Plasma Cell Lesions Research Articles

Cocamidopropyl betaine: another possible oral healthcare chemical associated with plasma cell lesions of the oral cavity.

Cocamidopropyl betaine: another possible oral healthcare chemical associated with plasma cell lesions of the oral cavity.

Bilateral Testicular Plasmacytoma Preceding Multiple Myeloma with Extramedullary Renal Involvement: A Case Report

Multiple myeloma (MM) is a clonal proliferation of plasma cells in the bone marrow, with criteria including bone marrow plasma cells ≥10% or biopsy-proven plasmacytoma with myeloma-defining events. Solitary plasmacytoma (SP) represents a singular clonal plasma cell lesion without myeloma-defining events, while extramedullary disease (EMD) is an aggressive form of MM characterized by independent growth outside the bone marrow microenvironment. We present a unique case of a 64-year-old patient with bilateral testicular plasmacytoma anteceding the development of Immunoglobulin G (IgG) kappa-type MM, featuring extramedullary renal involvement.

Solitary Bone Plasmacytoma Mimicking Oral Cavity Neoplasm – A Rare Case

Plasmacytomas are localized monoclonal plasma cell lesions with no evidence of systemic involvement which are divided into solitary bone plasmacytoma (SBP) and extra-medullary plasmacytoma (EMP). The diagnosis of plasmacytomas (PCM) in the oral regions is challenging given the atypical clinical manifestations and low frequency. Here, we report an extremely rare case of plasmacytoma in an elderly male which initially appeared to be arising from the left buccal mucosa on clinical examination but after radiological imaging and intra-operative findings, the epicentre was found to be in the left infratemporal fossa (ITF). The patient underwent en-bloc compartment resection with high clearance of the ITF which proved to be an effective management strategy. It is crucial for the head and neck surgeon to be aware of the solitary bone plasmacytoma in the oral and maxillofacial region in order to identify it early and provide these patients with the best care possible before complications arise.

Intra Oral Plasma Cell Neoplasm: A Case Report

Plasmacytomas are rare solitary soft tissue tumors that arise from proliferations of malignant transformed monoclonal plasma cells and can be diagnosed through biopsy and histopathologic examination. These lesions are closely associated with multiple myelomas, which should be ruled out in all these cases by necessary laboratory and radiographic examinations. A 41yrs old female came to surgery department with a complaint of slow-growing painless mass of 1.0 x0.5 x0.5cm at angle of the mandible. A diagnosis of solitary plasmacytoma was made on the basis of clinical, radiographic, and histopathological findings. Early diagnosis of plasmacytomas is of great importance. Radiotherapy is the common modality of treatment with or without adjuvant chemotherapy. Progression to plasma cell lesion is possible; thus, close follow-up of the patient is essential after the completion of the therapeutic procedure.

Plasma cells in oral lesion: A clue to diagnosis or a diagnostic dilemma.

Plasma cells can just represent a part of host inflammatory response or form the cornerstone of diagnosis such as IgG4-related disease (IgG4RD) and plasma cell dyscrasias and sometimes create a diagnostic dilemma. The study aims to discuss a series of plasma cell lesions which we encountered in the oral cavity, discuss the diagnostic conundrum of plasma cell lesions. We also propose a working classification for their interpretation. All plasma cell lesions affecting the oral and maxillofacial region were retrieved from the archives of the Department of Oral and Maxillofacial Pathology. The cases were analyzed on the basis of histomorphology and immunohistochemical markers along with clinical, imaging and laboratory findings. Thirteen (0.64%) of 2026 oral lesions were diagnosed with plasma cell lesions. Out of 13 cases, 9 were plasma cell gingivitis, 2 IgG4-RD, 1 plasma cell myeloma and 1 plasmablastic lymphoma. Representative case from each category is discussed along with one case of well-differentiated squamous cell carcinoma (WDSCC) masquerading as plasma cell dyscrasias. We discuss the practical difficulties faced during the diagnosis of these oral plasma cell entities along with a working classification and propose an efficient diagnostic scheme for the correct characterization of these lesions.

Clinicopathological and immunohistochemical analysis of plasma cell gingivitis- A retrospective study.

This study aims to describe the demographics and clinicopathological characteristics of the cases of plasma cell gingivitis (PCG) reported in our institute, supported by a review of pertinent literature. Further, we investigated the role of the cluster of differentiation CD138, Ki67, CD56, and CD117 immunoexpression in the differential diagnosis of PCG from plasma cell dyscrasias. All histopathologically confirmed cases of PCG, whose relevant details could be obtained, were included in this study. They were subjected to panel of immunohistochemical markers to exclude plasma cell malignancies. Further, published English literature for PCG since 1970-2020 was reviewed. Nine histopathologically confirmed cases of PCG, were retrieved from the archives of our department. The cases comprised 3 males and 6 females with their ages ranging between 14 and 82 years. The plasma cells exhibited equivocal reactivity for kappa and lambda; and immunonegativity for CD56, CD117 with low Ki67 proliferation index. Published literature in English showed 43 cases of PCG were predominantly female; the diffuse involvement of maxilla and mandible was a common finding. In addition to kappa lambda reactivity, an immunoprofile of CD138, Ki67, CD56, and CD117 may be used as a diagnostic adjunct to exclude malignant plasma cell lesions in confusing cases.

Plasma Cell Rich Osteomyelitis: A Rare Entity

Plasma cell rich osteomyelitis is a rare finding characterised by a plethora of plasma cells localised in the affected bone without the typical clinical features of infection. It usually affects the metaphysis of long bones with a radiological appearance as a dense thickening of bone without sequestrum formation. We present an atypical case of plasma cell osteomyelitis with a lesion in the metaphysis as well as the diaphysis of the humerus without sclerosis but with sequestrum formation. An 11-year-old girl was brought to OutPatient Department (OPD) with complaints of post-traumatic pain and swelling at left shoulder and proximal arm since one and a half months with aggravation of symptoms since last 10 days. Patient had also been treated for Urinary Tract Infection (UTI) by a paediatrician who prescribed antibiotics and antipyretics because of which fever subsided but the pain persisted. The x-ray of left shoulder with arm revealed a fracture of surgical neck of humerus with cortical irregularity noted in the mid-shaft of humerus along with lamellated periosteal reaction suggestive of post-traumatic osteomyelitis with a pathological fracture. Clinicoradiologic diagnosis of pathological fracture of left neck of humerus was made with an underlying neoplastic or infective aetiology. An open biopsy was taken from left proximal humerus. Histopathological examination showed plasma cells in sheets having abundant basophilic cytoplasm, round to eccentric nuclei and perinuclear hoff along with lymphocytes and few polymorphs with surrounding area showing fibrosis, oedema and hyperemia. A diagnosis of chronic plasma cell osteomyelitis was rendered, which is an uncommon condition without specific clinical findings and an ambigious cause. Histopathology is the definitive tool for obtaining an accurate diagnosis and we strongly recommend a meticulous histopathological examination correlated with clinico-radiological description for a correct diagnosis in order to avoid an increased frequency of diagnosis of neoplastic plasma cell lesion as well as for advocating the correct treatment. This case is discussed for presentation of plasma cell osteomyelitis and also to report a case of chronic primary plasma cell rich osteomyelitis with atypical clinical features.

A Randomized Phase III Trial of Melphalan and Dexamethasone (MDex) Versus Bortezomib, Melphalan and Dexamethasone (BMDex) for Untreated Patients with AL Amyloidosis

A Randomized Phase III Trial of Melphalan and Dexamethasone (MDex) Versus Bortezomib, Melphalan and Dexamethasone (BMDex) for Untreated Patients with AL Amyloidosis

A Randomized Phase III Trial of Melphalan and Dexamethasone (MDex) Versus Bortezomib, Melphalan and Dexamethasone (BMDex) for Untreated Patients with AL Amyloidosis

A Randomized Phase III Trial of Melphalan and Dexamethasone (MDex) Versus Bortezomib, Melphalan and Dexamethasone (BMDex) for Untreated Patients with AL Amyloidosis

Case Report

Overproduction of a vascular endothelial growth factor secreted by neoplastic cells in some plasma cell neoplasms is postulated to be responsible for the syndrome of polyneuropathy, organomegaly, endocrinopathy, monoclonal protein, and skin changes and the rarer syndrome of adenopathy and extensive skin patch overlying a plasmacytoma. The authors present a case of a 57-year-old man who presented with an erythematous left flank skin patch and subsequent discovery of an underlying 10th rib plasmacytoma with lambda light chain restriction. The tumor was strongly positive for CD31, a marker known to be involved in angiogenesis and cell adhesion. Immunohistochemical studies were initially confounding and later shown to be due to the effects of decalcification procedures. The authors discuss the natural history of this unusual entity and the diagnostic challenges in evaluating this lesion. The authors finally postulate whether strong CD31 expression could be related to paraneoplastic phenomena associated with some plasma cell lesions.

A Multiple Myeloma Patient Presenting with Multiple Hepatic Masses

A 47-year-old male with Multiple Myeloma (MM) presented with a history of worsening jaundice and intermittent abdominal discomfort for one month. Physical examination was unremarkable except for the icterus and palpable, nontender liver extending 2 cm below the right costal margin. The liver function test was more consistent with an obstructive pathology. MRCP showed at least six hepatic masses- largest of which measured 16.4 × 11.2 cm, severe upper abdominal and retroperitoneal adenopathy and moderate to severe intrahepatic biliary duct dilatation due to extrinsic compression of Common Bile Duct (CBD) by a 6.0 × 5.7 cm porta-hepatis mass. A CAT-scan guided hepatic-mass-biopsy showed plasmacytoma. Endoscopic Retrograde Cholangiopancreatography with stent placement in CBD was done and the patient was discharged upon clinical improvement. Multiple Myeloma is a monoclonal, plasma-cell neoplasm that usually produces large amount of a specific immunoglobulin. Though Extramedullary plasmacytoma (EMP) is not uncommon feature of MM, it is rarely considered as a specific part of the clinical picture of MM. Though the most common mechanism for development of EMP is local growth of the malignant tissue outside the bone, it can also be formed in various distant organs via hematogenous spread of the malignant plasma cells. Hepatic plasmacytoma is considered a rare entity and literature is limited to few case notes. Out of two distinct pathologic variants of hepatic plasmacytoma, infiltrative plasma-cell lesion are more common that macroscopic-nodular form. There are reports of nodular-hepatic plasma cell tumor being diagnosed incidentally or presenting with clinical features of hepatocellular injury and/or cholestasis. We have presented a rare case of hepatic plasmacytoma in MM with intrahepatic and porta-hepatis macroscopic nodules occurring simultaneously. This clinical picture of obstructive jaundice with multiple liver masses, a porta-hepatis mass and severe abdominal adenopathy usually generates differential diagnoses of primary liver tumor, metastases, gall bladder carcinoma, cholangiocarcinoma or abscesses. If a patient has pre-existing multiple myeloma, plasmacytoma should invariably be added to the differential diagnosis. doi: http://dx.doi.org/10.4021/jmc1470w

Early onset, EBV− PTLD in pediatric liver-small bowel transplantation recipients: a spectrum of plasma cell neoplasms with favorable prognosis

AbstractEBV− posttransplantation lymphoproliferative disorders (PTLDs) are rare compared with EBV+ PTLDs, occur later after transplantation, and have a poor response to treatment. Few studies have reported EBV− PTLD in pediatric solid-organ transplantation recipients. We describe 5 cases of EBV− PTLD in recipients of combined liver and small bowel allografts ranging in age from 16 months to 7 years. EBV− PTLD developed 9-22 months (median, 15) after transplantation. Morphologically, the lesions ranged from atypical plasma cell hyperplasia (a term not currently included in the World Health Organization classification) to plasmacytoma like. In all cases, in situ hybridization for EBV was negative, and molecular studies demonstrated clonal IgH gene rearrangements. Protein electrophoresis showed multiple clonal paraproteins in 4 of 5 cases. In 2 cases with a donor-recipient sex mismatch, FISH cytogenetics demonstrated that the plasma cells were of mixed donor/recipient origin. One patient died before therapy. Four patients were treated with high-dose dexamethasone, and 1 patient subsequently required thalidomide. All 4 remain in remission 75-128 months (median, 86) after diagnosis. In contrast to reports of EBV− PTLD in adults, these plasma cell lesions occurred early after transplantation and resolved completely after minimal treatment.

Case Reports and Differential Diagnosis of Hemorrhagic Ulcerative Lesions on the Vermilion Zone

The vermilion zone of the lips is mucocutaneous junction between the skin and the oral mucosa of lips. Diseases of the vermilion zone may be related to a local or systemic condition, and can be manifestation of a systemic disease. In this cases, we introduced patients with hemorrhagic, ulcerative lesions on the vermilion zone and reported plasma cell cheilitis and lesion of the vermilion zone related to Stevens-Johnson syndrome(SJS).

Plasma cell granuloma in the oral cavity

AbstractPlasma cells are terminally differentiated B lymphocytes which are typically found in the red pulp of the spleen, medulla of the lymph nodes, tonsils, lamina propria of the entire gastrointestinal tract, mucosa of the nose and upper airway, and sites of inflammation. They are characterised by basophilic cytoplasm with an eccentrically placed nucleus. They range in size from 14 to 20 µm. A plasma cell's main function is to produce immunoglobulins or antibodies. Plasma cell granuloma is a plasma cell lesion which merits discussion because it is typically found in the oral cavity. This lesion is not a neoplastic process, nor is it associated with a monoclonal expansion of a single plasma cell; instead, this is a reactive, inflammatory lesion which usually involves the gingival tissue.

Targeted overexpression of Bcl-XLin B-lymphoid cells results in lymphoproliferative disease and plasma cell malignancies

AbstractMultiple myeloma is an incurable malignancy, and there is currently no mouse model that fully recapitulates the development and progression of the disease. We now describe a transgenic mouse that expresses a Bcl-XLtransgene under the control of the 3′κ immunoglobulin light chain enhancer, which is most active in murine B cells in late developmental stages. These mice developed nonmalignant plasma cell foci in the bone marrow and soft tissues and hyaline tubular casts in the kidneys. Median survival of the 3′KE/Bcl-XLmice was similar to littermate controls. When the 3′KE/Bcl-XLmouse was crossed to an Eμ/c-Myc transgenic mouse, median survival of double transgenic progeny was 5.5 weeks. Peripheral blood and soft tissues were infiltrated with immature/mature B cells, and plasma cell lesions were identified in the bone marrow of all mice coexpressing Bcl-XLand c-Myc. These B- and plasma cell lesions demonstrated features consistent with malignancy. These results indicate that the 3′κ immunoglobulin light chain enhancer can effectively target expression of Bcl-XLto B cells in late developmental stages, and they provide direct evidence that Bcl-XLcan contribute to plasmacytomagenesis. Furthermore, this murine model serves as an important step in developing a novel genetically induced mouse model of plasma cell malignancies exhibiting bone marrow involvement. (Blood. 2004;103:2779-2786)

Pelvic Castleman's disease presenting as an adnexal tumor

Pelvic Castleman's disease presenting as an adnexal tumor

Plasmacytic lesions of the bone marrow

Although the first cases of the plasma cell lesions were described in the 19th century, it was Wright who in 1900 suggested that the neoplastic myeloma cells morphologically resembled variants of plasma cells. Later it was discovered that these malignant cells produced monoclonal immunoglobulins, an important marker for the diagnosis and follow-up of patients afflicted with the disease. The usefulness of bone marrow examination was recognized in the late 1930s and is today regarded as the most important factor in the definitive diagnosis of myeloma and related disorders, namely macroglobulinemia, monoclonal gammopathy of undetermined significance, and reactive plasmacytosis of the bone marrow. Differential diagnosis of the above mentioned disorders proven to be the B cell diseases will be the main focus of this presentation and their morphological variations will be emphasized. The usefulness of immunostaining of bone marrow aspirate sections as well as biopsy will also be highlighted.

A Clincopathologic Study

We report 9 patients with an unusual plasma cell proliferative disorder of the upper aerodigestive tract. Six patients were men and three, women. The age at presentation ranged from 40 to 67 years with a mean of 54 years. Symptoms at presentation included dysphonia, dysphagia, difficulty breathing, and oral pain. These plasma cell lesions typically produced a cobblestone or warty appearance of the upper aerodigestive tract mucosa including the larynx, pharynx, palate, lips, mouth, tongue, and trachea in varying combination of multiple sites in each patient. Histologically, all lesions were characterized by psoriasiform epithelial hyperplasia with dyskeratosis and dense subepithelial plasmacytosis. Plasma cells were mature but so expansive and diffuse in infiltration as to suggest extramedullary plasmacytoma. Immunohistochemistry for kappa and lambda light chain showed polyclonal immunoglobulin content in all cases examined. Microbial cultures and Warthin-Starry stains were negative for organisms. A variety of treatments including antibiotic therapy, corticosteroid administration, and surgical resection were unsuccessful. In two patients, the process required tracheostomy. This disorder has not been previously described with the exception of a single reported case, which is included in this series. The etiology, pathogenesis, and successful management of mucous membrane plasmacytosis remain unknown.

Plasma Cell Lesions of the Thyroid: Report of a Case of Solitary Plasmacytoma and a Review of the Literature

We report a case of a solitary plasmacytoma arising from a thyroid with longstanding Hashimoto's disease, and diagnosed by fine-needle aspiration cytology. Serum protein electrophoresis revealed an M-spike in the gamma-globulin region due to monoclonal IgG-lambda immunoglobulin. The thyroid tumor was treated with near-total thyroidectomy and irradiation, and the patient was well 6 years after surgery without evidence of multiple myeloma. The serum M-spike disappeared after the tumor resection and radiation therapy. Plasma cell lesions of the thyroid reported in the world literature are extensively reviewed. Solitary plasmacytomas occur most commonly in patients with Hashimoto's disease, and must be distinguished from plasma cell granulomas and involvement of the thyroid in multiple myeloma. Plasmacytomas should be considered in the differential diagnosis of a rapidly enlarging thyroid mass in a patient with known Hashimoto's disease.

Plasma cell dyscrasia: A case of POEMS syndrome with a unique dermatologic presentation

POEMS (polyneuropathy, organomegaly [hepatosplenomegaly or lymphadenopathy], endocrinopathy, M protein, and skin changes) syndrome is an uncommon plasma cell dyscrasia with diverse manifestations, including lymphadenopathy as well as those that comprise the acronym. Dermatologic changes may include hyperpigmentation, thickened skin, hypertrichosis, and papular angiomas. These changes are believed to result from humoral products of the plasma cell clone and frequently resolve with treatment of the neoplasm. We describe a man with typical POEMS syndrome with a unique skin lesion: a large, sharply circumscribed, pigmented plaque on the anterior chest wall centered over a plasmacytoma of the sternum. Results of histologic examination showed a proliferation of capillaries of varying size, enlarged fibroblasts, and increased amounts of collagen and proteoglycan from the dermis to the periosteum. Because the outer cortex of the sternum was eroded, peptide mediators of vascular and fibroblast proliferation may have diffused directly from the plasma cell lesion into the tissues of the chest wall.