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Disseminated growth of murine plasmacytoma: similarities to multiple myeloma.

Murine plasma cell tumors share a number of common features with human multiple myeloma, suggesting their possible use as a model for this disease. However, one major difference between the two is the peritoneal localization of murine tumors as opposed to bone marrow residence of malignant plasma cells in early stages of multiple myeloma. We have thus examined the ability of murine plasmacytoma to produce disseminated growth similar to that seen in myeloma or other lymphoid neoplasias. Of four murine cell lines evaluated, all were demonstrated to effect highly metastatic disease involving multiple organs, although variation was observed between lines. A temporal analysis was accordingly performed with the S107 line to assess the pattern of cellular localization. Both light microscopy and PCR analysis revealed that engraftment of plasma cells occurs first in the bone marrow, followed by dissemination to other sites including the spleen, lung, and liver. Cells passaged in vivo through the bone marrow display an entirely different metastatic pattern with no homing preference to bone marrow or any other organ, suggesting the occurrence of a phenotypic change. Microscopic osteolytic lesions were observed adjacent to plasma cell tumor masses in the bone marrow, indicating early stages of bone disease. These findings demonstrate previously unrecognized similarities between the murine and human diseases and suggest the use of this in vivo model for experimental approaches to the treatment of human disease.

Animals↗

[Extramedullary plasmacytoma of the maxilla].

A rare case of extramedullary plasmacytoma in a 71 year old patient is reported. A classification of plasma-cell tumors is given, and differences in the course of the disease, prognosis, and response to treatment between various types of plasma-cell tumors are discussed.

Aged↗

[Extramedullary anaplastic plasmacytoma].

A case of extramedullary plasmacytoma of the maxillary sinus, locally aggressive, in a 65 years old man is presented. Clinical diagnosis of adenocarcinoma was suspected but the pathological study showed an anaplastic morphology, with little plasmacytic differentiation and lack of stain with cytokeratins and epithelial membrane antigen (EMA), immunohistochemical marker of plasmatic cells, among others. Definitive diagnosis was based on light chain restriction and lack of multiple myeloma.

Adenocarcinoma↗

Plasmacytoma of scalp.

An interesting case of plasmacytoma of the scalp is described. Extramedullary plasmocytoma of scalp is rarely reported. This patient was treated with external radiotherapy dose of which was 40 Gy/20 fraction. Disease responded very well to radiotherapy.

Antineoplastic Agents↗

Nonsecretory multiple myeloma in a 26-year-old man with acquired immunodeficiency syndrome, presenting with multiple extramedullary plasmacytomas and osteolytic bone disease.

High grade B-cell lymphoma and leukemia have been well described in patients with the acquired immunodeficiency syndrome (AIDS). Malignant transformation of more differentiated lymphoid cells has not been well described in these patients. We report a 26-year-old man with AIDS-associated multiple myeloma, who had a highly unusual presentation and clinical course. A review of the literature indicates that monoclonal gammopathy in patients seropositive for the human immunodeficiency virus (HIV) is common. Multiple myeloma and extramedullary plasmacytomas, diseases that are extraordinarily rare in young persons, are now being reported in patients with AIDS and should be added to the list of neoplastic diseases now associated with HIV infection.

Acquired Immunodeficiency Syndrome↗

Massive hematuria due to extramedullary plasmacytoma invading the bladder.

Bladder involvement by extramedullary plasmacytoma is a rare condition. A 46-year-old woman with known IgA-lambda multiple myeloma who developed this condition is described. The patient suffered from massive hematuria, which led to hypovolemic shock. Prompt supportive treatment by blood transfusions, fulguration of the bleeding mucosa and continuous bladder irrigation stopped the bleeding. Subsequent bladder irradiation lead only to partial response of the tumor.

Female↗

[Angiofollicular lymphatic hyperplasia with plasmacytoma and polyneuropathy: a case report with immunohistochemical study].

A rare case of a 43-year-old man with polyneuropathy, monoclonal gammopathy, myeloma and Castleman's disease of plasma cell type was diagnosed. Immunohistological examination of the lymph node with Castleman's disease showed polyclonal binding while the myeloma was monoclonal containing IgA with lambda-light chains. At the immunoelectrophoresis IgA/IgA paraprotein was demonstrated. The possible pathogenetical relationship between polyneuropathy and plasmacytoma as well as Castleman's disease will be discussed.

Adult↗

Extramedullary Plasmacytoma of the Breast with Serum IgD Monoclonal Protein: A Case Report and Review of the Literature.

A case of extramedullary plasmacytoma (EMP) of the breast in a 49-year-old woman is reported. Six cases of EMP of the breast have been previously reported inthe world literature, but this case is unusual in that it was associated with serum IgD lamda monoclonal protein detected by serum immuno-electrophoresis. The protein was identical to the immunoprotein found in proliferating cells of the breast. Bone marrow aspiration revealed normal plasma cells indicating that the breast tumor did not represent extramedullary involvement of multiple myeloma or myelomatosis. An associated tumor was found in the nasal cavity after local treatment (mastectomy) of the breast tumor, but the patient remained disease-free 12months after adjuvant chemotherapy using nidlan, natulan, alkelan, prednisone, cyclophosphamide and vincristine.

Journal Article↗

Intracranial plasmacytoma: a case report.

Multiple myeloma may have extraosseous manifestations in the cranial region. It may be a solitary intracranial tumour without any other signs of multiple myeloma, or intracranial disease may be a part of generalised disease, as in the present case. Our patient had received chemotherapy for multiple myeloma for 9 months, with good response. However, her condition suddenly deteriorated, with signs of increased intracranial pressure and a 5-cm-diameter tumour infiltrating the meninges and brain was found in the left temporal fossa. The radiological diagnosis, based on contrast-enhanced CT and angiography, was not straightforward or specific for plasmacytoma, as chemotherapy for the extracranial disease had been successful. Diseases such as meningioma, metastasis, lymphoma, chondrosarcoma or haemangioma had to be considered.

Aged↗

Disseminated extramedullary plasmacytomas.

A 53-year-old man developed multiple, widespread infiltrative tumors of his lips, eyelids, ears, distal fingers and toes, tongue, buccal mucosa, scrotum, and larynx. Biopsy results of three involved sites were similar, with dermal infiltration by well-differentiated plasma cells. Bone marrow aspirate and biopsy were essentially normal. The patient responded well to therapy with cyclophosphamide, doxorubicin, vincristine, and prednisone. Extramedullary plasmacytoma is a rare disease that most often arises in the upper respiratory tract. The relationship of this entity to other forms of myelomatosis is discussed.

Antineoplastic Combined Chemotherapy Protocols↗

Graft-versus-myeloma after donor leukocyte infusion: maintenance of marrow remission but extramedullary relapse with plasmacytomas.

Adoptive immunotherapy with donor leukocytes has emerged as a promising strategy for the treatment of myeloma recurrence after allogeneic transplantation. 2.9 x 10(8)/kg donor mononuclear cells containing 1.4% CD34+ and 37% CD3+ cells were administered to a 48-year-old patient with non-secretory plasmablastic myeloma relapsing 9 months after a blood stem cell transplant from his HLA-identical sibling. In view of the extensive marrow infiltration and the aggressive behaviour of the disease, the donor cells were preceded by a course of EDAP chemotherapy. There was rapid clinical improvement, and CR was achieved on day 30 post infusion. However, three subcutaneous plasmacytomas showing anaplastic features developed within a few days. These failed to respond to interferon-alpha and continued to grow for 5 weeks in the absence of marrow plasmacytosis or other evidence of systemic disease. Grade 3 acute liver GVHD developed on day 79 which was controlled with immunosuppression. Overt systemic relapse occurred on day 90 as the GVHD came under control. The course of our case suggests highly proliferative malignant cells may escape the graft-versus-tumour effect of immunocompetent allogeneic cells in extramedullary sites subsequently resulting in overt systemic relapse if left untreated. New approaches are needed to deal with the problem of extramedullary disease recurrence.

Bone Marrow↗

[Infiltration patterns of plasmacytomas in magnetic resonance tomography].

PURPOSE: To define the different infiltration patterns in the spine in multiple myeloma, in correlation with histological and clinical findings. Quantitative signal evaluation with contrast media (Gd-DTPA). To compare the results in MRI with X-ray films. MATERIAL AND METHODS: 61 patients with proven multiple myeloma and 50 controls were examined (1.0 Tesla, T1-w SE, opposed phase GE images). RESULTS: Five infiltration patterns with different clinical stages were detected: normal bone marrow (11%) in cases of low interstitial marrow infiltration (biopsy), pure diffuse infiltration (25%), focal involvement (33%), combined diffuse/focal infiltration (23%) and a "salt-and pepper" pattern (8%). In diffuse plasmacytoma the 40% signal intensity increase was modification of diffuse infiltration. MRI proved to be more sensitive than radiography. CONCLUSION: MRI is able to show the type and the extension of bone marrow infiltration in multiple myeloma. Diffuse involvement can be objective with gadopentetate dimeglumine.

Adult↗

[Primary extramedullary plasmacytoma of the head-neck area].

BACKGROUND: A primary extramedullary plasmacytoma of the head and neck is a rare neoplasm with an incidence of 1%. The clinical features depend on localization. PATIENTS: The clinical features, the method of diagnosis, and response to treatment of two cases with different localization were analysed. RESULTS: For diagnosis immunohistological and serological investigations are necessary. CONCLUSIONS: The method of treatment is determined by complete staging.

Biomarkers, Tumor↗

The plasmacytoma growth inhibitor restrictin-P is an antagonist of interleukin 6 and interleukin 11. Identification as a stroma-derived activin A.

A stromal protein, designated restrictin-P, that specifically kills plasma-like cells was purified to homogeneity and shown to be identical with activin A. The specificity to plasma-like cells stemmed from the ability of restrictin-P/activin A to competitively antagonize the proliferation-inducing effects of interleukin (IL) 6 and IL-11. Restrictin-P further interfered with the IL-6-induced secretion of acute phase proteins by HepG2 human hepatoma cells and with the IL-6-mediated differentiation of M1 myeloblasts. A competition binding assay indicated that restrictin-P did not interfere with the binding of IL-6 to its receptor on plasma-like cells, suggesting that it may act by intervening in the signal transduction pathway of the growth factor. Indeed, concomitant addition of restrictin-P and IL-6 to cytokine-deprived B9 hybridoma cells was followed by sustained overexpression of junB gene until cell death occurred, while IL-6 alone caused a transient increase only. This altered response to IL-6 stimulation was accompanied by a moderate increase in STAT protein activation. Thus, in this study, we identified the plasmacytoma growth inhibitor, restrictin-P, as being activin A of stromal origin. It is shown that activin A is an antagonist of IL-6-induced functions and that it modifies the IL-6 signaling pattern.

Activins↗

Synthesis and secretion of light-chain immunoglobulin in two successive cycles of synchronized plasmacytoma cells.

Suspension-cultured mouse plasmacytoma cells (MPC-11) were accumulated in the late G1 phase by exposure to isoleucine-deficient medium for 20-24 h. The arrested culture was fed with complete medium enabling the cells to continue the cell cycle synchronously, undergo mitosis, and enter a second cycle of growth. This method of synchronization left the protein-synthesizing ability intact as judged by the polysome profile and the capacity of the cells to incorporate labeled amino acids into protein after the restoration of isoleucine. After incubation in isoleucine-deficient medium and the addition of isoleucine to the culture, cells entered the S phase after a short lag, as judged by [3H]thymidine incorporation into nucleic acid and by spectrophotometric measurement of nuclear DNA. The cells were in mitosis between 12 and 18 h as judged by the increase in cell count and analysis of cell populations on albumin gradients. Synthesis and secretion of light-chain immunoglobulin were maximal in the late G1/early S phase of the first cycle. During late S phase, G2 phase, and mitosis, both synthesis and secretion were observed to be at a low level; however, immediately after motosis the cells which then entered the G1 phase apparently commenced synthesis of light chain immunoglobulin straight away, although secretion of labeled material remained at a low level.

Cell Count↗

Plasmacytoma of the lung associated with nodular deposits of immunoglobulin.

A case of extramedullary plasmacytoma of the lung associated with nodular immunoglobulin deposits is presented. The main tumor was located in the posterior basal segment of the lower lobe of the left lung and showed intrabronchial polypoid growth. Multiple metastatic tumors were observed in regional lymph nodes and the visceral and parietal pleura. Histologically, the tumor was composed of sheets of plasma cells with mild atypia. A large amount of amorphous material resembling amyloid was observed in the tumors, and was more marked in the metastatic lesions. Immunohistochemically, the tumor cells were shown to contain monoclonal IgG-kappa immunoglobulin. The amorphous deposits were not identical to amyloid since congo red stain was negative and amyloid fibrils were not observed ultrastructurally. By Western blotting, immunoglobulin (IgG, kappa) was identified as the major component in an extract from the nodular deposits. In the preoperative serum from the patient, M-protein (IgG-kappa) was detected by immunoelectrophoresis. Bone marrow examination revealed no abnormality.

Female↗

CT of disseminated plasmacytoma in an AIDS patient.

It is well known that acquired immunodeficiency syndrome (AIDS) is associated with increased risk of neoplasms, particularly Kaposi sarcoma and non-Hodgkin lymphoma. There have been several recent reports in the literature describing plasma cell tumors in AIDS patients. We report the imaging findings in a case of widely disseminated plasmacytoma in a patient with known AIDS.

Acquired Immunodeficiency Syndrome↗