Pulmonary Plasmacytoma Research Articles

A case of primary pulmonary plasmacytoma

A case of primary pulmonary plasmacytoma

Multiple Myeloma with Lung Plasmacytoma

Multiple myeloma (MM) is a clonal proliferation of malignant plasma cells mainly affecting the bone marrow. Most common sites of extramedullary dissemination reported in the literature are skin, liver, kidneys and central nervous system. The presentation of MM with lung plasmacytoma is found to be very uncommon. We present a case of multiple myeloma associated with lung plasmacytoma. A 53-years-old man with history of shortness of breath and lung opacity visualized on a chest X-ray. Careful integration of clinical manifestations with radiological and biological data led to the diagnosis of multiple myeloma with pulmonary plasmacytoma.

Solitary extramedullary plasmacytoma in the lung misdiagnosed as lung cancer: A case report and literature review.

BackgroundExtramedullary plasmacytoma (EMP) is an extremely rare kind of soft tissue plasma cell neoplasm without bone marrow involvement or other systemic characteristics of multiple myeloma. Primary pulmonary plasmacytoma (PPP), with no specific clinical manifestations, is an exceedingly rare type of EMP. Because of its complexity, PPP is often difficult to diagnose. Computed tomography-guided percutaneous core needle biopsy (CT-guided PCNB) has been shown to have high sensitivity, specificity and accuracy for characterization of pulmonary lesion, particularly if malignancy is suspected. Here we presented a rare case of PPP diagnosed with CT-guided PCNB.Case presentationA 78-year-old female smoker who visited our outpatient clinic for a mass in the left lower lobe of the lung. Pathological based on CT-guided PCNB yielded a PPP with no lymph node or other distant metastasis.ConclusionsExtramedullary plasmacytoma should be considered in the differential diagnosis of a pulmonary mass.

P-200: Solitary pulmonary plasmacytoma: about a case

P-200: Solitary pulmonary plasmacytoma: about a case

SOLITARY PRIMARY PULMONARY PLASMACYTOMA: A RARE PRESENTATION

TYPE: Abstract TOPIC: Lung Cancer INTRODUCTION: Solitary Primary Pulmonary Plasmacytomas (SPPP) is a rare presentation of solitary intramedullary plasmacytoma. We report a case of Solitary Primary Pulmonary Plasmacytomas with the absence of circulating immunoglobulins which is an extremely rare presentation. CASE PRESENTATION: A 80 year old asymptomatic non-smoker gentleman was evaluated for anemia. Work up for anemia including bone marrow, serum electrophoresis and urine bence jones protein was negative. The whole body PET-CT revealed a 3 x 2 cm solitary lung nodule with increased FDG uptake in the apical segment of the right lower lobe lung. CT guided biopsy was inconclusive. Transbronchial lung biopsy revealed malignant plasma cells with CD138, CD56, V-38 and lambda light chain restrictions. He was diagnosed with Solitary Primary Pulmonary Plasmacytomas. He underwent 25 fractions of 45 Gys radiation with complete resolution. On follow up after 1 year there was no clinical, radiological or biochemical evidence or further extramedullary plasmacytoma. DISCUSSION: Solitary Primary Pulmonary Plasmacytoma is a very rare manifestation of extramedullary plasmacytoma. Diagnosis is by transbronchial lung biopsy, CT guided or ultrasound-guided biopsy and rarely surgical lung biopsy. Treatment options include radiotherapy, surgery and chemotherapy. In select few radiotherapy alone may show an excellent response. CONCLUSIONS: Solitary Primary Pulmonary Plasmacytomas is a very rare condition with a non-specific presentation. A differential of Solitary Primary Pulmonary Plasmacytomas should be considered in patients with solitary hilar lesion with anemia. Radiotherapy alone can have a complete resolution. DISCLOSURE: Nothing to declare. KEYWORD: primary pulmonary plasmacytoma, rare presentation, solitary extramedullary plasmacytoma, Lung cancer

A novel differential diagnosis for diffuse cavitating nodules: primary pulmonary plasmacytoma

BackgroundExtramedullary plasmacytoma is a rare monoclonal plasma cell neoplasm that originates from tissues other than the bone marrow and constitutes only 3%–5% of all plasma cell neoplasms. Most cases involve the upper respiratory tract. Extramedullary plasmacytoma involving the lung is extremely rare. Primary pulmonary plasmacytoma is a rare type of extramedullary plasmacytoma, usually presenting with a nodule or mass in hilar region. Literature search has shown very few cases of immunohistochemically confirmed cases of pulmonary plasmacytoma. Diffuse pulmonary infiltration is an unusual presentation.Case presentationWe report the case of a 56 year old lady with history of cough and breathlessness since one month. Computed Tomography revealed diffusely scattered multiple cavitating nodules and consolidation in both lungs. Computed Tomography guided biopsy of one of the lung nodules was done. Histopathologic examination and immunohistochemistry showed features of pulmonary plasmacytoma .This is an unique case of primary pulmonary plasmacytoma with the rare presentation as diffusely scattered multiple cavitating nodules and consolidation. According to our literature search, primary pulmonary plasmacytoma manifesting as cavitating nodules is being reported for the first time.ConclusionsPrimary pulmonary plasmacytoma should be also be considered in the differential diagnosis of multiple diffusely scattered cavitating lung nodules.

EXTRAMEDULLARY PULMONARY PLASMACYTOMA AS A COMPLICATION OF RELAPSED MULTIPLE MYELOMA

TOPIC: Pulmonary Manifestations of Systemic Disease TYPE: Fellow Case Reports INTRODUCTION: Extramedullary plasmacytoma (EMP) are rare manifestations of multiple myeloma (MM). We report a case of pulmonary EMP presenting as hilar mass. CASE PRESENTATION: A 51 year old female presented with hearing loss and right facial palsy. Medical history was significant for MM diagnosed 2 years prior, treated with bortezomib-prednisone therapy. 6 months ago, thoracic spine plasmacytoma were found requiring surgical resection and local radiation. Remission was perceived and she was maintained on Thalidomide. MRI brain and spine revealed meningeal enhancement with lytic bony lesions, concerning for metastatic disease. CT chest abdomen pelvis revealed a 4.5 x 5.5 cm right hilar mass with complete right lower lobe (RLL) bronchus occlusion, post-obstructive pneumonia, right pleural effusion, pleural thickening and nodularity. She underwent bronchoscopy with endobronchial biopsy of RLL bronchial nodules and EBUS guided transbronchial needle aspiration of right hilar mass. Pathology was consistent with plasma cell myeloma with plasmablastic features. Given her MM history and absence of EBV, primary plasmablastic lymphoma was less likely. A bone marrow biopsy showed >10% myeloma cells, thus her diagnosis was consistent with relapsed MM with extramedullary plasmacytoma (EMP) rather than primary pulmonary plasmacytoma (PPP). Subsequently she underwent systemic and intrathecal second line chemotherapy, but her course was complicated by rapidly progressive refractory disease and patient chose to pursue hospice care. DISCUSSION: EMP are seen in 7 % patients with MM at the time of diagnosis, whereas another 6% develop it later in the course of illness; these portend poor prognosis. Among them, pulmonary EMP are extremely rare. Other pulmonary complications of multiple myeloma include pneumonia, including organizing pneumonia like consolidation, multiple pulmonary nodules, interstitial infiltrates and pleural thickening and effusion. In contrast, primary solitary extramedullary plasmacytoma is a rare discrete plasma cell neoplasm within soft tissue, without bone marrow involvement or other systemic features of MM. They commonly occur in the aero-digestive tract, of which solitary PPP is a rare type. PPP have better prognosis and longer survival rates compared to EMP associated with MM. Their management also differs, EMP associated with MM are treated aggressively with chemotherapy and local radiation or surgery as needed, whereas solitary PPP are treated with radiation only. CONCLUSIONS: Knowledge of pulmonary EMP and its clinical course is important for physicians, such that the etiology of pulmonary abnormalities in patients with multiple myeloma are evaluated and determined in order to ensure appropriate therapy and patient counseling. REFERENCE #1: Bladé J, et al. Soft-tissue plasmacytomas in multiple myeloma: incidence, mechanisms of extramedullary spread, and treatment approach. J Clin Oncol. 2011;29(28):3805-3812 REFERENCE #2: Varettoni M, Corso A, Pica G, Mangiacavalli S, Pascutto C, Lazzarino M. Incidence, presenting features and outcome of extramedullary disease in multiple myeloma: a longitudinal study on 1003 consecutive patients. Ann Oncol. 2010;21(2):325-330. doi:10.1093/annonc/mdp329 REFERENCE #3: Prasad R, Verma SK, Sodhi R. Multiple myeloma with lung plasmacytoma. Lung India. 2011 Apr-Jun; 28(2): 136-138. DISCLOSURES: No relevant relationships by Jyotirmayee Lenka, source=Web Response No relevant relationships by Naman Sharma, source=Web Response

Acute kidney failure and extramedullary lung infiltration as initial presentation of multiple myeloma - case report

Introduction. Kidney failure in multiple myeloma is some-times initial symptomatology and a very serious complication with an unfavorable effect on the course and prognosis of the disease. Multiple myeloma is a disease characterized by the proliferation of plasmocytes in the bone marrow, and in rare cases, it can be extramedullary in various organs and systems. Pulmonary plasmacytoma localization is a rare extramedullary localization, especially when it represents one of the initial manifestations of multiple myeloma. Case report. We present a patient with progressive acute kidney failure who has started hemodialysis treatment. On chest radiography, a homogeneous shadow was observed along the left chest wall, and the multislice computed tomography (MSCT) pointed to the tumor formation in the pulmonary parenchyma in the projection of the left upper pulmonary lobe with signs of pleural infiltration, intercostal muscles, and V rib destruction. Laboratory examination indicated the presence of Bence-Jones proteinuria in the urine sample in addition to anemia syndrome and azotemia with hyperuricemia. After bronchoscopy and needle biopsy, diffuse infiltration of mature plasma cells was demonstrated in the cytological and histopathological findings of the lungs. The histopathological finding of bone marrow biopsy indicated multiple myeloma of Lambda type with infiltration of plasma cells ? about 70%. The hematologist determined a diagnosis of multiple myeloma BJ lambda III BCS, with extramedullary lung infiltration and acute kidney failure. Further treatment was continued according to the hematological protocol while performing intermittent hemodialysis. Conclusion. Sometimes, extremely rarely, and in completely asymptomatic patients with massive pulmonary infiltration observed initially, the differential diagnosis may also represent an extramedullary presentation of multiple myeloma, which should be considered.

Extramedullary Pulmonary Plasmacytoma in a Dog

Abstract In this case report we are presenting a rare case of primary pulmonary plasmacytoma in a dog in the context of clinical and pathological findings. A six-years-old, female Rottweiler was brought to the clinic with respiratory complaints. The patient was dyspneic and tachypneic, and there were friction sounds on auscultation of the lungs. Laryngeal and tracheal palpation induced severe cough. Lateral and ventrodorsal radiographs of the thorax showed increased opacity in the lungs and loss of cardiac silhouette. Based on clinical and radiological findings, diagnosis of a lung mass was made and surgery recommended. Under general anesthesia, bilobectomy of the right lung lobes by medial sternotomy was performed. Upon cytological and histopathological findings, plasmacytoma was diagnosed.

MULTIPLE ENDOBRONCHIAL PLASMACYTOMAS IN A PATIENT WITH PLASMA CELL LEUKEMIA

SESSION TITLE: Pulmonary Manifestations of Systemic Diesase SESSION TYPE: Fellow Case Report Posters PRESENTED ON: 10/09/2018 01:15 PM - 02:15 PM INTRODUCTION: Plasma cell leukemia (PCL) is a rare and aggressive plasma cell malignancy with an increased frequency of extramedullary involvement compared with multiple myeloma. We present a rare case of newly diagnosed PCL with multiple endobronchial lesions. CASE PRESENTATION: The patient is a 62-year-old woman with past medical history of COPD and granular cell tumor of the epiglottis who presented with increasing lethargy and altered mental status over a five-day period. She was cachectic and found to be oriented only to self, with initial lab work showing evidence of acute renal failure and hyperkalemia as well as a leukocytosis of 32,000/μl, hemoglobin level of 5.5 g/dl, and lipase of 7,676. Chest X-ray revealed multifocal opacities and broad-spectrum antibiotics were started for presumed pneumonia. CT of the head revealed a small intraventricular hemorrhage. She required intubation for progressive respiratory failure as well as vasopressors and CVVH. A bronchoscopy was performed, revealing two nodular endobronchial lesions in the right and left main stem bronchi; cryobiopsy of both lesions showed fibrotic tissue with a dense infiltrate of CD138-positive, lambda-restricted atypical cells, consistent with a high-grade plasma cell leukemia. Peripheral flow cytometry also revealed circulating plasma cells. Cultures sent from BAL were unrevealing. Critical illness precluded a more intensive regimen of chemotherapy and a course of intravenous dexamethasone was initiated. DISCUSSION: PCL is a rare and aggressive form of hematologic malignancy with a very poor prognosis, and can be either primary or secondary to end-stage multiple myeloma. It features a higher frequency of extramedullary involvement, anemia, thrombocytopenia, and acute renal failure than multiple myeloma. Extramedullary involvement in PCL is most commonly seen as hepatosplenomegaly and/or lymphadenopathy, with other reported sites of extraosseous involvement including soft tissue adjacent to bone, skin, liver, breast, and kidneys. Endobronchial involvement, particularly in multiple locations, appears to be an exceedingly rare form of extramedullary spread in both MM and PCL. A literature search reveals only two case reports describing the finding of multiple endobronchial plasmacytomas on histology obtained from bronchoscopy, neither in the setting of plasma cell leukemia. Plasma cell infiltration of the lung, termed “myeloma lung,” is a rare cause of acute respiratory failure in multiple myeloma & PCL, and may have explained persistent consolidations on CT scans that did not improve with antibiotics. Due to the severity of her illness, treatment was palliative, and she ultimately passed from complications of respiratory failure. CONCLUSIONS: The presence of multiple endobronchial plasmacytomas is a very rare presentation of extramedullary involvement in multiple myeloma and plasma cell leukemia and likely predicts an very poor prognosis. Reference #1: Niels W. C. J. van de Donk, Henk M. Lokhorst, Kenneth C. Anderson and Paul G. Richardson. “How I treat plasma cell leukemia.” Blood. 2012; 120(12):2376-2389. Reference #2: Joan Blade, Carlos Fernandez de Larrea, Laura Rosinol, Maria Teresa Cibeira, Raquel Jimenez, Ray Powles. “Soft-Tissue Plasmacytomas in Multiple Myeloma: Incidence, Mechanisms of Extramedullary Spread, and Treatment Approach.” Journal of Clinical Oncology. Oct 2011; 29(28):3805-3812. Reference #3: Carmen Montero, Ana Souto, Iria Vidal, Maria del Mar Fernandez, Marina Blanco, Hector Verea. Three Cases of Primary Pulmonary Plasmacytoma. Archivos de Bronconeumologia. 2009; 45(11):564-566. DISCLOSURES: No relevant relationships by Steven Cassady, source=Web Response No relevant relationships by Madhurima Koka, source=Web Response no disclosure on file for Matthew Paparo; No relevant relationships by Edward Pickering, source=Web Response No relevant relationships by Ashutosh Sachdeva, source=Web Response

Primary pulmonary plasmacytoma: a case report

Primary pulmonary plasmacytoma: a case report

A Rare Case of Pulmonary Plasmacytoma Secondary to Multiple Myeloma

A Rare Case of Pulmonary Plasmacytoma Secondary to Multiple Myeloma

気管支鏡直視下生検により診断され, 肺原発形質細胞腫と考えられた 1 例

気管支鏡直視下生検により診断され, 肺原発形質細胞腫と考えられた 1 例

アミロイド沈着を伴った肺形質細胞腫の1例

症例は80歳，男性．右肺下葉の結節影に対し近医で経過観察中，CTで増大傾向を認め紹介となった．胸部CTでは右肺S9に14mm大の結節影認め，肺癌を疑い手術施行した．胸腔鏡でアプローチ，腫瘍部を針生検したが迅速病理検査で悪性所見を認めなかったため，胸腔鏡下下葉部分切除を行った．最終病理検査では病変部に成熟型の形質細胞が多数増生を認め，間質にはアミロイドの沈着を認めた．免疫染色ではIgA-κ陽性形質細胞が多数で，extraosseous plasmacytoma with nodular pulmonary amyloidosisと診断された．血清および尿にM蛋白を検出せず，骨髄検査でも異常を認めず，肺原発髄外性形質細胞腫と診断した．術後2年経過したが，無再発生存中である．髄外性形質細胞腫の多くは上気道や口腔に発生し，肺に原発するものは稀である．若干の文献的考察を加え報告する．

Pulmonary plasmacytoma in multiple myeloma: a rare case of extramedullary spread

Pulmonary plasmacytoma in multiple myeloma: a rare case of extramedullary spread

Primary pulmonary plasmacytoma: a case report

BackgroundExtramedullary plasmacytoma is a plasma cell malignancy that most commonly occurs in the upper respiratory tract. These tumors account for less than 5% from all plasma cell neoplasms. In most of the cases, tumor first appears in the mucosa of the upper respiratory tract, mainly in the paranasal sinuses. When only located in the lower respiratory tract (primary pulmonary plasmacytoma), the diagnosis is difficult and is usually based on the pathological findings from excised tissue.Case reportWe present one case of primary pulmonary plasmacytoma, which accidentally was diagnosed in our hospital, and this is the first case of primary pulmonary plasmacytoma reported in our country. In the present article, we describe a primary pulmonary plasmacytoma (PPP) of the right lower lobe without loco-regional lymph node involvement, treated radically. The histological finding was confirmed by immunohistochemistry. There was no clinical evidence for the presence of multiple myeloma.ConclusionPrimary pulmonary plasmacytoma present a rare neoplasm which could be differentially diagnostically classified as adenocarcinoma. The diagnosis of this tumor is based on pathological findings from excised tissue. The radical surgical treatment presents primary treatment option and, if there are no signs of the dissemination of the disease or of the presence of multiple myeloma, adjuvant chemotherapy is not needed.

Primary pulmonary plasmacytoma: a case report and review of the literature

Primary pulmonary plasmacytoma: a case report and review of the literature

Primary Pulmonary Plasmacytoma: Unusual Presentation With Coexisting Amyloidosis and Bone Metaplasia

Primary Pulmonary Plasmacytoma: Unusual Presentation With Coexisting Amyloidosis and Bone Metaplasia

Pulmonary plasmacytoma: Exceptional parenchymal tumor in the elderly. About 2 cases

Pulmonary plasmacytoma: Exceptional parenchymal tumor in the elderly. About 2 cases

Localized Pleuropulmonary Crystal-storing Histiocytosis

Crystal-storing histiocytosis (CSH) localized to the thoracic region is a rare occurrence, often secondary to lymphoproliferative or plasma cell diseases. About 10 case reports have been previously published, and 3 of these have no relationship with clonal hematologic disorders. We collected here the first series of 5 consecutive cases of CSH involving lungs (4 cases) and pleura (1 case). There were 3 women and 2 men with a mean age at diagnosis of 65 years. All cases had an underlying hematologic disorder (2 B-cell marginal-zone lymphomas, 2 monoclonal gammopathy of undetermined significance and 1 pulmonary plasmacytoma). Despite a common morphology characterized by a dense and irregular growth of large eosinophilic histiocytes with intracytoplasmic refractile crystals, 2 cases presented with cystic changes at gross and imaging examinations, calcified amyloid was found in 2 cases, and 1 case showed an interstitial lung disease with nonspecific interstitial pneumonia pattern. Histiocytes were immunoreactive for CD68 (clones PGM-1 and KP-1) but were not for CD1a and S100; the associated lymphoplasmacellular disorder had a clonal profile on molecular analysis with κ light-chain restriction. Two cases were originally misdiagnosed as cystic fibrohistiocytic tumor and carcinoid tumor, thus confirming that CSH localized to this site may result in a diagnostic challenge with a broad spectrum of differential diagnoses. The presence of intracytoplasmic crystals and a plasma cell infiltrate around a histiocytic proliferation should alert the pathologist to consider CSH and to carefully investigate the presence of clonal hematologic disease.