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Murine T lymphomas with retroviral inserts in the chromosomal 15 locus for plasmacytoma variant translocations.

The frequent trisomy of murine chromosome 15 in T lymphomas suggests that it bears one or more genes conducive to T-cell neoplasia. One such gene seems to be c-myc, the oncogene frequently activated in B-lymphoid tumours either by retroviral insertion, as in the avian bursal lymphomas, or by a translocation to the immunoglobulin heavy-chain locus, as in the predominant t(12; 15) of murine plasmacytomas and the analogous t(14; 8) of human Burkitt lymphomas. The c-myc gene was strongly implicated in T-cell neoplasia when 15-25% of T lymphomas arising in AKR mice, a strain prone to leukaemia, were found to have retroviral inserts near c-myc. Proviruses near c-myc were also found in several T lymphomas induced by murine leukaemia viruses (MuLV) in both mice and rats, but many of the rat thymomas bear an insert instead at one of several other common sites, at least two of which have murine homologues on chromosome 15. We show here that some murine T lymphomas contain proviral inserts in the recently identified chromosome 15 locus for plasmacytoma variant (6; 15) translocations, which we have denoted pvt-1. Although 6; 15 breakpoints map cytogenetically to the same chromosome band as c-myc, the alterations of pvt-1 in tumours occur at least 72 kilobases (kb) from the c-myc promoters. The insertions in T lymphomas suggest that an altered pvt-1 locus is conducive to neoplasia in T cells as well as B cells, possibly via long-range effects on c-myc expression.

Animals↗

Extramedullary plasmacytoma of the head and neck region: clinicopathological correlation in 25 cases.

Extramedullary plasmacytomas (EMP) of head and neck are rare tumours. Between 1972 and 1993, 25 cases of EMP of head and neck were seen at our institute. The clinical and pathological features and response to treatment are presented. At initial presentation, 23 (92%) patients presented with disease confined to a single extramedullary site only and two patients had in addition clinical involvement of cervical lymph nodes. All except these two patients received radiotherapy to the primary site only as initial treatment. Initial primary control of local disease was obtained in 16 of 24 (67%) patients treated with radical intent. With salvage treatment of further radiotherapy and/or chemotherapy, local disease control was achieved in 21 of 24 (88%) patients. One patient was treated with palliative intent. Conversion to multiple myeloma was seen in two patients (8%). Pathologically, the tumours were classified into low, intermediate and high grade, which correlated closely with outcome. This classification has been used for the first time in extramedullary plasmacytomas and is based on the multiple myeloma grading criteria devised by Bartl et al (1987). Fifteen of eighteen (83%) low-grade tumours and only one of six (17%) intermediate- and high-grade tumours were locally controlled after primary radiotherapy. This is statistically significant for local control (P= 0.0019) but not for overall survival (P= 0.12). The median survival and 5-year overall survival is 68 months and 58.9% respectively. We recommend consideration of adjuvant chemotherapy in patients with higher grade disease.

Adult↗

Depression of cell-mediated immunity in plasmacytoma-bearing mice.

Previous reports have documented that mice bearing plasmacytomas (PC) are suppressed in their ability to mount a primary antibody response, whereas cellular immunity appears to be normal. Studies presented here provide evidence that T cell responsiveness is also depressed in BALB/c mice bearing the Lieberman plasmacytoma (Lpc-1). For instance, splenocytes from mice bearing large tumours were impaired in their in vitro ability to respond to the T cell mitogen, mount an appropriate alloreactive cytolytic T lymphocyte response, and produce interleukin-2 (IL-2). A population of suppressor cells was detected in the spleens 7 days after tumour implantation as evidenced by their ability to prevent normal splenocytes not only from responding to antigens in mixed lymphocyte culture, but also from producing IL-2. A similar inhibitory effect was observed with culture supernatants of these cells, indicating the existence of a soluble suppressive factor. Therefore, the present study demonstrates that cellular immune responses are impaired in mice bearing Lpc-1 tumours and that this effect may be due to the generation of suppressor cells and/or a suppressive factor.

Animals↗

Solitary extramedullary plasmacytoma of the premaxilla.

Solitary extramedullary plasmacytoma is a rare tumour with radiotherapy playing an important role in its management. This report describes the case history of a man with a solitary extramedullary plasmacytoma at an extremely rare site, the premaxilla, that posed certain diagnostic and therapeutic dilemmas. The patient underwent surgery followed by postoperative radiotherapy. The use of two modalities of treatment for this localized tumour has been justified by briefly reviewing the literature and defining the various prognostic factors. These prognostic factors in turn should guide the treatment of these uncommon tumours.

Combined Modality Therapy↗

A nitric oxide synthase inhibitor, N(G)-nitro-l-arginine-methyl-ester, exerts potent antiangiogenic effects on plasmacytoma in a newly established multiple myeloma severe combined immunodeficient mouse model.

Angiogenesis is one of critical factors in sustaining the growth, invasion and metastasis of certain solid tumours and haematological malignancies such as multiple myeloma (MM). In the present study, we examined the anticancer potential of an inhibitor of nitric oxide synthase (NOS), NG-nitro-l-arginine methyl ester (L-NAME), in a novel severe combined immunodeficient mouse model (KHM mouse) that harbours the highly sanguineous plasmacytoma cell line KHM-4, derived from a patient with highly chemoresistant MM. KHM mice were intraperitoneally administered with either L-NAME, doxorubicin, melphalan, or paclitaxel. A significant reduction in tumour sizes was noted in L-NAME-administered KHM mice while no significant reduction was observed in melphalan- or doxorubicin-administered mice. A profound decrease in angiogenesis was observed in tumour tissues from L-NAME- and paclitaxel-administered KHM mice. A marked decrease in human vascular endothelial cell growth factor (VEGF) levels was identified in tumour tissues from L-NAME-administered KHM mice, strongly suggesting that L-NAME suppressed VEGF production by tumour cells through its inhibition of NOS in tumour cells, resulting in reduced neovasculization in mice leading to the regression of tumour sizes. The present data represent the first observations that certain NOS inhibitors potentially serve as experimental agents for the treatment of chemoresistant MM and plasmacytoma.

Angiogenesis Inhibitors↗

IgD myeloma with multiple cutaneous plasmacytomas.

Extramedullary cutaneous plasmacytoma is an uncommon observation in clinical practice. In most of the cases it is usually an extension of underlying medullary plasmacytoma. This case report describes a patient with IgD myeloma who went into plateau phase following standard intravenous chemotherapy. After more than a year in plateau phase, he developed multiple fleshy nodular lesions in the skin. Biopsy of one of the lesions revealed relapse of myeloma in the skin. His IgD paraprotein remained in plateau phase and the bone marrow showed only 1% plasma cells. The patient has been treated with systemic intravenous chemotherapy followed by local radiotherapy.

Aged↗

An autopsy case of primary nodal plasmacytoma associated with Sjögren's syndrome.

An 81-year-old man with a 1 year history of Sjögren's syndrome and hypergammaglobulinemic purpura was admitted because of high fever and lymphadenopathy. Primary nodal plasmacytoma was suggested from the microscopic and immunohistochemical findings of an inguinal lymph node biopsy specimen. Although chemotherapy achieved a moderate response, the patient died 2 months later from respiratory and cardiac failure. We herein, is described a rare autopsy case of primary nodal plasmacytoma associated with Sjögren's syndrome, in which the clinical course was progressive and Epstein-Barr virus-encoded RNA 1 was positive in a small number of neoplastic plasma cells, showing some difference from previously reported cases.

Aged↗

Intraocular extramedullary plasmacytoma in a cat.

An 8-year-old, castrated male Domestic Short-haired cat was referred for evaluation of a possible intraocular neoplasm following previous ocular trauma. The eye was blind, and uveitis and an iridal mass were noted on examination. An enucleation was performed and the mandibular lymph node excised. Histopathologic examination revealed neoplastic proliferation of plasma cells in the iris and lymph node. No other evidence of disseminated disease was detected. This is the first case reported of an intraocular extramedullary plasmacytoma in the cat. The variation in clinical manifestations and potential association with multiple myeloma are not known at this time. Disseminated metastasis from a primary plasmacytoma of the uveal tract could also involve the bone marrow and be indistinguishable from multiple myeloma. Early enucleation, as in trauma-associated sarcomas, may be indicated to prevent metastasis. Periodic systemic evaluation for evidence of multiple myeloma should be performed.

Animals↗

Magnetic resonance imaging of spinal plasmacytoma.

AIM: To describe the magnetic resonance imaging (MRI) features of spinal plasmacytoma. MATERIALS AND METHODS: The clinical records and MRI findings in six patients (five men, one woman; age range 41-61 years) with histologically proven plasmacytoma of the spine were reviewed. All studies included sagittal T1- and T2-weighted spin-echo sequences and axial T1-weighted spin-echo sequences. Intravenous gadolinium DTPA was administered in four cases. RESULTS: MRI showed a characteristic appearances in four cases of low signal intensity curvilinear areas within the vertebra or cortical irregularity. CONCLUSION: Recognition of these imaging features can initiate the appropriate investigation as the commonest differential diagnosis for such lesions is metastasis.Shah, B. K. (2000). Clinical Radiology55, 439-445.

Adult↗

Renal involvement in multicentric Castleman disease with glomeruloid hemangioma of skin and plasmacytoma.

A 47-year-old man presented with fever of unknown origin, generalized weakness, edema, and renal failure. He had left-sided pleural effusion, generalized lymphadenopathy, multiple nontender cutaneous nodules, hepatomegaly, renal failure, and hypergammaglobulinemia. Axillary lymph node biopsy showed findings consistent with Castleman disease of the hyaline vascular type associated with interfollicular plasmacytosis. A renal biopsy performed in view of proteinuria and acute renal failure showed hypercellular glomeruli with capillary loop thickening and double contours consistent with membranoproliferative glomerulonephritis. Skin nodule biopsy showed a glomeruloid hemangioma characterized by dermal proliferation of capillary loops in a nodular manner resembling a glomerulus. He experienced clinical and biochemical remission with steroids. Discontinuation of steroid therapy was associated with recurrence of renal failure, reappearance of nodules, lymphadenopathy, and appearance of bony lytic lesions. Biopsy of bony lytic lesions showed plasmacytoma. The patient achieved complete remission on treatment with steroids and cyclophosphamide and is free of symptoms at the end of 40 months of follow-up. To our knowledge, this is the first case report of the occurrence of membranoproliferative glomerulonephritis, glomeruloid hemangioma of the skin, and plasmacytoma in a patient with multicentric Castleman disease without human immunodeficiency virus infection.

Biopsy↗

POEMS syndrome: cicatricial alopecia as an unusual cutaneous manifestation associated with an underlying plasmacytoma.

POEMS syndrome is a rare condition with cutaneous manifestations commonly including angiomas, hypertrichosis, hyperpigmentation, and thickening of the skin. We describe a male patient with a 2-year history of cervical lymphadenopathy, erythematous thickening of the skin on the neck, and progressive walking difficulties. The patient had an occipital erythema with scarring alopecia and sparse follicular pustules at the edge of the lesion. Further investigation revealed symmetric polyneuropathy, hepatosplenomegaly, monoclonal gammopathy, subclinical thyreopathy, and an osteolytic bone lesion of the skull. Histologically, a plasmacytoma with lambda cell restriction was found. The overlying skin showed marked fibrosis, with loss of hair follicles, and a plasma cell infiltrate of polyclonal origin. The cervical lymph nodes showed histologic characteristics of multicentric Castleman's disease, and the skin of the neck showed thickening and vasoproliferation. There was no evidence of further plamacytomas. After excision of the plasmacytoma and postoperative irradiation, the symptoms gradually resolved within a few months. A cicatricial lesion remained on the occiput without further folliculitis or hair loss on the rest of the scalp. This case illustrates the reactive character of POEMS syndrome as a paraneoplastic syndrome in myeloma patients.

Adult↗

Solitary plasmacytoma of the mandible in a renal transplant recipient.

A solitary plasmacytoma occurring in the mandible of a 15-year-old Korean male 6 years after renal transplantation is reported. The tumour presented as a hyperplastic gingival overgrowth in the right madibular molar area. Histology and immunohistochemistry revealed plasmacytoma and monoclonality of the kappa chain and IgG. In situ hybridization for Epstein-Barr virus encoded RNA (EBER) showed positive signals in the tumour cells. The tumour regressed after reducing the immunosuppressive agents with concurrent radiotherapy. The patient remains in a stable condition with normal renal functions after 7 years without recurrence. This case confirms that Epstein-Barr virus associated B-lymphoproliferative disorders are still a major complication of immunosuppression.

Adolescent↗

[Cardiac metastasis of a plasmacytoma with clinical manifestations of an extensive pulmonary embolism. Obstruction of the right ventricular outflow tract].

HISTORY AND CLINICAL FINDINGS: A 48-year-old man with advanced light-chain plasmacytoma was admitted because of severe dyspnoea and tachycardia. Physical examination revealed peripheral cyanosis and signs of right heart failure. INVESTIGATIONS: The partial pressure of oxygen and CO2 in arterial blood were both reduces (72 mm Hg and 33 mm Hg, respectively). Liver enzyme activities were increased, there was right heart enlargement radiologically and the ECG showed low voltage and typical signs of right heart strain. Echocardiography revealed cardiac metastases of the plasmacytoma with subtotal right ventricular outflow tract obstruction (RVOTO), without any signs of pulmonary emboli. TREATMENT AND COURSE: Palliative radiotherapy to the heart reduced the intracardiac tumor size and improved the patients' general condition. The signs of the RVOTO were markedly reduced in both the ECG and the echocardiogram. But after this initial improvement pneumonia developed, of which the patient died. Autopsy revealed radiation pneumonia with extensive fibrosis as the immediate cause of death. CONCLUSION: In patients with advanced neoplasia cardiac metastasis should be included in the differential diagnosis of dyspnoea, tachycardia or hypotension of uncertain etiology. Echocardiography is the diagnostic tool of choice.

Blood Gas Analysis↗

[Clinical picture and radiology of plasmacytoma. Analysis of 116 cases].

The primary clinical, laboratory, and radiological findings of 116 patients with plasmacytoma were analysed and correlated. Skeletal findings could be seen on the radiograms of 105 of 116 patients (= 90.5%): All of the five patients with solitary plasmacytoma and 96 of 111 patients with multiple myeloma showed osteolyses; four of 111 patients with multiple myeloma showed sole osteoporosis. The leading clinical symptom was skeletal pain; whenever the pain was located in the spine skeletal findings were evident. Paraproteinaemia turned out to be the most important laboratory finding. Its proportion depended on the grade of radiological findings.

Bone Neoplasms↗

[Primary plasmacytoma of the lymph node (plasmocytic lymphoma). The differential diagnosis of nodal plasma-cell proliferates].

HISTORY AND CLINICAL FINDINGS: A 60-year-old man was found on routine examination to have an enlarged, firm, cervical lymph node. He looked older than his age and his general condition was poor. He had no fever, nocturnal sweating or weight loss. Further examination revealed no hepatosplenomegaly on palpation, but numerous enlarged cervical lymph nodes were palpable. INVESTIGATIONS: Histological investigation of a cervical lymph node revealed a marked increase in slightly pleomorphic plasma cells with monotypic expression of IgM-kappa. Multiple myeloma was excluded on the basis of histological and cytological findings in the bone marrow. Serology revealed a mild antibody deficiency syndrome (gamma-globulin 7.8%) with signs of acute inflammation and an increase in alpha 2-globulin. There was no evidence of a monoclonal gammopathy on electrophoresis. A diagnosis of primary nodal plasmacytoma was made. COURSE: As the patient was asymptomatic at diagnosis he was not given chemotherapy. There was no evidence of tumour progression at follow-up examination two months later. His progress will be monitored closely. CONCLUSION: This patient's history is consistent with the prognosis generally associated with primary nodal plasmacytoma that is much better than that of multiple myeloma.

Diagnosis, Differential↗

[Plasmacytomas without paraproteins].

Rare plasmocytomas without paraprotein (frequency less than 1%) can present a diagnostic trap. Three observations give grounds for drawing attention to misinterpretation of symptoms and the problematic nature of the diagnosis. In one patient, a monoclonal immunoglobulin (kappa light-chains) was detectable in the bone-marrow myeloma cells (non-excretory plasmacytoma). In a further patient no paraprotein could be found in the myeloma cells (non-secretory plasmacytoma) despite repeated investigations. An additional unusual feature in a third patient was the simultaneous presence of chronic lymphocytic leukaemia; his plasmocytoma was first detected at autopsy.

Adult↗

Glutamic acid as a precursor to N-terminal pyroglutamic acid in mouse plasmacytoma protein (protein synthesis-initiation-immunoglobulins-pyrrolidone carboxylic acid).

Cell suspensions derived from a mouse plasmacytoma (RPC-20) that secretes an immunoglobulin light chain containing N-terminal pyroglutamic acid can synthesize protein in vitro. Chromatographic examination of an enzymatic digest of protein labeled with glutamic acid shows only labeled glutamic acid and pyroglutamic acid; hydrolysis of protein from cells labeled with glutamine, however, yields substantial amounts of glutamic acid in addition to glutamine and pyroglutamic acid. The absence of glutamine synthetase and presence of glutaminase in plasmacytoma homogenates is consistent with these findings. These data indicate that N-terminal pyroglutamic acid can be derived from glutamic acid without prior conversion of glutamic acid to glutamine. Since free or bound forms of glutamine cyclize nonezymatically to pyroglutamate with ease, while glutamic acid does not, the data suggest that N-terminal pyroglutamic acid formation from glutamic acid is enzymatic rather than spontaneous.

Amino Acyl-tRNA Synthetases↗