Extramedullary Plasmacytoma Diagnosed in an HIV-Positive Patient by an Unusual Clinical Presentation.

Paulo De Camargo Moraes,José Luiz Cintra Junqueira,Victor Angelo Martins Montalli,Luciana Butini Oliveira,Camila Maria Beder Ribeiro,Luiz Alexandre Thomaz

doi:10.1155/2016/6305173

Paulo De Camargo Moraes, José Luiz Cintra Junqueira + Show 4 more

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https://doi.org/10.1155/2016/6305173

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Abstract

The aim of this paper is to describe a case report of EMP in an HIV-positive patient. A 44-year-old, dark-skinned HIV-infected woman was referred to the Oral Diseases Treatment Center with a swelling at palate and left gingival fornix in the maxilla. Biopsy was taken and the oral lesion was diagnosed as EMP with well-differentiated plasma cells and restriction of the lambda light-chain. Skeletal survey was performed and no radiograph alterations were observed, thus supporting the diagnosis of EMP. Patient was referred to treatment and after two months of chemo and radiotherapy, an expanding lesion was observed in L5/S1 patient's vertebrae. Biopsy of the spinal lesion was consistent with lymphoma with plasmocitary differentiation, supporting the diagnosis of multiple myeloma (MM). Regarding the medical history, the final diagnostic was an oral extramedullary plasmacytoma with rapid progression into multiple myeloma. It is crucial to emphasize the relevance of HIV infection as a risk factor for both aggressive clinical behavior and unusual clinical presentation of extramedullary plasmacytoma cases.

Highlights

According to the World Health Organization (WHO), extramedullary plasmacytoma (EMP) is a monoclonal plasmatic soft-tissue proliferation, without bone marrow involvement
The present study reports a case of EMP with atypical features which have been associated with the presence of human immunodeficiency virus (HIV) infection
The case presented in this study showed a rapid evolution into MM, only 6 months after the initial diagnosis, in an aggressive clinical behavior

Summary

Introduction

According to the World Health Organization (WHO), extramedullary plasmacytoma (EMP) is a monoclonal plasmatic soft-tissue proliferation, without bone marrow involvement. It is a tumor composed almost exclusively of plasma cells arranged in clusters or sheets with a scant, delicate, supportive, and connective tissue stroma [1, 2]. Extramedullary plasma cell tumors occur in a wide variety of organs and tissues It has been reported in head and neck of more than 80% of the cases, usually in the nasal cavity with associated bone destruction [3, 4]. Its occurrence was associated with advanced myeloma and a poor prognosis

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