Journal List > Tuberc Respir Dis > v.69(2) > 1001525

Sung, Song, and Park: A Case of Multiple Pulmonary Plasmacytomas after Complete Remission of Multiple Myeloma

Abstract

Extramedullary plasmacytoma (EMP) is a rare disorder that typically occurs in the upper airway. Although the condition rarely arises in the lungs, a few cases have been reported. Here, we report a case of pulmonary plasmacytoma in 66-year-old man, who had been treated with VAD (vincrestine, adriamycin, dexamethasone) chemotherapy for multiple myeloma. The patient had been declared clear of multiple myeloma after 4 cycles of chemotherapy. Three months later, the patient had multiple masses visible on computed tomography (CT) and on positron emission tomography-computed tomography (PET-CT) with hot uptake. Subsequent studies using CT-guided needle biopsy and immunohistochemical stain showed pulmonary plasmacytoma. Bone marrow biopsy, serum, and urine M protein tests were repeated, showing no evidence of multiple myeloma. Pulmonary plasmacytomas, as extramedullary plasmacytomas, were considered an isolated manifestation of multiple myeloma recurrence. We treated the patient with concurrent chemoradiotherapy and the pulmonary plasmacytomas regressed dramatically.

Figures and Tables

Figure 1
(A) Chest radiograph on admission showed multifocal mass-like consolidations in left lung field. (B) Follow-up of chest radiograph obtained after chemoradiotherapy showed marked shrinkage of multiple masses in left lung filed.
trd-69-129-g001
Figure 2
(A) Initial chest CT scan displayed three nodules up to 4 cm were in left lung, and multiple disseminated small nodules were in both lung fields. (B) Chest CT scan after chemoradiotherapy showed much regression of previous lung masses.
trd-69-129-g002
Figure 3
PET CT showed multiple hot uptakes (SUV, 6.4~7.2) in both lung fields.
trd-69-129-g003
Figure 4
(A) Photomicrograph of the lung biopsy demonstrated many aggregates of plasma cells, suggestive of plasmacytoma (H&E stain, ×400). (B) Immunohistochemical staining of kappa light chain (H&E stain, ×200).
trd-69-129-g004

References

1. Corwin J, Lindberg RD. Solitary plasmacytoma of bone vs. extramedullary plasmacytoma and their relationship to multiple myeloma. Cancer. 1979. 43:1007–1013.
2. Woodruff RK, Whittle JM, Malpas JS. Solitary plasmacytoma. I: Extramedullary soft tissue plasmacytoma. Cancer. 1979. 43:2340–2343.
3. Knowling MA, Harwood AR, Bergsagel DE. Comparison of extramedullary plasmacytomas with solitary and multiple plasma cell tumors of bone. J Clin Oncol. 1983. 1:255–262.
4. Thoennissen NH, Schliemann C, Hungermann D, Bremer J, Juergens KU, Semik M, et al. Solitary plasmacytoma of the lung with coexisting sarcoid-like lesions. Ann Hematol. 2008. 87:417–420.
5. Koss MN, Hochholzer L, Moran CA, Frizzera G. Pulmonary plasmacytomas: a clinicopathologic and immunohistochemical study of five cases. Ann Diagn Pathol. 1998. 2:1–11.
6. Goźdiuk K, Kedra M, Rybojad P, Sagan D. A rare case of solitary plasmacytoma mimicking a primary lung tumor. Ann Thorac Surg. 2009. 87:e25–e26.
7. Hayes-Lattin B, Blanke CD, Deloughery TG. Pulmonary and intracerebral plasmacytomas in a patient without multiple myeloma: a case report. Am J Hematol. 2003. 73:131–134.
8. Adam Z, Bolcák K, Stanícek J, Pour L, Hájek R, Krejcí M, et al. The value of fluorodeoxyglucose positron emission tomography in multiple myeloma. Vnitr Lek. 2006. 52:207–214.
9. Luh SP, Lai YS, Tsai CH, Tsao TC. Extramedullary plasmacytoma (EMP): report of a case manifested as a mediastinal mass and multiple pulmonary nodules and review of literature. World J Surg Oncol. 2007. 5:123.
10. Kim SH, Kim ES, Hur JW, Lee JH, Chang SH, Kim YS, et al. A case of relapsed renal plasmacytoma after complete remission of multiple myeloma. Korean J Med. 2003. 64:114–118.
11. Vande Broek I, Stadnik T, Meurs A, Maes J, Van Camp B, Schots R. Extramedullary plasmacytoma of the cavernous sinus. Leuk Lymphoma. 2002. 43:1691–1693.
12. Liebross RH, Ha CS, Cox JD, Weber D, Delasalle K, Alexanian R. Clinical course of solitary extramedullary plasmacytoma. Radiother Oncol. 1999. 52:245–249.
13. Mayr NA, Wen BC, Hussey DH, Burns CP, Staples JJ, Doornbos JF, et al. The role of radiation therapy in the treatment of solitary plasmacytomas. Radiother Oncol. 1990. 17:293–303.
14. Creach KM, Foote RL, Neben-Wittich MA, Kyle RA. Radiotherapy for extramedullary plasmacytoma of the head and neck. Int J Radiat Oncol Biol Phys. 2009. 73:789–794.
15. Dimopoulos MA, Kiamouris C, Moulopoulos LA. Solitary plasmacytoma of bone and extramedullary plasmacytoma. Hematol Oncol Clin North Am. 1999. 13:1249–1257.
16. Wise JN, Schaefer RF, Read RC. Primary pulmonary plasmacytoma: a case report. Chest. 2001. 120:1405–1407.
17. Wang J, Pandha HS, Treleaven J, Powles R. Metastatic extramedullary plasmacytoma of the lung. Leuk Lymphoma. 1999. 35:423–425.
TOOLS
Similar articles