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Younis O, Odeh A, Saifi M, Dumaidi Y, Kazlak M. Hidden intruder: Plasmacytoma causing uncontrolled epistaxis in an elderly patient. Radiol Case Rep 2024; 19:2603-2607. [PMID: 38645963 PMCID: PMC11026723 DOI: 10.1016/j.radcr.2024.03.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 03/09/2024] [Accepted: 03/20/2024] [Indexed: 04/23/2024] Open
Abstract
Extramedullary plasmacytoma (EMP) is an uncommon tumor marked by the monoclonal growth of plasma cells without the characteristics of multiple myeloma. EMP represents 3% of all plasma cell tumors. An 89-year-old male patient with hypertension was admitted to our tertiary care hospital with uncontrolled unilateral epistaxis. After a year and a half of recurring epistaxis, the patient's bleeding became more frequent and could no longer be controlled with nasal packing. Angiofibroma was suspected as the initial differential diagnosis, and angiofibroma embolization was performed. The patient experienced difficulty swallowing and slurred speech and was diagnosed with an ischemic stroke. However, antiplatelet and tranexamic acid medications were contraindicated due to bleeding risks. The patient underwent functional endoscopic sinus surgery, and unexpectedly, histology results revealed a plasmacytoma. After surgery, the patient remained stable and was discharged for further management.
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Affiliation(s)
- Omar Younis
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Anas Odeh
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Motaz Saifi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Yazan Dumaidi
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
| | - Mazen Kazlak
- Department of Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine
- Department of Otorhinolaryngology, An-Najah National University Hospital, Nablus, Palestine
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Slama N, Bizid I, Bellalah A, Abdelali M, Laatiri MA. Extramedullary plasmacytoma of the orbit complicating the evolution of multiple myeloma in complete remission. Leuk Res Rep 2024; 21:100460. [PMID: 38707773 PMCID: PMC11066464 DOI: 10.1016/j.lrr.2024.100460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Revised: 04/13/2024] [Accepted: 04/15/2024] [Indexed: 05/07/2024] Open
Abstract
Orbital plasmacytoma is rare and has only been reported in the context of the initial diagnosis of multiple myeloma. Moreover, isolated orbital plasmacytoma without any signs of multiple myeloma is extremely rare. We report the case of a 59-year-old female patient diagnosed with IgA Kappa multiple myeloma. It was stage I ISS (International Staging System) and stage I R-ISS (Revised ISS). According to the Tunisian national protocol, the patient was included in the standard-risk group and was eligible for four cycles of CTD (Cyclophosphamide, Thalidomide, Dexamethasone) followed by autologous stem cell transplantation. Taking into account the partial response after the CTD cycles, the patient has benefited from two VTD cycles (Bortezomib, Thalidomide, Dexamethasone). Thus, complete remission was obtained. The patient refused autologous stem cell transplantation. Therefore, maintenance treatment based on Thalidomide only was started and received over a twelve-month period. Five months after the end of maintenance treatment, she reported frontal headaches that were resistant to symptomatic treatment, with ptosis in the right eye in physical examination. Brain MRI revealed the presence of a right cranio-orbital tissue mass with intra-orbital and extra-axial cerebral components. The mass measured 32/36 mm on axial sections and 47 mm in height. The patient underwent a complete resection of the cranio-orbital mass with cranioplasty. The histopathological examination of the mass with Immunohistochemistry staining confirmed the diagnosis of orbital plasmocytoma. An update of the multiple myeloma assessment did not reveal any biological, cytological or radiological signs in favor of multiple myeloma. Therefore the diagnosis of isolated orbital plasmacytoma without signs of multiple myeloma was made. Post-operative brain MRI showed complete disappearance of the right cranio-orbital tissue lesion. There was only a persistent meningeal enhancement of the dura mater at the surgical site, suggestive of post-operative changes. The patient was then referred for cranio-orbital radiotherapy.
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Affiliation(s)
- Nader Slama
- Hematology Department, Fattouma Bourguiba Hospital of Monastir, Avenue Farhat Hached, Monastir 5000, Tunisia
| | - Inaam Bizid
- Hematology Department, Fattouma Bourguiba Hospital of Monastir, Avenue Farhat Hached, Monastir 5000, Tunisia
| | - Ahlem Bellalah
- Pathology Department, Fattouma Bourguiba Hospital of Monastir, Avenue Farhat Hached, Monastir 5000, Tunisia
| | - Mabrouk Abdelali
- Radiology Department, Fattouma Bourguiba Hospital of Monastir, Avenue Farhat Hached, Monastir 5000, Tunisia
| | - Mohamed Adnene Laatiri
- Hematology Department, Fattouma Bourguiba Hospital of Monastir, Avenue Farhat Hached, Monastir 5000, Tunisia
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Kitamura W, Kobayashi H, Noda M, Iseki A, Sato Y, Maeda Y, Kuyama S. Spontaneous regression of multiple solitary plasmacytoma harboring Epstein-Barr virus: a case report and literature review. Int J Hematol 2024:10.1007/s12185-024-03765-5. [PMID: 38619657 DOI: 10.1007/s12185-024-03765-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/25/2024] [Accepted: 03/26/2024] [Indexed: 04/16/2024]
Abstract
We report a rare case of spontaneous regression (SR) in an elderly untreated patient with multiple solitary plasmacytoma (MSP). Diagnosis of MSP was confirmed through surgical resection of the left nasal cavity mass and subsequent biopsy of the right humerus. The patient was considered ineligible for chemotherapy due to poor performance status. At 3-month post-diagnosis, the patient's condition worsened with deteriorating bone lesions and emergence of a new serum monoclonal protein. However, these clinical findings completely disappeared at 6 months, and positron emission tomography-computed tomography at 1 year confirmed complete metabolic remission. Notably, peripheral blood lymphocyte counts were inversely correlated with tumor progression and remission. Pathological re-evaluation of the initial biopsy specimens revealed programmed cell death protein 1 (PD-1) expression in tumor-infiltrating CD8+ T cells. In addition, tumor cells were infected with Epstein-Barr virus (EBV) but were negative for programmed cell death ligand 1 (PD-L1) expression, which is the most potent immune escape mechanism in tumor cells. While the mechanism underlying SR remains unclear, our findings suggest that host immune response as well as EBV infection may contribute to SR. Further studies are needed to elucidate the clinicopathologic mechanisms of tumor regression in plasma cell neoplasms.
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Affiliation(s)
- Wataru Kitamura
- Department of Hematology, National Hospital Organization Iwakuni Clinical Center, 1-1-1, Atago-Cho, Iwakuni, 740-8510, Japan.
- Department of Hematology, Oncology and Respiratory Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan.
| | - Hiroki Kobayashi
- Department of Hematology, Oncology and Respiratory Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Minori Noda
- Department of Otorhinolaryngology, National Hospital Organization Iwakuni Clinical Center, 1-1-1, Atago-Cho, Iwakuni, 740-8510, Japan
| | - Akiko Iseki
- Department of Pathology, National Hospital Organization Iwakuni Clinical Center, 1-1-1, Atago-Cho, Iwakuni, 740-8510, Japan
| | - Yumi Sato
- Department of Pathology, National Hospital Organization Iwakuni Clinical Center, 1-1-1, Atago-Cho, Iwakuni, 740-8510, Japan
| | - Yoshinobu Maeda
- Department of Hematology, Oncology and Respiratory Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1, Shikata-Cho, Kita-Ku, Okayama, 700-8558, Japan
| | - Shoichi Kuyama
- Department of Respiratory Medicine, National Hospital Organization Iwakuni Clinical Center, 1-1-1, Atago-Cho, Iwakuni, 740-8510, Japan
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Jaafar NA, Hussain FA, Mat Lazim N. Successful Treatment of Extraosseous Plasmacytoma of the Oropharynx with Cervical Lymph Node Involvement. Indian J Otolaryngol Head Neck Surg 2024; 76:1220-1223. [PMID: 38440494 PMCID: PMC10908905 DOI: 10.1007/s12070-023-04228-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 09/07/2023] [Indexed: 03/06/2024] Open
Abstract
Extraosseous plasmacytoma, a rare plasma cell neoplasm, was observed in a 52-year-old male with uncommon presentation in the oropharynx with cervical lymph node involvement. The patient presented with dysphonia and left neck swelling. This case report primarily focuses on the management, resulting in a successful treatment through radiotherapy.
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Affiliation(s)
- Nurul Amilin Jaafar
- Department of Otorhinolaryngology-Head Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan Malaysia
| | - Faezahtul Arbaeyah Hussain
- Department of Pathology, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan Malaysia
| | - Norhafiza Mat Lazim
- Department of Otorhinolaryngology-Head Neck Surgery, School of Medical Sciences, Universiti Sains Malaysia Health Campus, 16150 Kubang Kerian, Kelantan Malaysia
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Ahirwar MK, Nanda S, Parida S, Mishra SS. Radiotherapy in Extramedullary Plasmacytoma of the Tongue with Nodal Involvement: A Case Report with One-Year Follow-Up. Indian J Otolaryngol Head Neck Surg 2024; 76:1143-1146. [PMID: 38440554 PMCID: PMC10908991 DOI: 10.1007/s12070-023-04185-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 08/24/2023] [Indexed: 03/06/2024] Open
Abstract
Tongue extramedullary plasmacytoma (EMP) with regional lymph node metastases is a very rare pathology. Despite being a rare entity, extramedullary plasmacytoma should be considered a differential diagnosis in cases of a mass or ulcer in the tongue. A 60-year-old lady presents with an ulcerative lesion over the right lateral border of the tongue with dimensions 3.5 × 2 cm for one year. Initially, on histopathological examination, a possibility of plasma cell neoplasm was suspected; on further IHC, serum protein electrophoresis, and radiological investigations, a definite diagnosis of solitary EMP of the right lateral border of the tongue with regional nodal metastases was confirmed. The patient received radiotherapy for the primary disease along with the involved neck nodal sites.
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Zhang S, Zhi Z, Yang J, Cao S, Wu N, Kang L, Zhao J. Skeletal muscle extramedullary plasmacytoma transformed into plasmablastic plasmacytoma: a case report. J Cancer Res Clin Oncol 2024; 150:65. [PMID: 38300308 PMCID: PMC10834611 DOI: 10.1007/s00432-023-05604-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Accepted: 12/29/2023] [Indexed: 02/02/2024]
Abstract
BACKGROUND Extramedullary plasmacytoma (EMP) is a rare plasma cell malignancy, especially when the tumor originates in skeletal muscle. Plasmablastic plasmacytoma is an anaplastic round cell tumor with highly malignancy and poor prognosis. To date, there have been no reports on the transformation of skeletal muscle EMP into plasmablastic plasmacytoma. Therefore, the diagnosis, treatment, and prognosis of cases of this pathologic transformation are unclear. CASE PRESENTATION This article reports a case of an elderly male patient who presented with a painless mass in the right calf and was diagnosed with EMP by puncture pathology. Complete remission was obtained after sequential chemoradiotherapy. 6 months later, another puncture was performed due to plasmablastic plasmacytoma multiple distant metastases, and the pathology showed that EMP was transformed to plasmablastic plasmacytoma. Despite aggressive antitumor therapy, the disease continued to deteriorate, and the patient ultimately died of respiratory failure. CONCLUSION The transformation of EMP into plasmablastic plasmacytoma is very rare, and its diagnosis and treatment require the participation of both experienced pathologists and clinicians. We report this case in order to raise clinicians' awareness of the diagnosis and treatment of EMP and its transformation to plasmablastic plasmacytoma, and to avoid misdiagnosis and underdiagnosis.
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Affiliation(s)
- Shuang Zhang
- Department of Oncology, Hebei General Hospital, NO.348 Heping West Road, Xinhua District, Shijiazhuang City, 050051, Hebei Province, People's Republic of China
- Graduate School, Hebei North University, Zhangjiakou, 075000, China
| | - Zheng Zhi
- Department of Basic Medicine, Hebei University of Chinese Medicine, Shijiazhuang, 050200, China
- Department of Hebei Province Chinese Medicine, Shijiazhuang, 050013, China
| | - Jie Yang
- Department of Oncology, Hebei General Hospital, NO.348 Heping West Road, Xinhua District, Shijiazhuang City, 050051, Hebei Province, People's Republic of China
- Department of Hematology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Shumin Cao
- Department of Oncology, Hebei General Hospital, NO.348 Heping West Road, Xinhua District, Shijiazhuang City, 050051, Hebei Province, People's Republic of China
- Graduate School, Hebei Medical University, Shijiazhuang, 050017, China
| | - Nan Wu
- Department of Oncology, Hebei General Hospital, NO.348 Heping West Road, Xinhua District, Shijiazhuang City, 050051, Hebei Province, People's Republic of China
| | - Lin Kang
- Department of Oncology, Hebei General Hospital, NO.348 Heping West Road, Xinhua District, Shijiazhuang City, 050051, Hebei Province, People's Republic of China
- Department of Pathology, Hebei General Hospital, Shijiazhuang, 050051, China
| | - Jing Zhao
- Department of Oncology, Hebei General Hospital, NO.348 Heping West Road, Xinhua District, Shijiazhuang City, 050051, Hebei Province, People's Republic of China.
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Plasma Cell Disease Group, Chinese Society of Hematology, Chinese Medical Association, Chinese Myeloma Committee-Chinese Hematology Association. [Consensus for the diagnosis and management of extramedullary plasmacytoma in China(2024)]. Zhonghua Xue Ye Xue Za Zhi 2024; 45:8-17. [PMID: 38527832 DOI: 10.3760/cma.j.cn121090-20231107-00253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 03/27/2024]
Abstract
Extramedullary plasmacytoma (EMP) is a special type of malignant plasmacytosis, which is complex and heterogeneous. Most EMP patients have poor prognosis and lack a stratified prognostic system or ideal treatment strategy supported by evidence-based medical evidence, which cannot meet clinical needs. In order to improve the understanding of this disease entity, Plasma Cell Disease Group, Chinese Society of Hematology, Chinese Medical Association and Chinese Myeloma Committee-Chinese Hematology Association developed the "Chinese Expert Consensus on the diagnosis and treatment of extramedullary plasmacytoma", which aims to standardize the clinical diagnosis and treatment of EMP and ultimately improve the overall survival of patients with plasmacytoma.
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Dawd D, Kapur S, Kotchetkov R. Isolated Non-Secretory Extramedullary Relapse of Multiple Myeloma Responded Completely to Localized Radiotherapy. Case Rep Oncol 2024; 17:423-429. [PMID: 38444889 PMCID: PMC10914379 DOI: 10.1159/000536675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Accepted: 01/31/2024] [Indexed: 03/07/2024] Open
Abstract
Introduction Non-secretory multiple myeloma (NSMM) is a rare form of multiple myeloma (MM) that is often difficult to detect and has not yet been well characterized. This is due to the lack of production or the presence of monoclonal protein (MP) levels below levels detectable by testing such as serum/urine electrophoresis and immunofixation. Case Presentation Two patients of ours were being treated for MM with typical courses of systemic therapy. By the third-line therapy, both developed an extramedullary mass, one in the pelvis and the other in the neck. In both cases, blood work showed no measurable MP, normal free light chain levels, and unremarkable skeletal surveys. Secondary malignancies were suspected due to the clinical presentation in each case, and biopsies confirmed the presence of non-secretory plasmacytomas. Both patients were only treated with localized radiotherapy with a total dose of 2,000 cGy in 5 fractions over 1 week. Ultimately, this resolved the original masses with no residual tumors. No changes had to be made to their systemic therapies, and both patients remained stable. Conclusion NSMM relapse is not unusual and should be suspected in patients with relapsed refractory disease. Relapse should be confirmed by a tissue biopsy, and secondary malignancies should be ruled out. Radiotherapy is an excellent option to treat localized relapse and preserve the current line of systemic anti-myeloma therapy.
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Affiliation(s)
- Danny Dawd
- Department of Medicine, University of Western Ontario, London, ON, Canada
| | - Shiv Kapur
- Department of Pathology, Royal Victoria Regional Health Centre, Barrie, ON, Canada
| | - Rouslan Kotchetkov
- Department of Oncology, Royal Victoria Regional Health Centre, Barrie, ON, Canada
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Mousavizadeh Ahmadabadi SM, Banar S, Parvas E, Shahbazi N, Biranvand H. Uncommon manifestation of multiple myeloma: A case report of intracardiac plasmacytoma presenting with severe heart failure and bilateral pleural effusion. Int J Surg Case Rep 2024; 114:109187. [PMID: 38160518 PMCID: PMC10800586 DOI: 10.1016/j.ijscr.2023.109187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2023] [Revised: 12/15/2023] [Accepted: 12/18/2023] [Indexed: 01/03/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Extramedullary intracardiac plasmacytoma is a rare type of plasma cell neoplasm that involves the heart. This article presents a case report of a patient with this condition and describes the surgical management of the disease. CASE PRESENTATION The patient was a 65-year-old male with a history of multiple myeloma in remission for two years who presented with shortness of breath and chest pain. Imaging studies revealed a mass in the right atrium of the heart, which was confirmed to be extramedullary intracardiac plasmacytoma on biopsy. The patient underwent surgical resection of the mass. CLINICAL DISCUSSION Extramedullary intracardiac plasmacytoma is a rare condition that can occur in patients with multiple myeloma. Early diagnosis and prompt treatment are crucial for improving the prognosis of affected individuals. Surgical resection may be a viable treatment option for some patients. CONCLUSION This case report highlights the potential risks and complications associated with surgical intervention in patients with extramedullary intracardiac plasmacytoma. Further research is needed to determine the best treatment approach for this rare condition and to improve patient outcomes.
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Affiliation(s)
- Seyed Mohammadali Mousavizadeh Ahmadabadi
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Shahid Rajaei Research & Training Hospital, Next to Mellat Park, Vali-Asr Ave, Tehran Postal code: 1995614331, Iran
| | - Sepideh Banar
- Heart Valve Disease Research Center, Rajaie Cardiovascular Medical and Research Center, Iran University of Medical Sciences, Tehran, Iran; Shahid Rajaei Research & Training Hospital, Next to Mellat Park, Vali-Asr Ave, Tehran Postal code: 1995614331, Iran
| | - Ehsan Parvas
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran
| | - Narges Shahbazi
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran
| | - Hamidreza Biranvand
- Tehran University of Medical Sciences, Tehran Heart Center, North Kargar Ave, Tehran Postal code: 1431715673, Iran.
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van Lanen RH, Huijs SM, Postma AA, Haeren RH. Cerebral tumor with hemi-dural enhancement as unique presentation of multiple myeloma: A case report. Brain Spine 2023; 4:102730. [PMID: 38510597 PMCID: PMC10951707 DOI: 10.1016/j.bas.2023.102730] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Revised: 11/28/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024]
Abstract
Introduction Intracranial multiple myeloma (MM) is a rare manifestation of MM, a malignant plasma cell disorder that primarily affects bone marrow. Dural involvement in MM is even rarer and can manifest as a dural mass. We present a case of MM presenting as an intracranial dural tumor with primary hemi-dural involvement. Research question This case report aims to investigate the clinical presentation, diagnostic challenges, and treatment approaches for intracranial multiple myeloma, with a focus on the extensive hemi-dural thickening and enhancement seen in this case. Material and methods A 73-year-old male presented with progressive dysphasia and weakness. MRI revealed a solid left frontal mass with significant mass-effect. Hemi-dural thickening and enhancement was present along with invasion of the skull. The patient underwent surgical resection of the tumor with dural and bone reconstruction. Results Histopathological examination confirmed MM diagnosis. Chemotherapy was started. Follow-up MRI showed complete tumor resection, but extensive hemi-dural thickening and enhancement persisted. Postoperative radiation therapy was considered. Discussion and conclusion MM with primary dural involvement is rare and poses diagnostic challenges. Postoperative treatment involves chemotherapy, the role of surgery and radiotherapy is not established. The extensive hemi-dural thickening and enhancement observed in this case require further investigation, and a wait-and-scan policy was recommended instead of radiotherapy.
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Affiliation(s)
- Rick H.G.J. van Lanen
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
| | - Sandra M.H. Huijs
- Department of Neurology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Alida A. Postma
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
- Department of Radiology, Maastricht University Medical Centre+, Maastricht, the Netherlands
| | - Roel H.L. Haeren
- Department of Neurosurgery, Maastricht University Medical Centre+, Maastricht, the Netherlands
- School for Mental Health and Neuroscience (MHeNs), Maastricht University, Maastricht, the Netherlands
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Mishra UP, Verma AK, Chaurasia JK. Solitary Extramedullary Plasmacytoma of Nasal Cavity. Indian J Otolaryngol Head Neck Surg 2023; 75:4060-4065. [PMID: 37974764 PMCID: PMC10645697 DOI: 10.1007/s12070-023-04061-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 07/01/2023] [Indexed: 11/19/2023] Open
Abstract
Solitary extramedullary plasmacytoma (SEP) of the nasal cavity is a rare neoplastic condition characterized by the localized proliferation of abnormal plasma cells. We present a case of SEP involving the nasal cavity in a 40-year-old male patient who presented with nasal obstruction and recurrent epistaxis. The diagnosis was confirmed through clinical evaluation, imaging studies, and histopathological examination of excised specimen. The patient underwent trans-nasal endoscopic excision of nasal mass without any adjuvant therapy, which resulted in successful local control. This case report highlights the clinical presentation, diagnostic approach, treatment modalities, and favourable prognosis associated with solitary extramedullary plasmacytoma of the nasal cavity.
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Affiliation(s)
- Utkal Priyadarshi Mishra
- Department of ENT- Head & Neck Surgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, 462020 Madhya Pradesh India
| | - Ashish Kumar Verma
- Department of ENT- Head & Neck Surgery, All India Institute of Medical Sciences, Saket Nagar, Bhopal, 462020 Madhya Pradesh India
| | - Jai Kumar Chaurasia
- Department of Pathology & Lab Medicine, All India Institute of Medical Sciences, Bhopal, 462020 Madhya Pradesh India
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12
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Kamboj V, Shenoy S V, Sriperumbudur S, Parvathareddy N. Solitary Bone Plasmacytoma Mimicking Oral Cavity Neoplasm - A Rare Case. Indian J Otolaryngol Head Neck Surg 2023; 75:2809-2813. [PMID: 38027534 PMCID: PMC10645874 DOI: 10.1007/s12070-023-03875-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 05/07/2023] [Indexed: 12/01/2023] Open
Abstract
Plasmacytomas are localized monoclonal plasma cell lesions with no evidence of systemic involvement which are divided into solitary bone plasmacytoma (SBP) and extra-medullary plasmacytoma (EMP). The diagnosis of plasmacytomas (PCM) in the oral regions is challenging given the atypical clinical manifestations and low frequency. Here, we report an extremely rare case of plasmacytoma in an elderly male which initially appeared to be arising from the left buccal mucosa on clinical examination but after radiological imaging and intra-operative findings, the epicentre was found to be in the left infratemporal fossa (ITF). The patient underwent en-bloc compartment resection with high clearance of the ITF which proved to be an effective management strategy. It is crucial for the head and neck surgeon to be aware of the solitary bone plasmacytoma in the oral and maxillofacial region in order to identify it early and provide these patients with the best care possible before complications arise.
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Affiliation(s)
- Vikrant Kamboj
- Department of Otorhinolaryngology and Head and neck Surgery, Kasturba Medical College, Mangalore Manipal Academy of Higher Education, Manipal, India
| | - Vijendra Shenoy S
- Department of Otorhinolaryngology and Head and neck Surgery, Kasturba Medical College, Mangalore Manipal Academy of Higher Education, Manipal, India
| | - Susmita Sriperumbudur
- Department of Otorhinolaryngology and Head and neck Surgery, Kasturba Medical College, Mangalore Manipal Academy of Higher Education, Manipal, India
| | - Navya Parvathareddy
- Department of Otorhinolaryngology and Head and neck Surgery, Kasturba Medical College, Mangalore Manipal Academy of Higher Education, Manipal, India
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Kapur K, Sharma M, Puj K, Bande V, Pandya S. Solitary endobronchial plasmacytoma-a rare differential of an endobronchial mass. Indian J Thorac Cardiovasc Surg 2023; 39:629-631. [PMID: 37885935 PMCID: PMC10597973 DOI: 10.1007/s12055-023-01557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 05/21/2023] [Accepted: 06/02/2023] [Indexed: 10/28/2023] Open
Abstract
Diagnostic dilemma, owing to the inconclusiveness of biopsy results, often leaves us with limited options to offer to the patients upfront, amongst the various armamentarium available. We hereby report a rare case of extramedullary plasmacytoma, whose diagnosis was established only on the final histopathology report with the aid of immunohistochemistry. A 50-year-old gentleman presented to our outpatient setup with computed tomography suggestive of a well-defined endobronchial mass occupying the left lower lobe bronchus. However, bronchoscopy and computed tomography-guided biopsies were inconclusive. After a routine metastatic workup, the patient underwent a left lower lobectomy following a provisional diagnosis of carcinoid on the frozen section. The final histopathology was solitary endobronchial plasmacytoma. Postoperative myeloma workup was within normal limits and the patient is doing well and disease free at 8 months of follow-up. This rare differential needs to be kept in mind while evaluating a case of well-defined endobronchial growth.
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Affiliation(s)
- Kanika Kapur
- Department of Surgical Oncology, GCRI Hospital, Ahmedabad, India
| | - Mohit Sharma
- Department of Surgical Oncology, GCRI Hospital, Ahmedabad, India
| | - Ketul Puj
- Department of Surgical Oncology, GCRI Hospital, Ahmedabad, India
| | - Vivek Bande
- Department of Surgical Oncology, GCRI Hospital, Ahmedabad, India
| | - Shashank Pandya
- Department of Surgical Oncology, GCRI Hospital, Ahmedabad, India
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14
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Yan X, Zhou Z, Cui J, Jiang X. Strengthen and consolidate: A case of screw augmentation for solitary plasmacytoma of cervical spine. Asian J Surg 2023; 46:5178-5179. [PMID: 37537062 DOI: 10.1016/j.asjsur.2023.07.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 07/07/2023] [Indexed: 08/05/2023] Open
Affiliation(s)
- Xianwei Yan
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Zelin Zhou
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jianchao Cui
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Xiaobing Jiang
- Department of Spinal Surgery, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China.
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15
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Inamdar A, Bhattacharyya S. Hematological entities with plasmacytic differentiation: a case report. J Med Case Rep 2023; 17:429. [PMID: 37749639 PMCID: PMC10521441 DOI: 10.1186/s13256-023-04082-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Accepted: 07/10/2023] [Indexed: 09/27/2023] Open
Abstract
INTRODUCTION Plasmacytoma, a localized tumor of monoclonal plasma cells without any clinical, radiological or physical evidence of plasma cell neoplasm (PCN), is a rare entity that accounts for 1% of PCN. Immunoglobulin M (IgM) extramedullary plasmacytoma of mediastinal region has never been reported and is a diagnostic challenge considering other differential diagnoses. CASE PRESENTATION We present the case of a 51-year-old African-American female with progressively increasing cough, dyspnea, and dysphagia for 6 months with a computed tomography (CT) scan revealing a subcarinal mass. The histopathological analysis of the mass reveals a diagnosis of lymphoma with plasma cell differentiation, with a differential of lymphoplasmacytic lymphoma and plasma cell neoplasm. The lymphoma panel via next-generation sequencing (NGS) and a myeloma-targeted fluorescent in situ hybridization (FISH) panel confirmed the diagnosis of IgM extramedullary plasmacytoma, an entity of rare occurrence. Treatment with radiation led to complete regression of the plasmacytoma with normal blood work-up. CONCLUSIONS This report describes the challenges of diagnosing IgM extramedullary plasmactyoma. Our case report highlights the importance of cytogenetics and NGS in establishing a correct diagnosis that indeed has prognostic and therapeutic implications.
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Affiliation(s)
- Arati Inamdar
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104-4238, USA.
| | - Siddharth Bhattacharyya
- Department of Pathology and Laboratory Medicine, Perelman School of Medicine at the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA, 19104-4238, USA
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16
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Mishra SS, Ahirwar MK, Nanda S. Solitary Extraosseous Plasmacytoma of Submandibular Gland - Report of a Rare Case. Indian J Otolaryngol Head Neck Surg 2023; 75:2306-2308. [PMID: 37636807 PMCID: PMC10447715 DOI: 10.1007/s12070-023-03606-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 02/16/2023] [Indexed: 03/02/2023] Open
Abstract
BACKGROUND Plasmacytomas are tumors involving plasma cells that can be either osseous or extraosseous. Solitary extraosseous plasmacytomas are rarely found in the head and neck region. Various pathological, immuno-histochemistry, and radiological investigations must be done to distinguish it from multiple myeloma. CASE A 41-year-old female presented with a progressively increasing mass in right submandibular region for 1 year. She also had complaints of dysphagia and dyspnea for 3 months. Histopathological examinations showed lymphoplasmacytic infiltrate and possibility of plasma cell neoplasm was suspected. On further investigations like immunohistochemistry, bone marrow biopsy, quantitative immunoglobulin, immunoelectrophoresis, and urine analysis, diagnosis of extraosseous plasmacytoma was made. Positron emission tomography-computed tomography (PET-CT) scan did not show any distant foci of the disease. The patient received definitive radiotherapy to the primary region and tolerated well. The patient is asymptomatic after 1 month of radiotherapy and is on regular follow-up. CONCLUSIONS Extraosseous plasmacytoma of the submandibular region is very rare but radiosensitive tumor. Multiple myeloma must be ruled out prior to start of any treatment. Long term follow ups are required to comment on disease progression, dissemination, or recurrence.
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17
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Lamb MM, Zeatoun A, Stack TJ, Kim S, Albastoni S, Singer B, Klatt-Cromwell C, Senior BA, Kimple AJ, Thorp BD. Plasmacytoma of the Head and Neck: Case Series and Review of the Literature. ORL J Otorhinolaryngol Relat Spec 2023; 85:231-237. [PMID: 37364541 DOI: 10.1159/000530946] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 04/24/2023] [Indexed: 06/28/2023]
Abstract
Solitary plasmacytoma is a rare neoplasm characterized by localized proliferation of monoclonal plasma cells and is classified as solitary bone or solitary extramedullary plasmacytoma. Here, we present two rare cases of plasmacytoma of the head and neck. The first is a 78-year-old male who presented with a 3-month history of epistaxis and progressive obstruction of the right nasal passage. Computerized tomography (CT) imaging revealed a mass in the right nasal cavity with destruction to the maxillary sinus. An excisional biopsy was performed revealing anaplastic plasmacytoma. The second is a 64-year-old male with a past medical history significant for prostate cancer who presented with a 2-month history of left ear pain and progressive non-tender temporal swelling. A PET/CT revealed a highly avid, destructive, and lytic left temporal mass with no other evidence of distant disease. A left temporal craniectomy and infratemporal fossa dissection revealed plasma cell dyscrasia with monoclonal lambda in situ hybridization. Although plasmacytomas are uncommon tumors of the head and neck, they may mimic other entities that require different treatment. Prompt and accurate diagnosis is critical for appropriate therapeutic decisions and prognosis.
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Affiliation(s)
- Meredith M Lamb
- Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina, Chapel Hill, North Carolina, USA,
| | - Abdullah Zeatoun
- Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Taylor J Stack
- Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sulgi Kim
- Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sara Albastoni
- Department of Pathology & Laboratory Medicine at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Bart Singer
- Department of Pathology & Laboratory Medicine at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Cristine Klatt-Cromwell
- Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brent A Senior
- Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Adam J Kimple
- Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina, Chapel Hill, North Carolina, USA
| | - Brian D Thorp
- Department of Otolaryngology/Head and Neck Surgery at the University of North Carolina, Chapel Hill, North Carolina, USA
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18
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Bangolo AI, Fwelo P, Trivedi C, Sagireddy S, Aljanaahi H, Auda A, Mohamed M, Onyeka S, Fisher M, Thapa J, Tabucanon EJ, Georgiev L, Wishart A, Kumari S, Erikson C, Bangura M, Paddy O, Madhukar R, Gomez EL, Rathod J, Naria M, Hajal B, Awadhalla M, Siegel D, Parmar H, Biran N, Vesole DH, Phull P, Weissman S. Interaction between age and gender on survival outcomes in extramedullary multiple myeloma over the past two decades. World J Clin Oncol 2023; 14:179-189. [PMID: 37124133 PMCID: PMC10134202 DOI: 10.5306/wjco.v14.i4.179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 02/20/2023] [Accepted: 03/17/2023] [Indexed: 04/21/2023] Open
Abstract
BACKGROUND Extramedullary multiple myeloma (MM) (EMM) is a rare and aggressive subentity of MM that can be present at diagnosis or develop anytime during the disease course. There is a paucity of data on the clinical characteristics and overall epidemiology of EMM. Furthermore, there is a scarcity of data on how the interaction of age and gender influences the survival of EMM.
AIM To evaluate the clinical characteristics of patients with EMM over the past 2 decades and to identify epidemiologic characteristics that may impact overall prognosis.
METHODS A total of 858 patients diagnosed with EMM, between 2000 and 2017, were ultimately enrolled in our study by retrieving the Surveillance, Epidemiology, and End Results database. We analyzed demographics, clinical characteristics, and overall mortality (OM) as well as cancer-specific mortality (CSM) of EMM. Variables with a P value < 0.1 in the univariate Cox regression were incorporated into the multivariate Cox model to determine the independent prognostic factors, with a hazard ratio (HR) of greater than 1 representing adverse prognostic factors.
RESULTS From a sample of 858 EMM, the male gender (63.25%), age range 60-79 years (51.05%), and non-Hispanic whites (66.78%) were the most represented. Central Nervous System and the vertebral column was the most affected site (33.10%). Crude analysis revealed higher OM in the age group 80+ [HR = 6.951, 95% confidence interval (95%CI): 3.299-14.647, P = 0], Non-Hispanic Black population (HR = 1.339, 95%CI: 1.02-1.759, P = 0.036), Bones not otherwise specified (NOS) (HR = 1.74, 95%CI: 1.043-2.902, P = 0.034), and widowed individuals (HR = 2.107, 95%CI: 1.511-2.938, P = 0). Skin involvement (HR = 0.241, 95%CI: 0.06-0.974, P = 0.046) and a yearly income of $75000+ (HR = 0.259, 95%CI: 0.125-0.538, P = 0) had the lowest OM in the crude analysis. Crude analysis revealed higher CSM in the age group 80+, Non-Hispanic Black, Bones NOS, and widowed. Multivariate cox proportional hazard regression analyses only revealed higher OM in the age group 80+ (HR = 9.792, 95%CI: 4.403-21.774, P = 0) and widowed individuals (HR = 1.609, 95%CI: 1.101-2.35, P = 0.014). Multivariate cox proportional hazard regression analyses of CSM also revealed higher mortality of the same groups. Eyes, mouth, and ENT involvement had the lowest CSM in the multivariate analysis. There was no interaction between age and gender in the adjusted analysis for OM and CSM.
CONCLUSION EMM is a rare entity. To our knowledge, there is a scarcity of data on the clinical characteristics and prognosis factors of patients with extramedullary multiple myeloma. In this retrospective cohort, using a United States-based population, we found that age, marital status, and tumor site were independent prognostic factors. Furthermore, we found that age and gender did not interact to influence the mortality of patients with EMM.
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Affiliation(s)
- Ayrton I Bangolo
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Pierre Fwelo
- Department of Epidemiology, Human Genetics, and Environmental Sciences, UTHealth School of Public Health, Houston, TX 77204, United States
| | - Chinmay Trivedi
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sowmya Sagireddy
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Hamed Aljanaahi
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Auda Auda
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Maryama Mohamed
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Sonia Onyeka
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Miriam Fisher
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Jyoti Thapa
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Erwin J Tabucanon
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Lyuben Georgiev
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Annetta Wishart
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Shilpee Kumari
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Conrad Erikson
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mary Bangura
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Orent Paddy
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Rashmi Madhukar
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Eugenio L Gomez
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Joshua Rathod
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mansi Naria
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Basel Hajal
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - Mohammad Awadhalla
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
| | - David Siegel
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - Harsh Parmar
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - Noa Biran
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - David H Vesole
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - Pooja Phull
- Division of Myeloma, John Theurer Cancer Center, Hackensack, NJ 07601, United States
| | - Simcha Weissman
- Department of Medicine, Palisades Medical Center, North Bergen, NJ 07047, United States
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Duminuco A, Romano A, Sabattini E, Villari L, Del Fabro V, Elia F, Palumbo GA, Di Raimondo F, Conticello C. Multicentric Castleman Disease and Concurrent Hematological Disorders: The Occurrence of Plasmacytoma and the Hypotheses Arising from Literature Review. Acta Haematol 2023; 146:331-337. [PMID: 37068478 DOI: 10.1159/000530601] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2022] [Accepted: 04/03/2023] [Indexed: 04/19/2023]
Abstract
The concomitant presence of Castleman disease (CD) with other hematological pathology is an event described in the literature with increasing frequency, able to modify the diagnostic and curative approach in such patients. Very few studies in the literature describe the association of CD with concomitant neoplastic diseases; the most frequent are Kaposi's sarcomas (especially in HIV and human herpes virus-8-positive patients) and lymphoproliferative disorders, such as lymphomas. Instead, since the association with plasma cell diseases such as multiple myeloma and plasmacytoma is infrequent, there is a lack of literature. This manuscript aimed to revise the literature by describing a rare case of CD and plasmacytoma and attempting to explain the underlying triggering mechanisms.
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Affiliation(s)
- Andrea Duminuco
- Division of Hematology with BMT, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Alessandra Romano
- Division of Hematology with BMT, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
- Department of Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Elena Sabattini
- Haematopathology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Loredana Villari
- Hematopathology Unit, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Vittorio Del Fabro
- Division of Hematology with BMT, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Federica Elia
- Division of Hematology with BMT, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Giuseppe A Palumbo
- Division of Hematology with BMT, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
- Department of Scienze Mediche Chirurgiche e Tecnologie Avanzate "G.F. Ingrassia", University of Catania, Catania, Italy
| | - Francesco Di Raimondo
- Division of Hematology with BMT, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Concetta Conticello
- Division of Hematology with BMT, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
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20
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Zeinali M, Navabi N, Zarei MR, Ranjbar Hassni A. Solitary Plasmacytoma of the Mandible: A Case Report. J Dent (Shiraz) 2023; 24:155-159. [PMID: 37051501 PMCID: PMC10084562 DOI: 10.30476/dentjods.2022.95247.1856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 07/25/2022] [Accepted: 08/16/2022] [Indexed: 04/14/2023]
Abstract
Plasmacytoma is an abnormal proliferation of monoclonal B-cells, and it can occur in several forms including multiple myeloma, solitary plasmacytoma of the bone, and extramedullary plasmacytoma primary. The solitary plasmacytoma of the bone accounts for about 3-10% of all plasma cell neoplasms, and occurs most often in the vertebrae, whereas the solitary plasmacytoma of the mandible is an extremely rare occurrence. This case report presents a 61-year-old woman with various underlying diseases diagnosed with solitary plasmacytoma of the mandible. This case is very well documented with radiographic imagery, clinical, and histopathological findings.
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Affiliation(s)
- Mahdie Zeinali
- Postgraduate, Dept. of Oral Medicine, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Nader Navabi
- Dept. of Oral Medicine, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Mohammad Reza Zarei
- Dept. of Oral Medicine, Kerman Dental School, Kerman University of Medical Sciences, Kerman, Iran
| | - Alireza Ranjbar Hassni
- Student Research Committee, Dental School, Kerman University of Medical Sciences, Kerman, Iran
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21
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Ramírez AS, Gutiérrez SVE, Ascencio LMA, Rodríguez PA, Ortiz OAS, González RF, Heredia JNS. Solitary plasmacytoma of the sacrum treated with microwave ablation in conjunction with high dose of dexamethasone: A case report and review of the literature. Surg Neurol Int 2023; 14:145. [PMID: 37151461 PMCID: PMC10159330 DOI: 10.25259/sni_1127_2022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2022] [Accepted: 04/06/2023] [Indexed: 05/09/2023] Open
Abstract
Background Plasma cell neoplasms are characterized by the neoplastic proliferation of a single clone of plasma cells. Solitary plasmacytomas most often occur in bone, but they can also be found in soft tissues. Case Description A 53-year-old male presented with localized sacral pain and urinary incontinence. His radiographic studies showed a solitary sacral plasmacytoma (i.e., involving the bone). He was successfully managed with high-dose dexamethasone and microwave ablation (MWA). Conclusion Plasmacytomas of bone can be occasionally successfully managed with MWA, adjuvant cytoreduction therapy, and high doses of dexamethasone.
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Affiliation(s)
| | - Sergio Valente Esparza Gutiérrez
- Department of Neurosurgery, Hospital Civil “Dr. Juan I. Menchaca,” Mexico
- Corresponding author: Sergio Valente Esparza Gutiérrez, Department of Neurosurgery, Hospital Civil “Dr. Juan I. Menchaca,” Guadalajara, Mexico.
| | | | | | | | - Rodrigo Fraga González
- Department of Neurosurgery, Hospital Regional Valentin Gomez Farias Instituto de Seguridad y Servicios Sociales de los Trabajadores del Estado (ISSSTE), Zapopan, Mexico
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22
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Souza PKD, Amorim RO, Sousa LS, Batista MD. Dermatological manifestations of hematologic neoplasms. Part I: secondary specific skin lesions. An Bras Dermatol 2023; 98:5-12. [PMID: 36344350 PMCID: PMC9837649 DOI: 10.1016/j.abd.2022.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2021] [Revised: 06/02/2022] [Accepted: 06/03/2022] [Indexed: 11/06/2022] Open
Abstract
Cutaneous manifestations occur during the course of hematologic malignancies and precede, follow, or are late events in relation to the diagnosis. They result from paraneoplastic phenomena, tumor infiltrations, and immunosuppression resulting from the hematologic neoplasia itself or its treatment. The dermatologist must be aware of these conditions, which can help both in the diagnosis of the underlying disease and in the reduction of patient morbidity. This review (part I) addresses skin lesions associated with direct infiltration by systemic hematologic malignancies.
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Affiliation(s)
| | - Rafael Oliveira Amorim
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil,Corresponding author.
| | | | - Mariana Dias Batista
- Department of Dermatology, Universidade Federal de São Paulo, São Paulo, SP, Brazil
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23
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Zhang YH, He YF, Yue H, Zhang YN, Shi L, Jin B, Dong P. Solitary hyoid plasmacytoma with unicentric Castleman disease: A case report and review of literature. World J Clin Cases 2022; 10:13364-13372. [PMID: 36683640 PMCID: PMC9850993 DOI: 10.12998/wjcc.v10.i36.13364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/17/2022] [Accepted: 12/05/2022] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Solitary plasmacytoma and unicentric Castleman disease (UCD) are rare lymphoproliferative disorders characterized by monoclonal plasma cells and a single set of locally enlarged lymph nodes, respectively.
CASE SUMMARY A 48-year-old Han Chinese man presented to our department with a neck mass and progressive foreign body sensation in his throat. 18F-FDG positron emission tomography revealed focally increased radioactivity centered around the hyoid, and computed tomography (CT) revealed osteolytic lesions. Histopathology revealed Castleman-like features and CD138/CD38-positive mature plasma cells. Systemic work-up ruled out the possibility of POEMS syndrome, lymphoma, and multiple myeloma, leading to a final diagnosis of solitary hyoid plasmacytoma with UCD. The patient underwent partial hyoid resection and selective neck dissection, followed by intensity-modulated radiotherapy. 99mTc-MDP single-photon emission computed tomography/CT reevaluation showed neither local recurrence nor distant bone metastasis at the 40-mo follow-up.
CONCLUSION The diagnostic process and differential diagnosis of this rare case provided valuable educational information to clinicians.
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Affiliation(s)
- Yan-Hui Zhang
- Department of Otolaryngology-Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Yi-Feng He
- Department of Radiology, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Hao Yue
- Department of Pathology, Shanghai Cancer Center, Fudan University, Shanghai 200032, China
| | - Yue-Ni Zhang
- NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150028, Heilongjiang Province, China
| | - Lei Shi
- NHC Key Laboratory of Molecular Probes and Targeted Diagnosis and Therapy, The Fourth Affiliated Hospital of Harbin Medical University, Harbin 150028, Heilongjiang Province, China
| | - Bin Jin
- Department of Otolaryngology-Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
| | - Pin Dong
- Department of Otolaryngology-Head and Neck Surgery, Shanghai General Hospital, Shanghai Jiao Tong University, Shanghai 200080, China
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Benbarka SS, Shubert PT, Irusen EM, Allwood BW, Koegelenberg CFN. The utility of chest ultrasound-guided fine-needle biopsy in the diagnosis of plasmacytoma. Afr J Thorac Crit Care Med 2022; 28. [PMID: 36844937 DOI: 10.7196/AJTCCM.2022.v28i4.242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/27/2022] [Indexed: 12/24/2022] Open
Abstract
Background Plasmacytoma is a plasma cell dyscrasia originating from a single clone of plasma cells of B-lymphocyte lineage and produces a monoclonal immunoglobulin. Transthoracic fine-needle aspiration (TTNA) under ultrasound (US) guidance is a well-validated technique for the diagnosis of many neoplasms and has been shown to be safe and cost effective, with diagnostic yields comparable to more invasive techniques. However, the role of TTNA in the diagnosis of thoracic plasmacytoma is not well established. Objectives The aim of this study was to assess the utility of TTNA and cytology in confirming a diagnosis of plasmacytoma. Methods All cases of plasmacytoma diagnosed from January 2006 to December 2017 by the Division of Pulmonology, Tygerberg Hospital, were retrospectively identified. All patients who underwent an US-guided TTNA and of whose clinical records could be retrieved were included in this cohort. The International Myeloma Working Group's definition of a plasmacytoma was used as the gold standard. Results A total of 12 cases of plasmacytoma were identified and 11 patients included (one patient was excluded owing to missing medical records). Six of the 11 patients (mean age 59.5 ± 8.5 years) were male. Radiologically, most had multiple lesions (n=7), most commonly bony (n=6) with vertebral body involvement (n=5) and pleural-based lesions (n=2). Rapid onsite evaluation (ROSE) was performed and documented in 6 of the 11 cases, and a provisional diagnosis of plasmacytoma was suggested in 5 of the 6 patients (83.3%). The final laboratory cytological diagnoses of all 11 cases were compatible with plasmacytoma which was further confirmed via a bone marrow biopsy (n=4) and by serum electrophoresis (n=7). Conclusion US-guided fine-needle aspiration is feasible and is useful to confirm a diagnosis of plasmacytoma. Its minimally invasive nature may be the ideal investigation of choice in suspected cases.
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Abstract
Neck masses can be defined as any abnormal swelling or growth from the level of base of skull to clavicle. They can be benign or malignant so a thorough investigation is necessary to reach to a final diagnosis. Here we report a case series of three unusual neck masses presenting to the Out patient Department of Otorhinolaryngology and Head and Neck Surgery in R. G. Kar Medical College, a tertiary care hospital of Kolkata in a span of 1.5 years. The rarity of the etiology behind the neck masses makes this case series unique.
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Affiliation(s)
- Riya Das
- Dakshinpally, Kalibari Road, Post- Rahara, North 24 Paragnas, Calcutta, 700118 India
| | - Tanmoy Sarkar
- Dakshinpally, Kalibari Road, Post- Rahara, North 24 Paragnas, Calcutta, 700118 India
| | - Sweta Verma
- Dakshinpally, Kalibari Road, Post- Rahara, North 24 Paragnas, Calcutta, 700118 India
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Loap P, Vignon M, Bouscary D, Kirova Y. Pediatric Plasma Cell Neoplasms: A Population-Based Study. Clin Lymphoma Myeloma Leuk 2022; 22:841-846. [PMID: 35941071 DOI: 10.1016/j.clml.2022.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 06/20/2022] [Accepted: 07/06/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Plasma cell neoplasms are exceptionally rare in the pediatric population; the demographic characteristics and the clinical outcomes of plasma cell neoplasms in this population are currently poorly understood. The aim of this study was to provide a comprehensive analysis of pediatric plasma cell neoplasms, based on the United-States Surveillance, Epidemiology, and End Results (SEER) program registries. MATERIALS AND METHODS All pediatric patients (aged less than 20 years) diagnosed with a malignant plasma cell neoplasm were retrieved from the SEER Program database (18 registries), collecting patient records between 2000 and 2018. The plasma cell neoplasm type, sex, age at diagnosis, year of diagnosis, race and origin, primary disease site, follow-up duration, and vital status at the last known contact were retrieved and analyzed. RESULTS The age-adjusted incidence rate of plasma cell neoplasms for 1,000,000 person-years was 0.06 for the pediatric population (compared with 90.6 for the adult population). The types of pediatric plasma cell neoplasms predominantly consisted of plasmacytomas, with 11 solitary extraosseous plasmacytoma (42.3%) and 7 solitary bone plasmacytoma (26.9%), while plasma cell myelomas represented only a minority of the neoplasms (8 patients; 30.8%). Most plasmacytomas were localized in the head and neck region. Hispanic patients represented 50% of the pediatric plasma cell neoplasm cases (but only 11.1% of adult cases, P < .01). Female-to-Male ratio was 1.36. Five-year overall survival rates were 88.2% (95% confidence interval [95% CI]: 74.2%-100%) for pediatric plasmacytoma and 36.5% (95% CI: 12.4%-100%) for pediatric plasma cell myeloma (P = .013). CONCLUSION This first population-based study of pediatric plasma cell neoplasms underlines the rarity of this entity and demonstrates its unique characteristics, including the significant predominance of plasmacytomas, of female patients, and of patients from hispanic origin, and the poor clinical outcomes of pediatric plasma cell myeloma patients.
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Affiliation(s)
- Pierre Loap
- Institut Curie, Department of Radiotherapy, Paris, France.
| | | | | | - Youlia Kirova
- Institut Curie, Department of Radiotherapy, Paris, France
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Ono H, Iwatsu S, Otsuka E, Kato Y. Incidentally Detected Extramedullary Plasmacytoma of the Gallbladder: A Case Report and Literature Review. Intern Med 2022; 62:1145-1149. [PMID: 36104190 PMCID: PMC10183269 DOI: 10.2169/internalmedicine.0035-22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Extramedullary plasmacytoma (EMP) can rarely occur in conjunction with multiple myeloma (MM). EMPs are usually detected in the upper aerodigestive tract (UAD) but can also occur along the digestive tract. However, the involvement of gallbladder is uncommon. Gastrointestinal tract symptoms often lead to the diagnosis of EMP in the gallbladder. An 81-year-old man was referred to our hospital with suspected primary gallbladder carcinoma. He was subsequently operated on, and the pathological findings showed EMP of the gallbladder without MM.
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Affiliation(s)
- Hideki Ono
- Department of Gastroenterology, Oita Prefectural Hospital, Japan
| | - Shinichi Iwatsu
- Department of Gastroenterology, Oita Prefectural Hospital, Japan
| | - Eiichi Otsuka
- Department of Hematology, Oita Prefectural Hospital, Japan
| | - Yuji Kato
- Department of Gastroenterology, Oita Prefectural Hospital, Japan
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Kelley JT, Fuller LD, Lai KK, Yantiss RK, Dzedzik S, Alapat D, Mashayekhi A, Alpert L, Gonzalez RS, Owens SR, Arber DA, Lamps LW. Gastrointestinal, Hepatic and Pancreatobiliary Involvement by Plasma Cell Neoplasms: Clinicopathologic Correlations in a Retrospective Cohort of 116 Cases. Histopathology 2022; 81:742-757. [PMID: 35984728 DOI: 10.1111/his.14778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Revised: 06/23/2022] [Accepted: 08/13/2022] [Indexed: 11/28/2022]
Abstract
AIMS Plasma cell neoplasms (PCNs) may involve the gastrointestinal (GI) tract in two forms: plasmacytoma (PC), an isolated lesion which lacks marrow involvement, and extramedullary myeloma (EMM). However, previous literature on PCNs involving the GI tract, liver and pancreas is limited. We evaluated the clinicopathologic features of the largest series of GI PCNs to date. METHODS AND RESULTS Six institutional archives were searched for GI, liver and pancreas cases involved by PCNs. Medical records were reviewed for clinical and imaging features. Histopathologic features evaluated included involved organ, tumor grade and marrow involvement. Overall, 116 cases from 102 patients were identified. Tumors most presented as incidental findings (29%). The liver was most involved (47%), and masses/polyps (29%) or ulcers (21%) were most common findings. Most cases had high-grade morphology (55%). The majority (74%) of GI PCNs were classified as EMM due to the presence of marrow involvement at some point during the disease course, occurring within a year of marrow diagnosis in 46% of patients. PC was classified in 26% of patients due to the lack of marrow involvement. Most (70%) patients died from disease within 10 years (median 14.1) of diagnosis and more than half (58%) died within 6 months. CONCLUSION PC and EMM involving the GI tract, liver and pancreas have a wide range of clinicopathologic presentations. Tumors may occur virtually anywhere in the GI tract or abdomen and may precede the diagnosis of marrow involvement. Both GI PC and EMM are associated with a poor prognosis.
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Affiliation(s)
- Justin T Kelley
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | | | - Keith K Lai
- Department of Pathology, Cleveland Clinic, Cleveland, OH, USA
| | - Rhonda K Yantiss
- Department of Pathology and Laboratory Medicine, Weill Cornell Medicine, New York, NY, USA
| | - Siarhei Dzedzik
- Department of Pathology and Laboratory Medicine, New York-Presbyterian Hospital, New York, NY, USA
| | - Daisy Alapat
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Azin Mashayekhi
- Department of Pathology, University of Arkansas for Medical Sciences, Little Rock, AR, USA
| | - Lindsay Alpert
- Department of Pathology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Raul S Gonzalez
- Department of Pathology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Scott R Owens
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
| | - Daniel A Arber
- Department of Pathology, University of Chicago School of Medicine, Chicago, IL, USA
| | - Laura W Lamps
- Department of Pathology, University of Michigan, Ann Arbor, MI, USA
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Pasricha S, Diwan H, Bansal D, Jajodia A, Agarwal M, Gupta G, Sharma A, Durga G, Kamboj M, Koyyala VPB, Mehta A. Intrathyroidal Plasmacytoma with Pleomorphic Multilobated Bizarre Cells: A Rare Primary Clinicopathological Presentation Mimicking Anaplastic Carcinoma of Thyroid. Head Neck Pathol 2022; 16:1257-1262. [PMID: 35699904 PMCID: PMC9729440 DOI: 10.1007/s12105-022-01465-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 05/24/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Plasmacytoma involving thyroid gland is infrequent and can present as either primary extramedullary plasmacytoma or secondary to multiple myeloma. METHODS AND RESULTS We present a case of 71 years old male who complained of a huge anterior neck swelling accompanied by dysphagia and dyspnoea. Fine needle aspiration cytology was suggestive of anaplastic carcinoma of thyroid (ATC), however, the subsequent histomorphology supported by immunohistochemistry (IHC) astoundingly favoured the diagnosis of plasmacytoma. Further evaluation revealed the presence of lymphadenopathy and single bone lesion in the present case which was rather suggestive of secondary involvement of thyroid to multiple myeloma. However, the case was unique in view of its presentation as a rapidly enlarging thyroid mass associated with stridor and cytomorphological findings which were of an undifferentiated malignancy favouring ATC. The use of a broad and judicious IHC panel clinched the final diagnosis of plasmacytoma. CONCLUSION The present case emphasizes the diligent use of IHC in such cases given different therapeutic and prognostic implications.
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Affiliation(s)
- Sunil Pasricha
- grid.418913.60000 0004 1767 8280Department of Histopathology and Cytopathology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 110085 India
| | - Himanshi Diwan
- grid.418913.60000 0004 1767 8280Department of Histopathology and Cytopathology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 110085 India
| | - Divya Bansal
- grid.418913.60000 0004 1767 8280Department of Histopathology and Cytopathology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 110085 India
| | - Ankush Jajodia
- grid.416721.70000 0001 0742 7355Department of Radiology, Juravinski Cancer Centre and St. Joseph’s Healthcare Hamilton, Hamilton, Canada
| | - Mudit Agarwal
- grid.418913.60000 0004 1767 8280Department of Head and Neck Oncology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 110085 India
| | - Gurudutt Gupta
- grid.418913.60000 0004 1767 8280Department of Histopathology and Cytopathology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 110085 India
| | - Anila Sharma
- grid.418913.60000 0004 1767 8280Department of Histopathology and Cytopathology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 110085 India
| | - Garima Durga
- grid.418913.60000 0004 1767 8280Department of Histopathology and Cytopathology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 110085 India
| | - Meenakshi Kamboj
- grid.418913.60000 0004 1767 8280Department of Histopathology and Cytopathology, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 110085 India
| | | | - Anurag Mehta
- grid.418913.60000 0004 1767 8280Laboratory Services & Molecular Diagnostics, Rajiv Gandhi Cancer Institute & Research Centre, Delhi, 110085 India
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Dewangan A, Singh S, Singh J, Kumar N, Kumar K. Parotid gland swelling as an initial presentation of Multiple Myeloma: a case report. Cardiovasc Hematol Disord Drug Targets 2022; 22:CHDDT-EPUB-123274. [PMID: 35579156 DOI: 10.2174/1871529x22666220509203157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Revised: 03/05/2022] [Accepted: 03/16/2022] [Indexed: 06/15/2023]
Abstract
INTRODUCTION Parotid swellings are commonly encountered in ENT Clinics, the cause of which could range from neural conditions, endocrine problems, vitamin deficiencies, and sialadenitis, which may even be a manifestation of an underlying systemic disease. Multiple myeloma represents a clonal proliferation of plasma cells and is a condition in which a parotid swelling might be present, although very uncommon. CASE PRESENTATION We report a case of 60-year-old female presented with unilateral parotid swelling, which led to a diagnosis of multiple myeloma based on the investigations. CONCLUSION Various imaging modalities are currently available to assess the extent of the swelling and evaluate the soft tissue and osseous involvement. The clinician must have a rigorous insight into the several clinical manifestations and the sites of involvement of the different conditions to make a proper diagnosis.
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Affiliation(s)
- Ankita Dewangan
- Junior Resident, Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Swati Singh
- Junior Resident, Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Jitendra Singh
- Assistant Professor, Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Nilesh Kumar
- Associate Professor, Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
- Associate Professor, Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
| | - Kailash Kumar
- Professor and Medical Superintendent, Department of General Medicine, Institute of Medical Sciences, Banaras Hindu University, Varanasi, Uttar Pradesh, India
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Chu TH, Jung SH, Kim K, Lee JH, Mun YC, Bang SM, Yoon DH, Lee HS, Min CK, Lee JJ. Relapse with plasmacytoma after upfront autologous stem cell transplantation in multiple myeloma. Ann Hematol 2022. [PMID: 35445844 DOI: 10.1007/s00277-022-04776-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Accepted: 01/25/2022] [Indexed: 11/27/2022]
Abstract
Please present P values consistently.Plasmacytoma has been reported to be associated with a poor prognosis in patients with multiple myeloma (MM). In this study, we evaluated the incidence of relapse with plasmacytoma and survival outcomes after upfront autologous stem cell transplantation (ASCT). This study retrospectively analyzed the data of 303 patients with MM who underwent upfront ASCT between April 2000 and April 2018 at eight institutes in the Republic of Korea. In total, 52 patients (17.1%) had plasmacytoma at MM relapse after upfront ASCT, of whom, 27 had paramedullary plasmacytoma (PMD) and 25 had extramedullary plasmacytoma (EMD). Patients with initial plasmacytoma were more likely to have plasmacytoma at MM relapse than those without initial plasmacytoma (37.1% vs. 11.2%). Over a median follow-up of 66.0 months, patients with plasmacytoma at relapse had significantly inferior overall survival (OS) than those without plasmacytoma (43.9 vs. 100.7 months, P < 0.001), but the OS did not significantly differ between patients with EMD and those with PMD (42.2 vs. 56.6 months, P=0.464). After MM relapse, all patients received salvage therapy, and progression-free survival after relapse was significantly shorter in patients with plasmacytoma than in those without (6.4 vs. 12.4 months, P = 0.007). This study showed that plasmacytoma frequently developed at MM relapse after upfront ASCT in patients with plasmacytoma at the time of diagnosis. Plasmacytoma at relapse was significantly associated with a poor prognosis.
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Raghuram S, Faizal B, Sanjeevan KV, Eapen M, Nair IR, Philip A, Pavithran K. Recurrent extramedullary plasmacytomas without multiple myeloma: A case report with review of the literature. Cancer Treat Res Commun 2022; 31:100550. [PMID: 35358819 DOI: 10.1016/j.ctarc.2022.100550] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2020] [Revised: 12/14/2021] [Accepted: 03/20/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND Extramedullary plasmacytoma (EMP) is an uncommon presentation and usually occurs in conjunction with multiple myeloma (MM). An EMP without developing MM at any point is an extremely rare presentation, and only seven such cases have been reported in the literature to date. PRESENTATION OF CASE We present a case of EMP, who presented with multiple recurrent lesions in rare sites like nasal cavity, testis and skin without the involvement of bone marrow at any point of disease course. He was treated with multiagent chemotherapy (DT-PACE) and continues to be in remission at 29 months post-chemotherapy, which is the longest amongst all the cases reported so far. DISCUSSION AND CONCLUSIONS There are no clearly defined guidelines to treat EMP. Our case had a clinical presentation at very unusual sites and was treated with DT-PACE regimen as against the previous seven reported cases and had the most prolonged period of remission.
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Affiliation(s)
- Saadvik Raghuram
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre P.O.AIMS Ponekkara, Kochi-682041, Kerala, India
| | - Bini Faizal
- Department of Otorhinolaryngology, Amrita Institute of Medical Sciences and Research Centre P.O.AIMS Ponekkara, Kochi-682041, Kerala, India
| | - K V Sanjeevan
- Department of Urology, Amrita Institute of Medical Sciences and Research Centre P.O.AIMS Ponekkara, Kochi-682041, Kerala, India
| | - Malini Eapen
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre P.O.AIMS Ponekkara, Kochi-682041, Kerala, India
| | - Indu R Nair
- Department of Pathology, Amrita Institute of Medical Sciences and Research Centre P.O.AIMS Ponekkara, Kochi-682041, Kerala, India
| | - Arun Philip
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre P.O.AIMS Ponekkara, Kochi-682041, Kerala, India
| | - Keechilat Pavithran
- Department of Medical Oncology, Amrita Institute of Medical Sciences and Research Centre P.O.AIMS Ponekkara, Kochi-682041, Kerala, India.
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Crain MA, Vasilakis GM, Adkins JR, Adelanwa A, Hogg JP, Lakhani DA, Kim C. Primary nodular chest amyloidoma: A case report and review of literature. Radiol Case Rep 2022; 17:631-637. [PMID: 35027986 PMCID: PMC8715137 DOI: 10.1016/j.radcr.2021.11.048] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 11/21/2021] [Indexed: 11/28/2022] Open
Abstract
Primary nodular chest wall amyloidoma, in which a solitary mass of amyloid is deposited in and around the lungs with no evidence of systemic amyloidosis, is extremely rare, most often asymptomatic, and may resemble primary bronchogenic carcinoma. As a result, there are fewer than 100 cases published in the literature and no controlled clinical trials. Primary nodular chest wall amyloidoma is typically diagnosed either as an incidental radiological finding or after very serious and destructive mass growth at which point late-stage respiratory and pain symptoms finally develop, most often in elderly patients. We present imaging studies of a 61-year-old male patient with an unusually massive and destructive chest wall mass, originating in the chest wall, diagnosed as chest wall amyloidoma by histopathology analysis. Our CT, MRI, and PET scan findings are consistent with and contribute to the developing pattern of imaging characteristics seen in other case studies, which can be used to identify amyloidoma before it becomes destructive using non-invasive imaging analyses.
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Affiliation(s)
| | | | | | - Ayodele Adelanwa
- Department of Pathology, West Virginia University, Morgantown, WV
| | - Jeffery P Hogg
- Department of Pathology, West Virginia University, Morgantown, WV
| | | | - Cathy Kim
- Section of Cardiothoracic Imaging, Department of Radiology, West Virginia University, 1 Medical Center Drive Morgantown, WV 26506, USA
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Abstract
18F-Fluorodeoxyglucose (FDG) PET has been used for staging of hematologic malignancies for years. In multiple myeloma, this imaging modality can be used in many different scenarios, including initial staging, evaluation of treatment response, and investigation of residual disease or early relapse. FDG PET-CT has excellent diagnostic performance, similar to other advanced imaging modalities such as whole-body CT and MRI, and it is particularly helpful for the assessment of extramedullary disease. It also offers important prognostic information on survival and risk of relapse, both at baseline and after therapy. This review will cover the main applications, advantages, and limitations of FDG PET-CT in multiple myeloma and related clonal plasma cell proliferative disorders, such as smoldering multiple myeloma and plasmacytoma.
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Affiliation(s)
- Joao R T Vicentini
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA
| | - Miriam A Bredella
- Division of Musculoskeletal Imaging and Intervention, Massachusetts General Hospital and Harvard Medical School, Boston, USA. .,Division of Musculoskeletal Imaging and Intervention, Department of Radiology, Massachusetts General Hospital, 55 Fruit Street - YAW 6, Boston, MA, 02114, USA.
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35
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Nguyen TTH, Eo MY, Sodnom-Ish B, Cho YJ, Kim SM. Solitary plasmacytoma in the maxillary sinus: 10-year follow-up. J Korean Assoc Oral Maxillofac Surg 2021; 47:471-475. [PMID: 34969021 PMCID: PMC8721414 DOI: 10.5125/jkaoms.2021.47.6.471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Revised: 10/29/2019] [Accepted: 11/06/2019] [Indexed: 11/20/2022] Open
Abstract
Solitary plasmacytoma (SP) is an uncommon form of plasma cell neoplasm occurring intraosseously or in soft tissue and presents as a single mass of monoclonal plasma cells. SP in the maxillary sinus is rare and can be misdiagnosed as other maxillary sinus tumors. The essential examinations in patients with the initial diagnosis of plasmacytoma are bone marrow biopsy, serum and urine electrophoresis, and kappa/lambda ratio (κ:λ ratio) to rule out multiple myeloma (MM). Herein, a rare case of SP in the maxillary sinus treated by surgery and localized radiation is reported. At the 10-year follow-up examination, local recurrence or disseminated development of MM were not evident.
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Affiliation(s)
- Truc Thi Hoang Nguyen
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Mi Young Eo
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Buyanbileg Sodnom-Ish
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Yun Ju Cho
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
| | - Soung Min Kim
- Department of Oral and Maxillofacial Surgery, Dental Research Institute, School of Dentistry, Seoul National University, Seoul, Korea
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Lee DH, Kim JH, Jang WY, Jung S, Lim SC. Sellar plasmacytoma with massive bleeding during surgery. Cancer Treat Res Commun 2021; 30:100499. [PMID: 34922217 DOI: 10.1016/j.ctarc.2021.100499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 12/04/2021] [Accepted: 12/09/2021] [Indexed: 06/14/2023]
Abstract
Plasmacytoma in the sellar region is an extremely rare occurrence. Sellar plasmacytoma is often difficult to differentiate from pituitary tumors both clinically and radiologically. The occurrence of cranial nerve palsy, the preservation of pituitary hormone function, the presence of sellar floor destruction, and better contrast enhancement are regarded as the differentiating factors between sellar plasmacytoma and pituitary tumors. We recommend adding the massive bleeding properties of sellar plasmacytoma as another characteristic which differentiates it from a pituitary tumor.
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Affiliation(s)
- Dong Hoon Lee
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Jo Heon Kim
- Pathology, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Woo Youl Jang
- Neurosurgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Shin Jung
- Neurosurgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea
| | - Sang Chul Lim
- Department of Otolaryngology-Head and Neck Surgery, Chonnam National University Medical School & Hwasun Hospital, Hwasun, South Korea.
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Abstract
Plasma cell neoplasms are a group of diseases involving the malignant proliferation of plasma cells. One common type of plasma cell neoplasm is multiple myeloma, which typically occurs diffusely in the bone marrow. It can manifest with a variety of presentations, including bone pain, fractures, anemia, infection, hypercalcemia, and renal failure. A less common type of plasma cell neoplasm is the solitary plasmacytoma, which is a local proliferation of plasma cells in the bone or extramedullary tissues. They rarely recur after local radiation therapy.An 83-year-old woman was noted on routine labwork to have elevated total serum protein, and serum immunofixation confirmed IgG/Kappa paraprotein. There was no evidence of end-organ damage characteristic of myeloma: hypercalcemia, renal dysfunction, anemia, or bone lesions. She was diagnosed with monoclonal gammopathy of undetermined significance and placed on observation. Seven years later, she developed mild anemia and an increasing M spike. No abnormalities were found on bone marrow biopsy apart from mildly increased plasma cell proliferation (7-10% of total cells). A PET scan showed increased gastric uptake, concerning for possible gastric malignancy. Upper gastrointestinal endoscopic ultrasound revealed extrinsic compression of the stomach fundus and body due to a 40 mm mass and associated adenopathy. Pathology revealed a kappa-restricted plasma cell neoplasm positive for CD138.The patient underwent radiation therapy localized to the gastric area. Subsequent evaluation revealed a persistent gastric mass. Attempted biopsy resulted in a gastrointestinal bleed, rendering her unable to undergo treatment with lenalidomide and aspirin. She is currently undergoing chemotherapy with bortezomib, cyclophosphamide, and dexamethasone. The case illustrates the potential diversity of plasma cell dyscrasia clinical manifestations. Gastric plasmacytomas are an uncommon type of extramedullary plasmacytoma, particularly rare when resistant to radiation therapy.
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Affiliation(s)
- Chloe Weidenbaum
- Department of Internal Medicine, University of Tennessee Health Science Center Nashville, Nashville, TN, USA
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Perret C, Bertani R, Barbosa MM, Batista S, Koester SW, Maria PS, Schiavini H. Hemorrhage due to attempted excision of a frontal exophytic lesion: A cautionary tale. Surg Neurol Int 2021; 12:512. [PMID: 34754562 PMCID: PMC8571271 DOI: 10.25259/sni_601_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/08/2021] [Indexed: 11/27/2022] Open
Abstract
Background: Despite mainly benign, exophytic subcutaneous cranial masses present with a myriad of differential diagnosis possibilities, ranging from simple, superficial lesions to complex lesions involving the central nervous system. Although the gold standard imaging modality for the diagnosis of these lesions is magnetic resonance imaging, Doppler Ultrasonography can be a useful, inexpensive, and available tool for evaluation of lesions that could potentially be safely treated in the primary care setting, and lesions that would demand advanced neurosurgical care. Case Description: This patient presented with a complex exophytic plasmocytoma that was first diagnosed and erroneously approached as a subcutaneous lipoma with surgical resection in an outpatient surgical setting. This interpretive approach resulted in the failure of the procedure due to significant hemorrhage. The patient was immediately referred to neurosurgical care and transferred to our center. Admission doppler ultrasound imaging revealed absence of the frontal bone, the enriched and profuse vascularization, allowing further and proper diagnostic approach and treatment. Conclusion: Ultrasound could be a reliable, fast, and simple imaging method aiding practitioners to perform a better workup for patients with exophytic subcutaneous cranial masses.
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Affiliation(s)
- Caio Perret
- Department of Neurological Surgery, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, Brazil
| | - Raphael Bertani
- Department of Neurological Surgery, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, Brazil
| | - Mauricio Mendes Barbosa
- Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, Rio de Janeiro, Brazil
| | - Savio Batista
- Department of Internal Medicine, School of Medicine, Federal University of Rio de Janeiro, R. Prof. Rodolpho Paulo Rocco, Rio de Janeiro, Brazil
| | - Stefan W Koester
- Department of Neurological Surgery, Vanderbilt University School of Medicine, Nashville, Tennessee, United States
| | - Paulo Santa Maria
- Department of Neurological Surgery, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, Brazil
| | - Hugo Schiavini
- Department of Neurological Surgery, Hospital Municipal Miguel Couto, Rua Mario Ribeiro, Brazil
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Choi CW, Park YK, Shin HK, Lim JW, Her K. Sternal Resection and Reconstruction for Solitary Plasmacytoma of the Sternum: Case Report. J Chest Surg 2021; 54:400-403. [PMID: 33234766 PMCID: PMC8548202 DOI: 10.5090/jcs.20.103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2020] [Revised: 09/24/2020] [Accepted: 10/05/2020] [Indexed: 11/21/2022] Open
Abstract
A 63-year-old patient was admitted with a sternal fracture and mass. On evaluation, most of the body of the sternum had been destroyed by a tumor. Radical resection of the sternum was performed and part of the major pectoral muscles adherent to the sternal tumor was also resected. The chest wall defect was reconstructed with mesh, bone cement, and a titanium rib plate system. Reconstruction with this method seemed to be an appropriate procedure to prevent instability of the chest wall.
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Affiliation(s)
- Chang Woo Choi
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - You Kyeong Park
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Hwa Kyun Shin
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Jae Woong Lim
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
| | - Keun Her
- Department of Thoracic and Cardiovascular Surgery, Soonchunhyang University Bucheon Hospital, Bucheon, Korea
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Kulkarni S, Shroff JA, Meghana SM, Godge P, Yadav M, Naik CS. Solitary plasmacytoma of mandible: an unusual bilateral presentation. Autops Case Rep 2021; 11:e2021298. [PMID: 34458168 PMCID: PMC8387062 DOI: 10.4322/acr.2021.298] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 03/01/2021] [Indexed: 11/23/2022] Open
Abstract
Plasmacytoma is a neoplastic proliferation of monoclonal plasma cells, which can present clinically as solitary bone neoplasm, extramedullary plasmacytoma, and multiple myeloma. The biological behavior of these tumors is variable from periods of clinical latency to rapid growth and progression from localized forms to more disseminated multiple myeloma. We present the case of solitary plasmacytoma of the mandible with rare bilateral involvement in a 65-year-old female patient. This paper highlights the importance of understanding the maxillofacial manifestations of the disease by the dentist for early diagnosis and thus better prognosis.
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Affiliation(s)
- Sandip Kulkarni
- Terna Dental College and Hospital, Department of Oral Pathology and Microbiology, Navi Mumbai, Maharashtra, India
| | - Jashika Adil Shroff
- Terna Dental College and Hospital, Department of Oral Pathology and Microbiology, Navi Mumbai, Maharashtra, India
| | - S M Meghana
- Terna Dental College and Hospital, Department of Oral Pathology and Microbiology, Navi Mumbai, Maharashtra, India
| | - Pournima Godge
- Terna Dental College and Hospital, Department of Oral Pathology and Microbiology, Navi Mumbai, Maharashtra, India
| | - Monica Yadav
- Terna Dental College and Hospital, Department of Oral Pathology and Microbiology, Navi Mumbai, Maharashtra, India
| | - Charudatta Shridhar Naik
- Terna Dental College and Hospital, Department of Oral and Maxillofacial Surgery, Navi Mumbai, Maharashtra, India
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Axenhus M, Bogdanovic N. Confusion, cognitive impairment, and spinal cord compression caused by plasmacytoma: a case report. BMC Neurol 2021; 21:303. [PMID: 34362322 PMCID: PMC8342271 DOI: 10.1186/s12883-021-02332-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Accepted: 06/29/2021] [Indexed: 11/25/2022] Open
Abstract
Background Plasmacytomas are rare tumors comprised of neoplastic monoclonal plasma cells and can be found anywhere in the body. Plasmacytomas that involve the nervous system can give rise to diffuse symptoms depending on their location. Patients with confusion or dementia might be difficult to neurologically assess in an acute setting and the subtle symptoms of neurological pathology caused by rare malignancies might go undiagnosed. Case presentation The patient is an 80 year old man presenting to the ER with walking difficulties, pain, and confusion. He underwent neurological evaluation for dementia and was eventually diagnosed with possible Alzheimer’s disease and a malignant plasmacytoma causing spinal cord compression. His CSF sample showed normal amyloid rate and very low Aβ. Following rehabilitation and oncological treatment, his walking ability and confusion improved. Conclusion This case is unique as we demonstrate that spinal cord compression by plasmacytoma can lead to abnormal CSF levels of several known pathology markers for Alzheimer’s disease and neuronal damage. We suggest that highly divergent amyloid CSF levels could be indicative of spinal pathologies affecting CSF circulation. We also suggest closer assessment of elderly confusion patients in ER settings by consultants specialized in neurological disorders.
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Affiliation(s)
- Michael Axenhus
- Department of Neurobiology, Care Sciences and Society, Section of Neurogeriatrics, Center for Alzheimer Research, Karolinska Institute, Solna, Sweden. .,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden.
| | - Nenad Bogdanovic
- Department of Neurobiology, Care Sciences and Society, Division of Clinical Geriatrics, Karolinska Institute, Solna, Sweden.,Theme Inflammation and Aging, Karolinska University Hospital, Huddinge, Sweden
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Mauro GP, Neffá PP, Villar RC, Martinez GA, de Andrade Carvalho H. Safety and Feasibility Analysis of a Prospective Trial on Stereotactic Body Radiotherapy for Solitary Bone Plasmacytoma. Acta Haematol 2021; 144:627-632. [PMID: 34247172 DOI: 10.1159/000516570] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/15/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND There have been reports on the use of hypofractionated stereotactic body radiotherapy (SBRT) for bone plasmacytomas, but no prospective data are available. We present the initial analysis of an ongoing prospective protocol on SBRT addressing the feasibility and safety of this treatment for solitary bone plasmacytomas. PATIENTS AND METHODS A prospective cohort of SBRT for solitary bone plasmacytoma was developed. Patients could receive different doses depending on the index bone, from single fraction for skull base lesions, 24 Gy in 3 fractions for spine lesions, and 30 Gy in 5 fractions for other bones. Overall survival, bone events, local control, and progression to multiple myeloma (MM) were measured and compared to our retrospective cohort of patients treated with conformal standard-dose radiotherapy. Quality of life was assessed via the EORTC QLQ-C30 questionnaire, and toxicities were assessed by the CTCAE v5.0 criteria. After 1 year or the inclusion of 5-10 patients, a feasibility and safety analysis was programmed. RESULTS Between April 2018 and April 2019, 5 patients were included. All were male, with a median age of 53.1 years. The median follow-up was 21.8 months. No patient had local progression, bone event, or died. Two patients had progressions to MM. The mean survival free of progression to MM was 18.6 months, compared to 19 months in the retrospective cohort; median values were not reached. There were no grade 3 toxicities. CONCLUSION SBRT for plasmacytoma is safe and feasible. More robust data are awaited.
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Affiliation(s)
- Geovanne Pedro Mauro
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- School of Medicine, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil
| | - Pedro Pereira Neffá
- Department of Internal Medicine, Discipline of Hematology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Rosangela Correa Villar
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Radiotherapy Department of Boldrini Childrens Center, São Paulo, Brazil
| | - Gracia Aparecida Martinez
- Department of Internal Medicine, Discipline of Hematology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
| | - Heloísa de Andrade Carvalho
- Department of Radiology and Oncology, Faculdade de Medicina FMUSP, Universidade de Sao Paulo, São Paulo, Brazil
- Hospital Sírio-Libanês, São Paulo, Brazil
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Hwang H, Lee SK, Kim JY. Comparison of conventional magnetic resonance imaging and diffusion-weighted imaging in the differentiation of bone plasmacytoma from bone metastasis in the extremities. Diagn Interv Imaging 2021; 102:611-618. [PMID: 34127433 DOI: 10.1016/j.diii.2021.05.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2021] [Revised: 05/19/2021] [Accepted: 05/22/2021] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare conventional magnetic resonance imaging (MRI) and diffusion-weighted imaging (DWI) in the differentiation of bone plasmacytoma from bone metastasis in the extremities. MATERIALS AND METHODS A total of 65 patients with 27 bone plasmacytomas (11 men; mean age, 63.6±8.2 [SD] years) and 38 patients with bone metastases (20 men; mean age, 64.1±11.5 [SD] years) were retrospectively included. Plasmacytomas and metastases were compared for size, peritumoral edema, signal intensity (SI), SI pattern, apparent diffusion coefficient (ADC) values and standard deviation (SD) of ADC. Receiver operating characteristic analysis with area under the curve (AUC) was used to calculate sensitivity, specificity, and accuracy of MRI and DWI for the diagnosis of plasmacytoma according to a defined cut-off value. RESULTS On conventional MRI, plasmacytomas showed less peritumoral edema (22% vs. 71%; P<0.001), were more often hyperintense on T1-weighted image (48% vs. 18%; P=0.022) and more homogeneous on T2-weighted image (78% vs. 26%; P<0.001) and contrast-enhanced T1-weighted images (70% vs. 25%; P=0.001) than bone metastases. Mean ADC value and SD of ADC were significantly lower in bone plasmacytomas (760.1±196.9 [SD] μm2/s and 161.5±62.7 [SD], respectively) than in bone metastases (1214.2±382.6 [SD] μm2/s and 277.0±110.3 [SD], respectively) (P<0.001). Using an ADC value≤908.3μm2/s, DWI yielded 88% sensitivity and 78% specificity for the diagnosis of plasmacytoma. ADC value yielded best area under the curve (AUC=0.913), followed by SD of ADC (AUC=0.814) and homogeneity on T2-weighted images (AUC=0.757). The combination of conventional MRI and DWI (AUC=0.894) showed improved diagnostic performance over conventional MRI alone (AUC= 0.843) for discriminating between plasmacytoma and metastasis. CONCLUSION Conventional MRI in combination with DWI can be useful to discriminate between bone plasmacytoma and bone metastasis in the extremities.
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Affiliation(s)
- Hyejung Hwang
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
| | - Seul Ki Lee
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea.
| | - Jee-Young Kim
- Department of Radiology, St. Vincent's Hospital, College of Medicine, The Catholic University of Korea, 06591 Seoul, Republic of Korea
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Ma Y, Cui S, Yin YJ. Infiltrating ductal breast carcinoma with monoclonal gammopathy of undetermined significance: A case report. World J Clin Cases 2021; 9:3675-3679. [PMID: 34046469 PMCID: PMC8130065 DOI: 10.12998/wjcc.v9.i15.3675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Revised: 03/03/2021] [Accepted: 03/23/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Infiltrating ductal breast carcinoma with monoclonal gammopathy of undetermined significance (MGUS) is rare and easily misdiagnosed. Most patients are first diagnosed with MGUS. We report a rare case of MGUS secondary to infiltrating ductal breast carcinoma. We also review the literature to analyze the clinical characteristics and diagnostic methods.
CASE SUMMARY A 51-year-old woman underwent modified radical mastectomy for infiltrating ductal carcinoma of the right breast and was then treated with radiation and chemotherapy. A decreased platelet count was found on routine blood examination, and MGUS was subsequently diagnosed. This is the first report of the occurrence of MGUS after breast cancer surgery.
CONCLUSION Vigilance is required to distinguish this rare comorbidity from breast plasmacytoma.
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Affiliation(s)
- Yi Ma
- Department of Hematology, Qinghai University Affiliated Hospital, Xining 810000, Qinghai Province, China
| | - Sen Cui
- Department of Hematology, Qinghai University Affiliated Hospital, Xining 810000, Qinghai Province, China
| | - Yu-Juan Yin
- Department of Hematology, Qinghai University Affiliated Hospital, Xining 810000, Qinghai Province, China
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Martí A, Morón S, Chinchilla S, González E. PET/CT F18-FDG with soft tissue plasmacytomas in multiple myeloma. Eur J Hybrid Imaging 2021; 5:6. [PMID: 34181151 PMCID: PMC8218103 DOI: 10.1186/s41824-021-00100-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 03/21/2021] [Indexed: 11/10/2022] Open
Abstract
Multiple myeloma is characterized by malignant proliferation of clonal plasma cells. Usually, appears as a generalized disease but it can present as solitary bone plasmacytoma or a solitary soft tissue mass or extramedullary plasmacytoma. In the case of extramedullary involvement, it could present as soft tissue plasmacytomas and the prognosis is poor. The 18F-FDG PET/CT could be a valuable tool for characterization of the medullary and extramedullary involvement. We present a case of F18-FDG PET/CT with extramedullary involvement with soft tissue plasmacytomas in the setting of MM.
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Affiliation(s)
- Alejandro Martí
- Department of Nuclear Medicine and PET/CT, National Cancer Institute and PET/CT Idime, Bogotá, Colombia
| | | | - Sandra Chinchilla
- Department of Pathology, National Cancer Institute, Bogotá, Colombia
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46
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Cho R, Myers DT, Onwubiko IN, Williams TR. Extraosseous multiple myeloma: imaging spectrum in the abdomen and pelvis. Abdom Radiol (NY) 2021; 46:1194-1209. [PMID: 32870348 DOI: 10.1007/s00261-020-02712-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/29/2020] [Accepted: 08/18/2020] [Indexed: 10/23/2022]
Abstract
Multiple myeloma represents a subset of plasma cell dyscrasias characterized by the proliferation of plasma cells typically in the bone marrow, representing approximately 1% of all cancers and 15% of hematologic malignancies. Often multiple myeloma is limited to the skeletal system; however, a small percentage (<5%) of patients will develop extraosseous manifestations. We review the current WHO classification of plasma cell dyscrasias and use multimodality imaging including US, CT, MRI, and PET-CT to illustrate the spectrum of extraosseous multiple myeloma in the abdomen and pelvis. Because extraosseous multiple myeloma is associated with a poorer prognosis and decreased survival, it is important for the radiologist to become familiar with a variety of extraosseous manifestations in the abdomen and pelvis, especially in a patient with a known diagnosis of multiple myeloma and the development of an abdominal or pelvic mass.
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Ailawadhi S, Frank R, Ailawadhi M, Kanji Z, Jani P, Fiala M, Abdulazeez M, Ahmed S, Aggarwal CS, Aulakh S, Hodge D, Roy V, Alegria VR, Paulus A, Chanan-Khan A, Sher T. Utilization of radiation therapy in multiple myeloma: trends and changes in practice. Ann Hematol 2021; 100:735-741. [PMID: 33438047 DOI: 10.1007/s00277-020-04371-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 12/06/2020] [Indexed: 10/22/2022]
Abstract
Plasma cell disorders including plasmacytomas and multiple myeloma (MM) are exquisitely radiosensitive, and thus, radiation therapy (XRT) is used effectively in their management. The role of XRT in the setting of novel MM therapeutics has not been explored. The 2016 National Cancer Database (NCDB) for MM with patients diagnosed between 2004 and 2013 was studied. Association between utilization of XRT as part of initial therapy and patient, disease, or treating facility characteristics was studied. A total of 111,281 cases with 91.6% MM, 7% osseous plasmacytoma (PLA-O), and 1.4% extramedullary plasmacytoma (PLA-E) were identified. XRT was utilized as part of initial therapy in 25.4% cases, including 69.3% of PLA-O, 60% of PLA-E, and 21.5% of MM patients. Patients with PLA-E and MM were significantly less likely to receive XRT as compared to PLA-O (p < 0.001). A significantly decreased use of XRT was noted over time (p < 0.001), and for advancing patient age (p < 0.001), women (p < 0.001), and blacks (p < 0.001), and with increasing income (p = 0.015). Patients with Medicare were less likely to receive XRT (OR 0.86, 95% CI 0.78, 0.94) as compared to uninsured as were those with initial treatment at academic or high-volume facilities and facilities performing stem cell transplant. There was overall decreased utilization of XRT in recent years, possibly due to advent of efficacious systemic agents for MM therapy, with a higher XRT utilization for plasmacytomas. Patterns of XRT use need to be explored prospectively, so that uniform standards of healthcare delivery can be maintained and treatment heterogeneity can be minimized.
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Affiliation(s)
- Sikander Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA. .,Division of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA.
| | - Ryan Frank
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Meghna Ailawadhi
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Zahara Kanji
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Prachi Jani
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Mark Fiala
- Division of Oncology, Washington University School of Medicine, St. Louis, MO, USA
| | - Mays Abdulazeez
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Salman Ahmed
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | | | - Sonikpreet Aulakh
- Department of Hematology-Oncology, West Virginia Cancer Institute, Morgantown, WV, USA
| | - David Hodge
- Department of Health Science Research, Mayo Clinic, Jacksonville, FL, USA
| | - Vivek Roy
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Victoria R Alegria
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Aneel Paulus
- Division of Cancer Biology, Mayo Clinic, Jacksonville, FL, USA
| | - Asher Chanan-Khan
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.,Hematology-Oncology, St. Vincent's Cancer Center, Jacksonville, FL, USA
| | - Taimur Sher
- Division of Hematology-Oncology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
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Mani AM, Devasia AJ, Nair A, Benjamin RN, Prabhakar AT, Sivadasan A, Mathew V, Aaron S, George B, Alexander M. Monoclonal Gammopathies of 'Neurological Significance': Paraproteinemic Neuropathies. Can J Neurol Sci 2021; 48:616-25. [PMID: 33397535 DOI: 10.1017/cjn.2020.278] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES To study the clinical profile and outcomes of patients with paraproteinemic neuropathy (PPN) and to explore the utility of nerve conduction studies (NCSs) to differentiate between the demyelinating subtypes. METHODS We did a retrospective analysis of patients diagnosed with PPN between January 2010 and December 2019 in an inpatient setting. The study population consisted of patients above 16 years of age presenting with clinical features suggestive of chronic peripheral neuropathy and on evaluation was found to have PPN. RESULTS A total of 74 patients were identified. The patients were predominantly in the 6th decade, and the majority were males. The subtypes of PPN were monoclonal gammopathy of undetermined significance (MGUS) (45.9%), POEMS syndrome (polyneuropathy, organomegaly, endocrinopathy, monoclonal plasma cell disorder, and skin changes) (24.3%), solitary plasmacytoma (17.6%), multiple myeloma (8.1%), and AL amyloidosis (4.1%). There are specific features on NCS which can help in identifying POEMS syndrome and IgM MGUS. The majority of patients with PPN tend to stabilize or improve with treatment; however, many have a severe residual disability. New terminology and classification of these entities as 'monoclonal gammopathies of neurological significance' can aid in early diagnosis and the development of effective treatment, to prevent residual disability. CONCLUSION PPN has a heterogeneous spectrum of clinical, biochemical, and electrophysiological features. NCS can help distinguish POEMS syndrome and IgM MGUS from other demyelinating subtypes.
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Abstract
OBJECTIVES Plasma cell myeloma (PCM) involving skin is rare and occurs in 1% to 4% of patients with PCM. We evaluated the clinicopathologic features, cytogenetic findings and clinical follow-up in a series of PCM cases with cutaneous involvement. METHODS Cases of PCM with cutaneous involvement were retrospectively reviewed with clinical data. RESULTS Skin involvement in PCM occurred in older individuals (mean, 75 years) and was more frequent in men (7/10 patients). All cases showed bone marrow involvement preceding the cutaneous lesions. Histopathologically, the infiltrate was plasmacytic (n = 5) or primitive or plasmablastic (n = 4), and 1 case showed predominantly lymphoplasmacytic features with cyclin D1 immunoreactivity and CCND1 gene rearrangement. Concurrent amyloid deposition was seen in one biopsy, and another case demonstrated coexisting squamous cell carcinoma. The most common immunophenotype was CD138+, CD20-, and CD56+ with light chain restriction. Cytogenetic analysis (available for 7 cases) showed multiple hyperdiploid abnormalities. Follow-up was available for 8 cases (mean, 42 months; range, 11-156 months) and showed short-term disease-related death in 7 of 8 patients. CONCLUSIONS Cutaneous involvement in PCM demonstrates a diverse cytomorphologic spectrum with plasmacytic, plasmablastic, or lymphoplasmacytic features and may show concurrent amyloid deposition or neoplasms such as squamous cell carcinoma. Cutaneous involvement typically occurs late in the course of the disease and likely portends poor outcome.
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Affiliation(s)
- Gauri Panse
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Antonio Subtil
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Jennifer M McNiff
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Earl J Glusac
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Christine J Ko
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Anjela Galan
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Peggy Myung
- Department of Dermatology, Yale School of Medicine, New Haven, CT
- Department of Pathology, Yale School of Medicine, New Haven, CT
| | - Mina L Xu
- Department of Pathology, Yale School of Medicine, New Haven, CT
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Vong S, Navarro SM, Darrow M, Aminololama-Shakeri S. Extramedullary Plasmacytoma of the breast in a patient with Multiple Myeloma. J Radiol Case Rep 2020; 14:14-23. [PMID: 33717400 DOI: 10.3941/jrcr.v14i12.4110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Extramedullary plasmacytoma of the breast is rare. It is important to recognize the imaging findings and include it as a differential consideration in multiple myeloma patients with a breast mass. A 74-year-old woman undergoing chemotherapy for relapsed multiple myeloma presented with a palpable mass in her right breast. A screening mammogram four months prior was unremarkable. She underwent a diagnostic right mammogram which showed two well-circumscribed hyperdense masses. An ultrasound of the right breast showed mixed echogenic masses with indistinct margins and increased vascularity. Ultrasound guided biopsy confirmed the presence of an extramedullary plasmacytoma. A follow-up whole body PET/CT demonstrated an FDG-avid right breast mass with extensive osseous metastases.
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Affiliation(s)
- Stephen Vong
- Department of Radiology, UC Davis Health, Sacramento, California, USA
| | | | - Morgan Darrow
- Department of Pathology and Laboratory Medicine, UC Davis Health, Sacramento, California, USA
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