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Cureus Aug 2023Multiple myeloma (MM) is a relatively common malignancy that primarily affects the bone marrow, while extramedullary disease (EMD) occurs in the skin and muscle, lung...
Multiple myeloma (MM) is a relatively common malignancy that primarily affects the bone marrow, while extramedullary disease (EMD) occurs in the skin and muscle, lung pleura, lymph nodes, liver, and CNS. Myelomatous pleural effusion (MPE) is a rare extramedullary manifestation of MM in which pleural fluid is composed almost entirely of abnormal plasma cells. MPE and other types of EMD are associated with poor prognosis, and MPE can present emergently due to tension physiology. We report a case of a patient with massive MPE presenting with contralateral midline shift. There are exceedingly few such cases and this report highlights a unique presentation of this rare clinical entity. Epidemiology, radiographic features, diagnosis, treatment, and implications for the prognosis of the disease are discussed.
PubMed: 37680422
DOI: 10.7759/cureus.43040 -
International Journal of Surgery Case... Jan 2024Plasmacytoma is a rare hematological malignancy with a more favorable prognosis than multiple myeloma. This case report focuses on a unique solitary bone plasmacytoma...
INTRODUCTION
Plasmacytoma is a rare hematological malignancy with a more favorable prognosis than multiple myeloma. This case report focuses on a unique solitary bone plasmacytoma (SBP) at the craniovertebral junction (CVJ), managed through surgery and radiotherapy.
CASE PRESENTATION
A 50-year-old patient presented with four months of worsening neck pain and cervicobrachial neuralgia. Despite treatment and physiotherapy, symptoms persisted. Clinical examination revealed neck stiffness, with no motor or sensory deficits. Radiographs and MRI showed an infiltrating axis lesion without instability signs. A CT-guided biopsy yielded inconclusive results. To address instability and establish a diagnosis, a curettage biopsy of the C2 posterior arch was performed, followed by occipito-C4 fusion using an iliac crest graft. Histological examination confirmed SBP. Adjuvant radiotherapy and chemotherapy were administered. At four-year follow-up, there was no multiple myeloma progression, but limited neck mobility were reported, with stable fusion observed on imaging.
DISCUSSION
Solitary bone plasmacytoma primarily affects the axial skeleton, with rare upper cervical spine involvement. Diagnostic criteria include histological confirmation, normal bone marrow analysis, unremarkable imaging (except for the primary lesion), and absence of end-organ damage related to lymphoplasmacytic proliferative disorders. Clinical presentation is nonspecific, and MRI is valuable for soft tissue assessment. Radiotherapy is the primary treatment, with surgery reserved for specific indications.
CONCLUSION
Solitary bone plasmacytoma is a rare condition with a favorable prognosis when promptly managed. This case underscores the importance of early diagnosis and treatment to prevent recurrence or multiple myeloma progression. A multidisciplinary approach, including surgery when necessary, is crucial for optimal outcomes.
PubMed: 38128293
DOI: 10.1016/j.ijscr.2023.109176 -
Deutsches Arzteblatt International Nov 2023
Topics: Humans; Plasmacytoma; Bone Neoplasms; Magnetic Resonance Imaging; Pain
PubMed: 38154049
DOI: 10.3238/arztebl.m2023.0092 -
A Case Report of Plasmacytoma in a 28-Year-Old Patient: Bridging the Age Gap in a Rare Presentation.Cureus Oct 2023Plasmacytoma, an uncommon malignancy originating from plasma cells, predominantly manifests in the elderly demographic. However, its incidence among young adults remains...
Plasmacytoma, an uncommon malignancy originating from plasma cells, predominantly manifests in the elderly demographic. However, its incidence among young adults remains infrequent. Herein, we present a case involving a 28-year-old young adult diagnosed with solitary bone plasmacytoma. The patient presented with acute exacerbation of chronic lower back pain of two years, which, upon hospitalization, was attributed to a lumbar spine compression fracture. Comprehensive blood analysis, imaging studies, and pathology assessments suggested the likelihood of solitary plasmacytoma, devoid of indicators characteristic of multiple myeloma (MM). The patient was given symptomatic treatment and underwent surgical spine decompression, followed by the commencement of radiation therapy to address the malignancy. Subsequent to radiotherapeutic intervention, a noteworthy amelioration in pain and overall condition was observed. This case report assumes importance due to the insight it provides into the natural progression of solitary plasmacytoma. Patients with pathological fractures warrant thorough assessment for solitary plasmacytoma, necessitating vigilant monitoring for its potential evolution into MM. This case serves as a pertinent illustration of the need to expand our existing knowledge of solitary bone plasmacytoma, moving beyond the conventional notion that it predominantly afflicts the elderly population.
PubMed: 38022027
DOI: 10.7759/cureus.47671 -
Cureus Jul 2023Solitary bone plasmacytoma (SBP) is a proliferation of monoclonal plasma cells found in a solitary osteolytic lesion. These osteolytic lesions can present as either bone...
Solitary bone plasmacytoma (SBP) is a proliferation of monoclonal plasma cells found in a solitary osteolytic lesion. These osteolytic lesions can present as either bone pain or pathological fracture. We present this interesting case of a 63-year-old male that was found to have a plasmacytoma confined to the femoral neck following the presentation of a pathological fracture. After surgical resection and biopsy, we placed a distally fixating hemiarthroplasty. To our knowledge, there is only one other reported case of a pathological fracture of the femoral neck due to plasmacytoma.
PubMed: 37654934
DOI: 10.7759/cureus.42726 -
Surgical Neurology International 2024Parasellar plasmacytomas are rare neurosurgical entities. Intrinsic characteristics of these tumors, such as adjacent bone erosion and symptoms resulting from invasion...
BACKGROUND
Parasellar plasmacytomas are rare neurosurgical entities. Intrinsic characteristics of these tumors, such as adjacent bone erosion and symptoms resulting from invasion and mass effect, may lead to the possibility of a solitary extramedullary plasmacytoma (SEP) as a differential diagnosis.
CASE DESCRIPTION
We present the case of a 39-year-old male with a 1-month history of bilateral decreased visual acuity, retroocular pulsating pain, and chromatic vision loss. A computed tomography scan of the head revealed a parasellar lesion causing chiasmatic compression, as well as clival, orbital, sphenoidal, and ethmoidal invasion. A combined transorbital and endonasal endoscopic approach was found suitable, and gross total resection was achieved. Histological analysis of the lesion established the diagnosis of a SEP. After radiotherapy, a new magnetic resonance imaging was performed, revealing a recurrence of the lesion with a high grade of invasion. The patient was treated with palliative radiotherapy, as surgical resection did not seem feasible.
CONCLUSION
Surgical resection and radiotherapy may achieve remission of these lesions; however, recurrence rates remain high despite any treatment modality. Patients with this condition must be followed up with a multidisciplinary team due to the high risk of multiple myeloma progression.
PubMed: 38468666
DOI: 10.25259/SNI_915_2023 -
Journal of Blood Medicine 2024Outcomes for patients with multiple myeloma has significantly improved through the years. This is mainly related to the use of novel agents.
INTRODUCTION
Outcomes for patients with multiple myeloma has significantly improved through the years. This is mainly related to the use of novel agents.
METHODS
This is a retrospective study that reviewed presentation and outcome of 139 patients with multiple myeloma at the Windsor Essex Regional Cancer Centre from Jan. 1, 2015 to Dec. 31, 2019. Median age was 71 years and most patients had higher risk disease (65.5% either R ISS stage II or III). 30% had high risk FISH for myeloma including del.17P, t (4:14), t (14:16) and Gain (1q21). In terms of presentation, 38.8% had anemia (hemoglobin <100g/L), 18.7% had hypercalcemia, 74.1% had skeletal lytic lesions, 38.8% had pathologic fracture and 17.3% had plasmacytoma.
RESULTS
Almost all (92%) of the patients were treated using at least one novel agent (proteasome inhibitor or immunomodulators [ImiDs]). Cyclophosphamide, bortezomib, and dexamethasone (CyBorD) was the most used treatment regimen (48.9%) followed by bortezomib, melphalan and prednisone (BMP) at 28.8% and lenalidomide, dexamethasone (LenDex) at 14.4%. With respect to response to therapy, 51.8% had at least Very good partial response (VGPR), while 9.4% had progressive disease. 33% had autologous stem cell transplant. After a median follow up of 2.4 years, median overall survival was 3.7 years. 2 years overall survival and relapse-free survival were 70% and 83%, respectively.
DISCUSSION
Our study showed comparable outcome for patients with multiple myeloma despite older age and higher risk disease. Outcome is expected to improve with the introduction of more novel agents.
PubMed: 38434928
DOI: 10.2147/JBM.S434055 -
Ear, Nose, & Throat Journal Apr 2024Solitary bone plasmacytoma (SBP) is a rare hematological malignancy that usually occurs in the spine and rarely in the skull. It rarely presents in the skull base, but...
Solitary bone plasmacytoma (SBP) is a rare hematological malignancy that usually occurs in the spine and rarely in the skull. It rarely presents in the skull base, but presenting symptoms are associated with cranial nerve involvement depending on the site of the disease. We present the case of a 61-year-old man with an unusual presentation of hoarseness secondary to vocal fold palsy. Imaging showed a large bony lesion in the temporo-occipital region with involvement of the jugular foramen. Further detailed diagnostic procedures confirmed SBP of the skull base. Radiotherapy was given with an uneventful recovery of vocal fold function. Skull base plasmacytoma can be considered as a differential diagnosis of causes of unilateral vocal fold palsy. Early therapeutic management may improve vocal fold function.
PubMed: 38634321
DOI: 10.1177/01455613241249039 -
Haematologica Nov 2023
Topics: Humans; Multiple Myeloma; Plasmacytoma; Bone Neoplasms
PubMed: 36951162
DOI: 10.3324/haematol.2022.282214 -
Indian Journal of Pathology &... 2023Myelomatous pleural effusion (MPE) is a very rare condition with a poor prognosis. In our case of multiple myeloma (MM) with early recurrence presenting with a MPE,...
Myelomatous pleural effusion (MPE) is a very rare condition with a poor prognosis. In our case of multiple myeloma (MM) with early recurrence presenting with a MPE, management of the treatment is discussed together with the case presentation. A 35 year old female patient with a diagnosis of lambda light chain MM presented with complaints of dyspnea and pain in the left shoulder 2 months after autologous transplantation. On physical examination, respiratory sounds were decreased in the lower lobe of the left lung and there was dullness. Pleural effusion and plasmacytoma, more prominent on the left, were detected on chest X ray and thorax computed tomography (CT). The pleural fluid collected during therapeutic thoracentesis was examined by flow cytometry, cytology, and peripheral smear examination and as a result, the patient was considered to have early recurrence after autologous transplantation, DRd chemotherapy was immediately started, and clinical and radiological improvement was observed. Pleural effusion developing in patients with MM should be evaluated in terms of MPE. In the presence of MPE, the duration of response to treatment is short, thus effective and dynamic treatment methods for bridging should be used before referral of the patients to clinical trials and hematopoietic stem cell transplantation.
Topics: Female; Humans; Adult; Multiple Myeloma; Hematopoietic Stem Cell Transplantation; Transplantation, Autologous; Pleural Effusion; Exudates and Transudates
PubMed: 38084549
DOI: 10.4103/ijpm.ijpm_1233_21