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Solitary plasmacytoma of the vertebral column. A report of 15 cases.

The clinical features and the treatment results of 15 patients with solitary plasmacytoma of the spine observed in a 28-year period (1950-1977) are reported. The signs at presentation were back pain in 4 cases and spinal cord compression in 11 cases. Three of these patients had paraplegia. Radiologically, the alteration encountered was an osteolytic lesion in all cases. The local treatment was radiotherapy in 11 cases and surgery plus radiotherapy in 4 cases. In 3 patients systemic chemotherapy was also employed. Seven patients are alive without signs of disease 3 to 9 years (mean 6 years) after diagnosis. Eight patients developed multiple myeloma in a period ranging from 1 to 8 years (mean 3.5 years). The relationship between multiple myeloma and solitary plasmacytoma of the spine, as well as the best treatment for the latter, are discussed.

Adult↗

Cutaneous plasmacytomas in dogs: a morphologic and immunohistochemical study.

Forty-nine cutaneous plasmacytomas in 46 dogs were studied. Tumors occurred at solitary sites in middle-aged to old dogs (mean age, 9.7 years) and most commonly involved the skin of the digits, lips, and ears. Initial diagnosis was made on the basis of light microscopic morphologic findings. Tumors were graded according to the extent of cellular differentiation and immunoreactivity to a panel of immunohistochemical markers (cytokeratins, canine IgG F[ab]2, neurofilament, neuron-specific enolase, S-100 protein, and vimentin). Immunoreactivity was limited to antibodies directed at canine IgG F(ab)2 and vimentin. Vimentin immunoreactivity was usually greater than that of canine IgG F(ab)2, but there was no correlation between immunoreactivity and histologic grade of the tumors. Thirty-six of 39 dogs (92.3%) followed (mean follow-up, 13 months) were cured by surgical excision. The results of this study indicate that canine cutaneous plasmacytomas are benign neoplasms that should be included in the differential diagnosis of cutaneous round cell tumors in dogs.

Animals↗

Cutaneous plasmacytomas with amyloid in six dogs.

Cutaneous plasmacytomas associated with local deposition of amyloid were diagnosed by light microscopy in a series of six older dogs (mean age 10.7 years) consisting of two Cocker Spaniels, a Poodle, a Weimeraner, and two mixed-breed dogs. The neoplasms occurred on the digits (2 dogs), forelimb (2 dogs), lip (1 dog), and ear (1 dog). In most cases, groups of neoplastic plasma cells were widely separated by large homogeneous islands of amyloid. The neoplastic cells had characteristic plasmacytoid features, but the degree of pleomorphism varied greatly between different neoplasms. In four of the six tumors, the diagnosis of plasmacytoma was confirmed by the demonstration of a monoclonal plasma cell population using immunofluorescent staining for anti-canine immunoglobulins. In these tumors, the neoplastic cells reacted with only one class of immunoglobulins (IgG). The amyloid did not react with any of the reagents used. The suspicion that the amyloid was of immunoglobulin origin (primary amyloid) was supported by its retention of birefringence under polarized light after treatment with potassium permanganate and staining with Congo red.

Amyloid↗

Comparison of extramedullary plasmacytomas with solitary and multiple plasma cell tumors of bone.

Patients with solitary osseous plasmacytomas (SOP) differ from those with extramedullary plasmacytomas (EMP) in that they are younger and the proportion of males is smaller. The median survival of the two groups is similar: 86.4 mo for SOP, and 100.8 mo for EMP. Progression-free survival, however, is much better for EMP. Only five EMP patients have progressed following initial radiation therapy: one developed a single bony lesion, two progressed to multiple myeloma, and two developed multiple EMP. Thus, 71% of EMP patients are progression free at 10 yr, and most deaths do not result from plasma cell neoplasia. In contrast, 13 SOP patients have progressed to develop additional osteolytic lesions, so that only 16% of SOP patients are progression free at 10 yr; death resulted from progression to multiple myeloma in most of these patients. In EMP patients the occurrence of involved lymph nodes at the time of diagnosis in seven, and initial relapse in regional nodes in three, suggest that consideration should be given to including regional lymph nodes in the radiation fields used to treat these patients.

Adult↗

Solitary plasmacytoma of bone: treatment, progression, and survival.

Twenty patients with solitary plasmacytoma of bone were treated by radiation therapy. Local control was achieved in 19 and most patients developed systemic myeloma. To evaluate disease progression, 65 patients, including 45 from published series, were analyzed. Younger patients seemed less likely to progress (P = .06), but other clinical characteristics including site of involvement and paraprotein status did not influence progression. After dissemination, patients had a clinical course similar to patients with stage I myeloma, with a median survival of 47 months. Overall, patients with solitary plasmacytoma of bone had an indolent course of disease, with a median survival of 10.7 years and a 5-, 10-, and 20-year survival of 75%, 52%, and 37%, respectively.

Adult↗

Intracranial extension and spontaneous hemorrhage of a sphenoid plasmacytoma.

A 71-year-old woman with IgG multiple myeloma presented initially with a compression fracture of the thoracic spine. She responded to radiation therapy and chemotherapy with melphalan and prednisone. One year later, she died from a plasmacytoma eroding intracranially from the greater wing of the sphenoid bone with an associated subdural hematoma. Uncal herniation had been preceded for several weeks by facial numbness. Cranial and intracranial plasmacytomas may occur as isolated lesions or as part of multiple myeloma and can present clinically in a variety of ways, most frequently with cranial nerve palsies. Large intracranial extensions may produce cerebral compression and spontaneous hemorrhage similar to that seen with other malignant intracranial neoplasms. The differential diagnosis of changes in level of consciousness in myeloma patients should include increased intracranial extension and spontaneous hemorrhage.

Aged↗

Solitary plasmacytoma of the calvarium: two cases treated by operation alone.

Two cases of solitary plasmacytoma of the calvarium operated on with radical removal are reported. The two patients were not submitted to postoperative radiotherapy, unlike other cases reported in the literature. The authors stress that solitary plasmacytoma of the calvarium may have a good prognosis if radically removed, and in these cases radiotherapy is not necessary.

Adult↗

Atypical monoclonal plasma cell hyperplasia of the central nervous system: precursor of plasmacytoma with evolutionary considerations.

Hematopoietic proliferations rich in plasma cells rarely occur within the central nervous system without the involvement of other organ systems. Depending on their histological pattern and cellular composition, several different terms, including plasmacytoma, plasma cell granuloma, hyalinizing plasmacytic granulomatosis, and inflammatory meningioma, are used for these lesions. We report a left temporal dural lesion composed of plasma cells, lymphocytes, histiocytes, and rare eosinophils with hyaline changes and a suggestion of follicle formation, which stained predominantly for IgG and kappa light chains. This lesion arose in an otherwise healthy 52-year-old woman. Free kappa light chains without a monoclonal peak were found in the urine. We are aware of only two other heterogeneous, predominantly plasmacytic, solitary dural lesions that were found to be monoclonal on immunohistochemical examination. The label atypical monoclonal plasma cell hyperplasia appears to suit the morphological characteristics of our lesion. We suggest that a spectrum of solitary plasmacytic lesions may occur within the central nervous system and that atypical plasma cell hyperplasias have the potential to evolve into plasmacytoma. The preneoplastic nature of this lesion and its potential for evolution to malignant myeloma should be considered when planning treatment and lifelong follow-up for patients.

Craniotomy↗

Extramedullary plasmacytoma of the larynx presenting with upper airway obstruction in a patient with long-standing IgD myeloma.

A rare case of upper airway obstruction due to an extramedullary plasmacytoma of the larynx in a patient with long-standing IgD myeloma is presented. Reports of patients with extramedullary plasmacytomas eventually developing multiple myeloma are common, however, the converse appears to be an extremely rare event. Attention is drawn to the problem of acquiring adequate tissue for diagnostic purposes as well as the use of immunohistochemical staining techniques. The patient required an urgent tracheostomy and was treated with radiotherapy.

Airway Obstruction↗

Extramedullary plasmacytoma of the submandibular gland.

Extramedullary plasmacytoma in the submandibular region is rare and on initial evaluation must be distinguished from multiple myeloma. The diagnostic evaluation includes appropriate radiological and pathological studies including immunohistochemistry. We report a case of extramedullary plasmacytoma in the submandibular gland. A review of the literature suggests that it has a good prognosis, if multiple myeloma is excluded. This patient was treated by surgical excision followed by radiotherapy.

Adult↗

Histopathologic and immunophenotypic characterization of extramedullary plasmacytomas in nine cats.

To contribute to the existing body of knowledge in the literature on the apparently rare extramedullary plasmacytoma in cats, lymphoid tumors with plasmacytic cellular morphology taken from nine cats were examined. The paraffin-embedded material was investigated by standard hematoxylin and eosin, and special staining techniques (Giemsa, Congo-red, and periodic acid-Schiff reaction). The tumors also were examined immunohistochemically for the presence of immunoglobulin G, immunoglobulin A, immunoglobulin M, immunoglobulin light chains (lambda, kappa), various amyloid proteins, and FeLV-antigen (p27 protein). An immunoglobulin-producing tumor of plasmacellular origin (extramedullary plasmacytoma [EMP]) could be diagnosed in all cases on the basis of immunohistochemical light-chain expression. All but one of the neoplasms occurred in the skin of older, predominantly male cats. As in humans and dogs, the following types could be identified according to their morphologic features: mature type (two), cleaved type (two), asynchronous type (four), and polymorphous type (one). The tumor tissue of three cats revealed amyloid deposits, which were immunohistochemically diagnosed as ALlambda-amyloid in all three cases.

Animals↗

Primary pulmonary plasmacytoma: a case report.

Most extramedullary plasmacytomas are associated with the upper respiratory tract. Primary pulmonary plasmacytomas are rare, and the treatment is surgical excision. This malignancy advances to multiple myeloma in a minority of patients. The patient in our case report is the first to experience renal failure due to hematologic monoclonal gammopathy. Postoperatively, serum protein electrophoresis reverted to normal.

Aged↗

Primary extramedullary plasmacytoma in cyclosporine-induced gingival overgrowth. A case report.

An unusual solitary extramedullary plasmacytoma developed in the gingiva of a 28 year-old male renal transplant patient with cyclosporine (CyA)-induced gingival overgrowth. On initial presentation, there was no suspicion of a tumor within the lesion. One year later, however, the lesion had increased progressively in size, and its surface was ulcerated. At this time, the lesion was excised by gingivectomy, and histopathological examination revealed plasmacytoma. CyA was discontinued and the patient has been closely observed for 4 years with no recurrence of the gingival lesion.

Adult↗

A rare case of extramedullary plasmacytoma in the mediastinum.

A rare case of extramedullary plasmacytoma in the mediastinum is reported. An 80-year-old man was admitted for further examination of a mediastinal tumor. Chest computed tomography (CT) revealed a large mediastinal mass and right interlobar pleural effusion. Needle biopsy under CT guidance established a diagnosis of plasmacytoma. Immunohistochemical staining revealed that the tumor cells were producing monoclonal IgA kappa. Serum immunoelectrophoresis revealed an IgA kappa monoclonal component with a serum concentration of 5,040 mg/ml. The bone marrow aspiration was normal. Bone roentgenogram and bone scintigram showed osteoporosis but no neoplastic lesion.

Aged↗

Primary extramedullary plasmacytoma of the lung.

A case with primary plasmacytoma of the lung is described. The patient, a 55-year-old Japanese female, who simultaneously had a pulmonary plasmacytoma and bladder carcinoma. The bladder tumor was treated with transurethral resection. Pathologically, the bladder tumor was a non-invasive, papillary transitional cell carcinoma, grade II. The lung tumor was located in the right upper lobe and upper lobectomy was performed. The tumor measured 2.8 x 2.7 x 2.0 cm and had a white-yellowish cut surface. Histologic, electron microscopic and immunohistochemical examinations of the lung tumor revealed monoclonal proliferation of plasma cells (IgA, lambda light chain). There was no evidence of multiple myeloma.

Female↗

Bulky plasmacytoma of the bone with intracranial invasion.

A 56-year-old man with left anterior chest pain showed two well-defined tumors in the left anterior chest wall and left parietal region. A large osteolytic lesion in the parietal bone and several punched-out lesions in the temporal bone were revealed by a skull X-ray examination. He showed monoclonal gammopathy (IgG, kappa type) and Bence Jones proteinuria, but no proliferation of plasma cells was observed in the bone marrow. The tissue specimens from both lesions consisted of abnormal plasma cells, indicating plasmacytoma. Although a bulky intracranial plasmacytoma was present, the patient did not exhibit intracranial hypertensive symptoms, or neurological abnormalities.

Bence Jones Protein↗

Crow-Fukase syndrome associated with extramedullary plasmacytoma.

A patient with extramedullary solitary tumor had progressive sensory motor neuropathy, generalized pigmentation of skin, pretibial edema and gynecomastia. Serological examination of this patient showed monoclonal IgA-lambda gammopathy. Histologically, the tumor was defined as an IgA (lambda type) positive extramedullary plasmacytoma by using peroxidase anti-peroxidase staining. The tumor was accompanied by angiofollicular lymphoid hyperplasia. Pathologically, it was recognized as an extramedullary plasmacytoma associated with Castleman's disease like changes, and was successfully treated by surgical resection, followed by irradiation.

Aged↗