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The sonographic and CT features of a case of solitary plasmocytoma of the liver are described. Dynamic CT findings of the tumor differ only slightly from those encountered in cavernous hemangiomas. Liver biopsy under ultrasound or CT guidance followed by immunohistochemical procedure can provide prompt diagnosis of this rare solitary liver tumor.
Polychemotherapy has improved prognostic parameters of survival in patients with plasmocytoma. The mean survival in patients given long-time prednisone and melphalan treatment is 20 months, in those given polychemotherapy over 30 months. In patients with a slow disease progression the combinations COPP and VMCP give satisfactory results in about 40%, but in a majority of patients more effective treatment is necessary. The authors compare the 5-year survival of two polychemotherapy groups with the prednisone and melphalan group. The mean survival after prednisone and melphalan was 33 months, after polychemotherapy (groups COPP, VMCP) 46 months and 57 months (VMCP + M2), respectively. Survival time was influenced by the clinical stage.
Amyloidosis associated with myeloma and its current classification are examined. The clinical example is reported of a patient with isolated micromolecular plasmocytoma in whom the amyloidosis appeared during the remission of the primary disease. The patient was not seen until a late stage when he was admitted to hospital with severe cardiac decompensation. Echocardiography revealed the location to be the cardiac muscle. The increase in left ventricular mass revealed by the ECG was in contrast with the low ECG voltages. Biopsy showed involvement of the oral cavity. The condition resisted all treatment and the patient died a few months after the onset of the amyloidosis. The view that amyloidosis associated with plasma cell dyscrasias should be classified with primary amyloidosis is supported.
The authors present a case of solitary bony plasmocytoma of the mandibule, with local amyloid deposition. Diagnosis was made at extemporaneous pathological examination, then confirmed by the examination of the fixed surgical sample. Immunoenzymologically the proliferation proved to be monoclonal, with secretion of kappa light chain. The patient was treated by surgical curettage and homologous cancelous bone filling, followed by 5,500 rads of electrontherapy. He was then regularly controlled during 8 years and remained free from local recurrence. All investigations in search of dissemination (Kahler disease) remained negative.
Multiple myeloma is the most frequent type of hemoblastic disorders including paraproteinemia. Most cases show a disseminated involvement; few patients have solitary lesions of the bones or connective tissues. Different localizations are the reason for the multiform clinical picture of the disease. The main symptoms result from neurological and dermatological involvement, less usual are gastrointestinal complaints. Fractures, neurological deficiencies, lack of antibodies and failure of the kidneys determine the course of plasmocytoma. Our case reports are demonstrating examples of the different clinical expressions.
Three murine plasmocytoma tumour which secrete specific antibodies have been studied for the effect of specific antigens (pneumococcal C polysaccharide and dinitrophenylated bovine gamma globulin) on the growth of these tumours in vivo. In each case, the effect of the specific antigen was to inhibit the growth of that tumour which synthesized the specific antibody. Low molecular weight haptens had no effect on tumour growth. We suggest that this antigen specific growth inhibitory effect is a function of the antigen's binding to membrane bound antibody resulting in defective membrane function.
Case report of a 70-year-old woman with plasmocytoma-associated bullous "amyloid purpura" and a lambda light-chain IgA paraproteinemia. Cutaneous hemorrhage with blisters, erosions, and milia in the intertriginous areas were the main clinical features. Amyloid deposits in the walls of blood vessels, and the pericollagenous affinity of the amyloid in the dermis are likely to be responsible for the increased capillary fragility, i.e., the hemorrhagic tendency and the infrapapillary blisters. A differentiation from epidermolysis bullosa acquisita and porphyria cutanea tarda is possible by means of the histological level of the blisters.
It is reported on the symptomatology, diagnostics and therapy in a 54-year-old patient with a micromolecular plasmocytoma of kappa-type. Here particularly the impressionable improvement of the clinical picture after an intermitting impact therapy with melphalan (alkeran) - prednisolone in a period of treatment of approximately 2 years is emphasized.
The results of conventional x-ray examination and skeleton scintiscanning in 32 patients with multiple or monostotic affection of the bones in plasmocytoma in primary diagnosis and after radiation treatment of individual osseous foci, are presented in a comparative study. 15% of the roentgenologically established defects could not be detected via scintiscan. Advantages of conventional x-ray examination are greater accuracy on the extension and danger of fracture or identification of existing fractures of osseous foci. On the other hand, the effects of radiation therapy after high-voltage treatment, or subsequent relapses as well as stationary findings in the bone after high-voltage treatment, are detected more easily by means of scintiscanning.
A report is given about ten patients with an extramedullary plasmocytoma situated in the head/neck region. The diagnostic possibilities, the spontaneous development and the effect of radiotherapy with or without surgical treatment are evaluated. Ablation and subsequent irradiation with a focal dose of at least 50 Gy offer the best changes to achieve a recovery without recurrences. In case of osseous destruction, especially if the primary tumor is localized in the maxillary sinuses, it is very difficult to attain a permanent remission. If only soft tissues, are affected, a combined surgical and radiologic treatment is possible even in case of an affection of regional lymph nodes.
The authors studied the solitary plasmocytoma, since it would appear to pose a triple problem: diagnostic, prognostic and therapeutic. 1. From a diagnostic standpoint, histological interpretation, even by experienced histopathologists would appear to be extremely difficult since study of the course showed that in a significant number of cases a carcinoma develops, indicating that the previous diagnosis was erroneous. 2. From a prognostic standpoint, the course would appear to be extremely variable in terms of survival, this being described in both the French as well as the American literature. However, there is a wide variation in differential statistical studies with regard to mean survival periods. 3. Finally, there is a wide range of opinions concerning therapy. Certain authors adopt a surgical approach only, whilst others use radiotherapy only. Few use a combination of radiotherapy and surgery even though this would appear to be logical since it falls in line with the standard attitude of oncologists concerning solid tumours. Rather than draw any conclusions, it would appear to be desirable to follow up this study with an adequate statistical number in order to define an overall position from both a prognostic as well as therapeutic standpoint.
Extramedullary plasmocytoma occurs in the nasal cavity relatively rarely. Basing upon the case of a 59-year old woman, the authors discuss the difficulties of diagnostic treatment and the course of the disease.
Between the plasma-cell neoplasms the solitary osseous plasmocitoma represents a low percentage of the whole totality. Unlike the multiple myeloma the plasmocytoma is a lesion potencially curable. The diagnose criteria that must fulfil these lesions are detailed. The AA. report a case sitting in the lower jaw. Review of the previous 28 cases communicated in the anglo-saxon literature. Special attention is paid to the radiotherapy on this sickness.
The non-tumorigenic cells of X63-Ag8.653 mouse plasmocytoma line transfected with murine interleukin 2 cDNA (X63-mIL-2) served us as the source of the cytokine to induce or to augment antitumor response in syngeneic BALB/c or semisyngeneic (CD2F1) mice challenged subcutaneously with either "wild" line tumor cells (X63/0) or with non-related methylcholantrene induced BFS1 fibrosarcoma of BALB/c mice. When applied peritumorally in several injections (2 to 6) to mice with non-advanced stages of the tumors, IL-2-secreting cells were able to cause tumor growth retardation in most of the treated mice and to induce tumor rejection in some of them. The combination chemoimmunotherapy was attempted in mice with advanced BFS1 fibrosarcoma using compound CBM-4A (the bromoanalog of ifosfamide) administered at various time (4 h or 3, 5 or 7 days) before the first of two local injections of transfected cells. The strategy proved to be more efficient in the tumor growth inhibition as compared with the cytostatic alone.
Analysis of the case-records of 61 patients with plasmocytoma revealed an equal sex-distribution with a mean age of 58.6 years. The most common initial symptom of the disorder was ossary pain. The diagnosis was confirmed by bone marrow cytology, demonstration of paraproteins in serum and urine and the characteristic radiological changes. Renal insufficiency, immunodeficiency syndrome, fractures and neurological defects complicated the clinical course in many patients.
Four cases of solitary extramedullary plasmocytoma of the larynx (3 men, 1 women) treated with radiotherapy are presented. Laboratory and X-ray examinations showed no evidence of systemic plasmacytoma. One patient was treated with conventional X-ray therapy and 3 patients with telegammatherapy Co-60. All patients survived 10 years with no evidence of disease.
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