A Rare Case of Extramedullary Adrenal Plasmacytoma Associated with IVC Thrombus: A Case Report with Review of Literature

Abstract

Extramedullary plasmacytoma (EMP) is one of the rare plasma cell malignancies. It accounts for 3% of all plasma cell tumors and most frequently presented in the aerodigestive tract. EMP may likewise involve the urinary tract, central nervous system (CNS), thyroid, breast, testis, parotid gland, lymph nodes, and skin. Only nine cases of the adrenal EMP were reported in the literature. Whether none of these cases were described to be concomitant with venous thrombus. Herein, we presented a 61-year-old male patient who presented with an incidentally discovered non-functioning right suprarenal mass. Magnetic resonance imaging (MRI) venography showed right non-adenomatous adrenal mass measured 11 × 9.5 × 12 cm. The tumor was associated with venous thrombus extending into the intrahepatic portion of the inferior vena cava (IVC). Bone scan suspected bony hot areas, but skeletal MRI excluded any lytic bony lesions or metastatic deposits. Core biopsy was taken and microscopic examination showed sheets of loosely cohesive malignant small rounded cells; most of them were plasma cells. Immunohistochemical staining was positive for Vimentin, CD-138, and CD-56. The pathological data were revised by two other eminent pathologists, and they confirmed the final pathological diagnosis to be adrenal plasmacytoma. We could conclude that, adrenal EMP is a truly rare entity, it can be associated with venous thrombus. Imaging is helpful in this setting for the identification of associated venous thrombus and to exclude any lytic bone lesions.