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Solitary dural plasmacytoma: case report.

Solitary intracranial plasmacytomas are exceedingly rare. Before this case report, only 14 cases of solitary dural and 4 cases of intracerebral plasmacytomas had been reported in the literature. We present a case of solitary plasmacytoma originating from the right frontal dura mater in a 52-year-old man; we also review the literature on the previous cases. To our knowledge, our patient is the first patient with a solitary dural plasmacytoma to be examined with magnetic resonance imaging.

Dura Mater↗

Plasmacytoma of the larynx.

Plasmacytoma involving the larynx is very rare. To the best of our knowledge there are only 79 cases reported in the world literature. We are adding 3 more cases; 2 cases were associated with multiple myeloma and 1 was considered to be a solitary or extramedullary plasmacytoma. The clinical picture was hoarseness and upper airway obstruction. In plasmacytoma of the larynx multiple biopsies are often nondiagnostic, sometimes revealing only chronic inflammation and amyloid infiltration in the tissues. Most authors agree that the treatment of choice is conservative surgical excision and radiation therapy. Surgery may also be reserved to excise residual scar tissue and fibrosis after treatment mainly to improve the airway and eliminate the tracheostomy tube. To confirm the definitive diagnosis of solitary plasmacytoma of the larynx, long-term follow-up of many years is necessary in order to rule out multiple myeloma.

Aged↗

Oncologic progression of bone plasmacytomas to multiple myeloma.

PURPOSE: To evaluate the clinical aspects, diagnoses, prognostic factors, and percent progression of plasmacytoma to multiple myeloma. MATERIALS AND METHODS: 103 medical records of patients suspected of plasmacytoma were surveyed covering the period between 1950 and 1998, and 30 were selected for analysis. Patients were classified into 2 groups: patients who did (n = 17) and did not (n = 13) progress to multiple myeloma. Comparative statistics regarding a variety of clinical aspects were developed. RESULTS: Patients who progressed to multiple myeloma were younger than those who did not (52.3 +/- 2.6 vs 62.6 +/- 3.4 years; mean +/- SEM; P = 0.02). There were no significant differences in gender between groups. A higher incidence of multiple recurrence was observed in patients who progressed to multiple myeloma (75%, P = 0.049). Both groups showed a prevalence of vertebral column injuries. No significant differences were found between groups regarding the disease period (from the onset of symptoms until diagnosis) (P = 0.20) and survival (P = 0.34). The average time to progression from plasmacytoma to myeloma was 41 +/- 39 months (mean +/- SD), and the progression rate was 57%. CONCLUSION: Patients who progressed to multiple myeloma were younger than those who did not. No significant differences were found between groups regarding sex, time from symptom onset to diagnosis, and survival time. In both groups, the most affected anatomic location was the vertebral column, and most affected sex was male. The average time to progression to multiple myeloma was 41 months. It was not possible to determine the factors that influenced the survival of patients with plasmacytoma or for those who progressed to multiple myeloma.

Age Factors↗

An autopsy case of Crow-Fukase syndrome which developed 18 years after the first manifestation of plasmacytoma.

A 57-yr-old woman developed Crow-Fukase syndrome 18 yr after resection of plasmacytoma of the rib. Irradiation applied to the relapsed plasmacytoma and systemic chemotherapy alleviated symptoms and signs, but the tumor relapsed in the unirradiated cervical lymph node and she died of Pseudomonas pneumonia during chemotherapy 3 yr after diagnosis. Biopsy of the lymph node revealed proliferation of IgG-lambda-positive atypical plasma cells while autopsy revealed plasmacytoma remnant in the pleura of the affected side 21 yr before. No amyloid was found on autopsy. Crow-Fukase syndrome can develop long after the origination of plasmacytoma.

Female↗

Inhibitory effect of lipopolysaccharide-stimulated P388D1 macrophage-like cells on plasmacytoma cells.

Culture supernatants of lipopolysaccharide-stimulated P388D1 macrophage-like tumor cells showed a growth inhibitory effect on plasmacytoma MOPC-315, MPC-11 and myeloma FO cells, but had no effect on J558 plasmacytoma cells. Based on the results of trypan blue staining and a 51Cr release assay, the supernatant had both cytotoxic and cytostatic activity for MOPC-315 plasmacytoma cells. The inhibitory activity was trypsin-sensitive, heat-stable at 100 degrees C for 20 min., but sensitive to 2-mercaptoethanol and cystein HCl. At least 6 hrs of exposure period were required for the P388D1 culture supernatant to show an inhibitory effect on plasmacytoma cells. Since the inhibitory activity could not be blocked by protease inhibitor or neutralized by antibodies to mouse IL-1 beta, IL-6 and TNF-alpha, the inhibitory factor(s) was distinct from the defined cytotoxic factors. After partial purification with DEAE-Sephacel and Sephacryl S-300 chromatography, four major active peaks with the molecular mass of 874-KDa (near the void volume), 112-KDa, 45-KDa and 18-KDa were obtained.

Animals↗

Management of intracranial plasmacytoma.

The authors report on a study of eight cases of intracranial plasmacytoma to identify the risk of progression to multiple myeloma and suggest the treatment required for cure of solitary lesions. The diagnosis of multiple myeloma or myelomatous changes was made in the immediate postoperative period in four patients (50%), two of whom had skull base lesions. Of the four remaining patients, three were treated with complete surgical resection and radiation therapy and had no recurrence of plasmacytoma or progression to multiple myeloma during mean follow up of 12 years (range 2-25 years); one patient underwent subtotal surgical resection and had recurrence of the tumor despite radiation therapy. It is concluded that multiple myeloma is unlikely to develop during the long term in patients with intracranial plasmacytoma who do not develop multiple myeloma or myelomatous changes in the early postoperative period. However, lesions that infiltrate the skull base are not likely to be solitary, and patients who harbor these neoplasms should undergo complete evaluation and close follow-up review to exclude multiple myeloma. A recurrence of solitary intracranial plasmacytoma is possible with subtotal surgical resection despite radiation therapy. Definitive treatment should consist of complete surgical resection with adjuvant radiation therapy.

Adult↗

Dural plasmacytoma revealing multiple myeloma. Case report.

The authors describe the case of a 72-year-old woman with dural plasmacytoma revealing an immunoglobulin (Ig) G-kappa multiple myeloma (MM). She presented with headaches and left hemiparesis. Magnetic resonance imaging demonstrated a right frontal extraaxial lesion arising from the dura mater, and biological studies revealed hypercalcemia, hyperproteinemia, and a serum gamma globulin peak. A diagnosis of IgG-kappa MM was based on microscopic examination and immunohistochemical analysis of the dural plasmacytoma as well as on signs of systemic myeloma after surgery. The patient died 3 years after the first symptoms of MM despite systemic chemotherapy and no recurrence of the dural plasmacytoma. Myelomatous involvement of the dura mater is a rare occurrence given that only three cases have been reported to date. Nevertheless, this pathological entity should be differentiated from solitary dural plasmacytoma (SDP) because the prognosis is radically different. Progression seems to be correlated with systemic disease in contrast to the long-term survival associated with SDP. Careful systemic evaluation should be made in such a presentation to rule out MM, which would require different management and has a different prognosis.

Aged↗

Passive immunity to murine plasmacytoma by rabbit antiidiotypic antibody to myeloma protein.

Antiidiotypic antisera to LPC-1 and MOPC-300 plasmacytoma globulins were produced in rabbits by immunization with the corresponding antigen and exhaustive immunoabsorption with normal BALB/c plasma and other myeloma globulins. IgG fractions of these antisera when given intraperitoneally on three consecutive days after tumor implantation, protected the animal specifically from the grafting of the corresponding plasmacytoma or induced regression of the tumors after their initial grafting and growth. In vitro cytotoxicity of the antisera to plasmacytoma cells was not demonstrated. Plasma of the antisera-treated normal BALB/c mice, though containing antiidiotypic antibody in high titers (320-640), was not cytotoxic to tumor cells. The inhibitory effect on tumor growth can be considered the result of passive immunization against plasmacytoma with xenogeneic humoral antibody.

Animals↗

A case of extramedullary plasmacytoma arising from the posterior mediastinum.

Plasmacytomas are a localized proliferation of plasma cells in the bone marrow, and are less frequently seen in extraosseous organs or tissues. Extramedullary plasmacytoma is a rare malignant neoplasm, and is especially uncommon when it arises from the mediastinum. Here, we report on a case of posterior mediastinal extramedullary plasmacytoma in a 64-year-old man. He was admitted with an asymptomatic right apical mediastinal mass, which was provisionally diagnosed as a neurogenic mass. However, a subsequent investigation revealed that this tumor was a rare case of IgG kappa type extramedullary plasmacytoma arising from the posterior mediastinum. The patient was treated with local radiation to the mediastinum and is doing well without further evidence of disease.

Biopsy, Needle↗

A case of primary plasmacytoma of lymph nodes.

Extramedullary plasmacytoma may originate in any organ, either as a primary tumor or as a facet of systemic multiple myeloma. These solid lesions most commonly affect the upper respiratory tract, gastrointestinal and urogenital tract, skin, and lung. Primary plasmacytoma of the lymph node is a rare hematologic neoplasm, which usually manifests as an enlargement of the cervical lymph nodes with no evidence of any other plasma cell dyscrasia. A 56-year-old man was admitted, due to the presence of multiple palpable masses in the right cervical and submandibular areas. Surgical resection revealed plasmacytoma of the lymph nodes. According to our full work-up, no evidence of the systemic involvement of plasma cell dyscrasia was discovered and thus, the diagnosis of primary plasmacytoma of the lymph node was made. Radiotherapy was administered, and the remnant mass was reduced substantially, to 1x2 cm in size. The patient was scheduled to be monitored by a PET CT scan, as well as by a neck CT scan.

Biopsy, Needle↗

Atrial plasmacytoma and hypercalcemia.

OBJECTIVE: To describe a patient with hypercalcemia due to multiple myeloma and an associated atrial plasmacytoma. METHODS: A case report is presented with clinical and laboratory findings. We review the differential diagnosis of hypercalcemia and discuss multiple myeloma and plasmacytomas. RESULTS: A 48-year-old woman presented to the emergency department with lethargy after sustaining trauma to the head. She was found to have a subdural hematoma and a parietal intraparenchymal hemorrhage. She had a serum calcium level of 17.2 mg/dL (normal, 8.4 to 10.6), anemia, thrombocytopenia, and renal insufficiency. Serum protein electrophoresis revealed a monoclonal gammopathy, and a bone marrow biopsy specimen was consistent with multiple myeloma. The patient required surgical evacuation of her subdural hematoma. Postoperatively, multiple complications developed, including a supraventricular tachycardia. She did not regain consciousness, and ventilatory support was withdrawn. On autopsy, she was found to have disseminated myeloma and an atrial plasmacytoma. CONCLUSION: This case report emphasizes the need to consider a plasmacytoma as a manifestation of multiple myeloma when localizing symptoms are present.

Bone Marrow↗

Colorectal plasmacytomas: a retrospective study of nine dogs.

Nine cases of colorectal plasmacytomas diagnosed between 1998 and 2001 were reviewed. Treatment consisted of complete surgical resection when possible. Two dogs had multiple plasmacytomas. Two dogs had local recurrence of the tumor at 5 and 8 months after resection. Two dogs were alive at 20 and 23 months with no recurrences at the time of follow-up. The median survival time was 15 months (range 5 to 33 months). Colorectal plasmacytomas are similar to mucocutaneous plasmacytomas, in that they tend to progress slowly and do not recur with complete excision.

Animals↗

Primary plasmacytoma arising in an endocervical polyp with detection of neoplastic cells on papanicolaou test. A case report and review of the literature.

Primary plasmacytomas of the female genital tract are extremely rare and present a substantial diagnostic challenge. Five cases morphologically representing plasmacytomas and localized to the uterine cervix have been reported previously; however, only 1 was shown to be monotypic for immunoglobulin light-chain expression. We report the case of a 37-year-old woman who had highly atypical plasma cells on her Papanicolaou test. A clinically detected endocervical polyp was removed and revealed a plasmacytoma, the diagnosis of which was substantiated by demonstrating monotypic lambda-light-chain restriction and a clonal immunoglobulin heavy-chain gene rearrangement. The cytologic and histopathologic findings of plasmacytomas of the uterine cervix are discussed, including the utility of immunophenotypic and molecular techniques to confirm the neoplastic diagnosis.

Adult↗

Extraosseous (extramedullary) plasmacytoma of the adrenal gland.

Plasmacytomas are clonal proliferations of atypical plasma cells that manifest a localized osseous or extraosseous growth pattern. Although many represent solitary lesions of bone, fewer arise in extraosseous (extramedullary) tissues. We report a case of a primary extraosseous plasmacytoma of the adrenal gland. Magnetic resonance imaging (MRI) with contrast revealed a 3.5-cm, right adrenal mass with heterogeneous enhancement. Although the mass was small and nonfunctioning, concern for malignancy based on MRI findings prompted laparoscopic resection. Histologic and immunohistochemical findings were consistent with a plasmacytoma. This is the third reported case, to our knowledge, of a primary plasmacytoma of the adrenal gland. The present case is unique in that a contrast MRI was performed, which showed heterogeneous enhancement of the mass, providing further evidence beyond heterogeneous hyperintensity on T2-weighted images for a possible malignant process. Another unique feature is that a biopsy specimen of the lesion was taken, although it was nondiagnostic.

Adrenal Cortex Neoplasms↗

Constitutive activation of STAT3 is associated with the acquisition of an interleukin 6-independent phenotype by murine plasmacytomas and hybridomas.

Interleukin 6 (IL-6), the major growth factor for myeloma cells, signals through the activation of signal transducers and activators of transcription (STAT) proteins. An important step in the malignant progression of murine plasmacytomas is the transition from dependence on IL-6 to a state of IL-6 independence. To elucidate the mechanism whereby IL-6 independence occurs, intracellular signaling events elicited by IL-6 in both IL-6-dependent and -independent plasmacytomas and hybridomas were compared. It was found that STAT3, a key molecule involved in IL-6 signaling, was constitutively activated and phosphorylated in IL-6-independent cell lines compared to the IL-6-dependent cells. Further comparison of upstream signaling pathways revealed that JAK-1 was constitutively present in anti-phosphotyrosine immunoprecipitates of IL-6-independent cells; gp130 was constitutively phosphorylated in a subset of IL-6-independent plasmacytomas, whereas other IL-6-independent lines showed no detectable gp130 phosphorylation in the absence of exogenous IL-6. Secretion of a factor capable of supporting the growth of IL-6-dependent cells was observed in one of the IL-6-independent plasmacytomas, but not in others, making an autocrine mechanism an unlikely explanation for IL-6 independence. These findings provide evidence that the constitutive activation of STAT3, either in the absence of detectable receptor-proximal events or associated with the concomitant activation of gp130, can contribute to the process of IL-6 independence.

Animals↗

[Extramedullary primary cutaneous plasmacytoma. Description of a case] .

Primary cutaneous plasmacytomas of the chest wall are very rare. In this report we describe a case of a 70-years old man, affected by chronic obstructive pulmonary disease and renal failure. He was admitted because of a painful tumor on the right lateral chest wall: a transcutaneous fine needle aspiration and excisional biopsy revealed as a metastasis from lung cancer without clinical and or radiological evidence of pulmonary tumors and or other neoplasms. Because of failure of chemotherapy, the patient had undergone to bone marrow biopsy that it revealed medullary plasmacytosis < 5% plasma cells with a beta 2 microglobulin elevated. An other following excisional biopsy of a chest wall with immunocytochemistry revealed to be a cutaneous plasmacytomas. The patient was treated with local irradiation for a total dose of 40 cGy and systemic chemotherapy, stopped because of death by myocardial infarction. Cutaneous plasmacytomas appear to be more aggressive than non cutaneous extramedullary plasmacytomas; they should be separately categorized from them in future studies.

Aged↗

[Metastases in peripheral lymph nodes as the first sign of anaplastic skeletal plasmacytoma--2 case reports].

The paper discusses two unusual cases of solitary skeletal plasmacytoma and multiple myeloma presenting clinically as a metastatic disease in cervical lymph nodes. The pathology report of lymph node plasmacytoma initiated an extensive clinical search for eventual discovery of skeletal disease in both patients. We are not aware of any report in the literature dealing with this issue (Medline 1970-2000). The early involvement of lymph nodes by plasmacytoma with the appearance of undifferentiated neoplasm is challenging and poses great difficulties in correct diagnosis; this is almost impossible from hematoxylin eosin slides. The problem is that one has to think about the rare possibility of metastasing plasmacytoma in differential diagnosis of anaplastic tumors in lymph nodes. Immunohistochemistry and clinical records are very helpful in making a final diagnosis.

Adult↗

Extramedullary plasmacytoma manifesting as a palpable mass in the nasal cavity.

We report a rare case of plasmacytoma of the nasal cavity in a 60-year-old man. The patient had a history of a steadily growing and palpable mass in the opening of the left nostril. The tumor was found to be localized, and it was identified as an extramedullary plasmacytoma. The patient underwent therapy with 55 Gy of radiation. Six months following the cessation of radiotherapy, the size of the tumor had not changed. The mass was then completely excised under microscopic vision. Histopathologic examination identified the growth as a plasmacytoma with monotypic light-chain expression. To optimize the management of patients with an extramedullary plasmacytoma of the head and neck, interdisciplinary management is mandatory.

Humans↗