts for only 3-5% of all plasma cell neoplasms. Meticulous adherence to the established diagnostic criteria helps the clinician to set the correct, yet very unusual and unexpected diagnosis.

Rare Presentation of Primary Extramedullary Plasmacytoma as Lip Lesion

Malignant plasma cell proliferation can be presented as part of disseminated disease of multiple myeloma, as solitary plasmacytoma of bone, or in soft tissue as extramedullary plasmacytoma. Extramedullary plasmacytomas represented approximately 3% of all plasma cell proliferation. Approximately 80% of extramedullary plasmacytomas occur in the head and neck region while the other 4% occur in the skin and to a lesser extent in the lip. In this paper, we report a rare case of primary cutaneous plasmacytoma involving the lip in a 65-year-old male. The patient presented with a nonhealing lower lip sore for the past 3 years. Upon further workup, there was no evidence of multiple myeloma or light chain disease. The patient was treated with radiation therapy and his last follow-up revealed no evidence of multiple myeloma or light chain disease.