A Patient with IgA Monoclonal Gammopathy Presenting as Myelomatous Pleural Effusion with Axillary Node Involvement

Seo-Jin Park; Hyun Ju Sung; Jeong-Ho Kim; Jae Woo Song; Kyung Soon Song

doi:10.5045/kjh.2006.41.1.41

Journal List > Korean J Hematol > v.41(1) > 1032697

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Park, Sung, Kim, Song, and Song: A Patient with IgA Monoclonal Gammopathy Presenting as Myelomatous Pleural Effusion with Axillary Node Involvement

Case Report

Korean J Hematol 2006;41(1):41-45.

Published online: 19 March 2006

DOI: https://doi.org/10.5045/kjh.2006.41.1.41

A Patient with IgA Monoclonal Gammopathy Presenting as Myelomatous Pleural Effusion with Axillary Node Involvement

Seo-Jin Park¹, Hyun Ju Sung², Jeong-Ho Kim¹, Jae Woo Song¹, Kyung Soon Song^1,

¹Department of Laboratory Medicine, Yonsei University College of Medicine, Seoul, Korea

²Abbot Korea Limited, Seoul, Korea

Correspondence to：Kyung Soon Song, M.D. Department of Laboratory Medicine, Yongdong Severance Hospital, Yonsei University College of Medicine 146-92 Dogok-dong, Gangnam-gu, Seoul 135-720, Korea Tel: +82-2-2019-3531, Fax: +82-2-3462-9483 E-mail: kssong@yumc.yonsei.ac.kr

Received 30 January 2006 Revised 17 February 2006 Accepted 22 February 2006

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Multiple myeloma is a cancer of plasma cells that produce monoclonal immunoglobulin, and the neoplastic plasma cells typically accumulate in the bone marrow with occasional involvement of other organs. Pleural effusion that is associated with multiple myeloma has been infrequently reported (＜6%) and myelomatous pleural effusion is extremely rare (＜1%). A 73-year-old woman was admitted to the department of dermatology for skin lesions on both arms and both ankles. A chest radiograph taken on admission showed a nodular lesion in the right upper lung and pleural effusion. Analysis of the pleural fluid revealed many atypical plasma cells, elevated levels of IgA (27.95g/L) and lambda light chain (9.16g/L), and monoclonal IgA-lambda paraprotein on immunofixation. The serum concentrations of IgA were elevated (33.08g/L) while the concentrations of IgG and IgM were decreased. Bone marrow aspirate smears contained increased levels of immature-appearing atypical plasma cells. This is only the third case of myelomatous pleural effusion that has been reported in Korea.

Keywords: Multiple myeloma, Pleural effusion, IgA-lambda paraprotein

REFERENCES

1). Bataille R., Harousseau J. Multiple myeloma. New Engl J Med. 1997. 336:1657–64.

2). Safa AM., Van Ordstrand HS. Pleural effusion due to multiple myeloma. Chest. 1973. 64:246–8.

3). Hwang HK., Lee CK., Lee KH., Hyun MS., Shim BS., Lee HW. A case of multiple myeloma with pleural effusion. Korean J Hematol. 1992. 27:161–5.

4). Kintzer JS., Rosenow EC., Kyle RA. Thoracic and pulmonary abnormalities in multiple myeloma. Arch Intern Med. 1978. 138:727–30.

5). Hata H., Matsuzaki H., Tanaka K, et al. Ectopic production of salivary-type amylase by a IgA-lambda-type multiple myeloma. Cancer. 1988. 62:1511–5.

6). Kwan WC., Lam SC., Klimo P. Kappa light-chain myeloma with pleural involvement. Chest. 1984. 86:494–6.

7). Kamal MK., Williams E., Poskitt TR. IgD myeloma with malignant pleural effusion. South Med J. 1987. 80:657–8.

8). Rodriguez JN., Pereira A., Martinez JC., Conde J., Pujol E. Pleural effusion in multiple myeloma. Chest. 1994. 105:622–4.

9). Kim YM., Lee KK., Oh HS, et al. Myelomatous effusion with poor response to chemotherapy. J Korean Med Sci. 2000. 15:243–6.

10). Hughes JC., Votaw ML. Pleural effusion in multiple myeloma. Cancer. 1979. 44:1150–4.

11). Sasser RL., Yam LT., Li CY. Myeloma with involvement of the serous cavities. Cytologic and immuno-chemical diagnosis and literature review. Acta Cytol. 1990. 34:479–85.

12). Kamble R., Wilson CS., Fassas A, et al. Malignant pleural effusion of multiple myeloma: prognostic factors and outcome. Leuk Lymphoma. 2005. 46:1137–42.

13). McMillen JJ., Krueger SK., Dyer GA. Leukocytoclastic vasculitis in association with immunoglobulin A myeloma. Ann Intern Med. 1986. 105:709–10.

14). Bayer-Garner IB., Smoller BR. Leukocytoclastic (small vessel) vasculitis in multiple myeloma. Clin Exp Dermatol. 2003. 28:521–4.

Fig. 1

Cytospin smears of pleural fluid showing clusters of plasma cells with marked atypia such as anisocytosis, immature forms, and multinucleation (Wright-Giemsa, ×1,000).

Fig. 2

Bone marrow aspiration and biopsy. (A) Aspiration smear showing increased atypical plasma cells with immature forms. (B) Biopsy section showing infiltration of immature plasma cells (A: Wright-Giemsa, ×1,000; B: Hematoxylin and Eosin (H&E), ×400).

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