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An unusual case of extensive cutaneous and subcutaneous plasmacytomas is reported. Breast involvement was also a feature in this individual. The relevant literature relating to this unusual presentation of myeloma is reviewed.
Class III DNA-dependent RNA polymerases were purified from the mouse plasmacytoma, MOPC 315. RNA polymerases IIIA and IIIB were solubilized from a whole cell extract and resolved by chromatography on DEAE-Sephadex. Chromatography on DEAE-cellulose, DEAE-Sephadex, CM-Sephadex, and phosphocellulose ion exchange resins and sedimentation in sucrose density gradients yielded chromatographically homogeneous Enzymes IIIA and IIIB which were purified approximately 22,000 and 53,000-fold respectively, relative to whole cell extracts. The specific activity of these enzymes was comparable to that reported for other purified eukaryotic RNA polymerases. Sucrose gradient sedimentation analysis suggested a molecular weight of approximately 650,000 for each of the class III enzymes.
Multiple plasmacytomas with IgA paraproteinemia, a low grade lymphoid neoplasm of differentiated B cells rarely seen in the young, were encountered in a 10-year-old child. T cell-depleted allogeneic bone marrow transplantation (BMT) was performed because of progressive disease despite chemotherapy. Donor T cells were infused after transplantation in gradually increasing numbers to achieve a graft-versus-tumor effect. Complete eradication of all tumor masses was achieved following BMT with normalization of serum immunoglobulin levels. The patient remains in complete remission 4 years after BMT. Allogeneic BMT should be considered early in the course of low-grade lymphoid malignancy in the younger age group.
We report the case of a 69-year-old woman presenting with a rapidly enlarging thyroid mass as the first extramedullary symptom of plasmacytoma. Extramedullary locations are found in less than 5% of patients with multiple myeloma and can arise in any tissue. If the patient presents with extramedullary lesions and the radiologist is unaware of the underlying disease process the masses can be mistaken for disseminated metastatic carcinoma or non-Hodgkin's lymphoma.
A case of extramedullary plasmacytoma of the spleen in a 39 years-old man was reported. The tumor occupied almost of the spleen and extended to the transverse colon. 67Ga scintigraphy and MRI, particularly T 2-weighted image were useful in diagnosis of the localization.
A patient with an obstructing, annular duodenal neoplasm is described. Percutaneous fine needle aspiration biopsy, and biopsy performed through an endoscope, confirmed that the lesion was an extramedullary plasmacytoma. The patient had been in clinical remission from multiple myeloma for the preceeding 13 months. Radiation therapy resulted in cessation of symptoms including gastrointestinal blood loss. After 5 months, recurrent obstructive symptoms and melena led to surgical extirpation of the tumor, with relief of all symptoms.
A case of macroglossia is presented the underlying cause of which was a generalized amyloidosis due to a plasmacytoma. Differential diagnosis of macroglossia comprises acromegaly, myxoedema, tumours, allergic reactions, inflammatory diseases, congenital muscular hypertrophy, glycogen storage defects and amyloidosis.
After a brief examination of the recent literature on non-secretory multiple myeloma, the Authors describe the immunohistologic study (peroxidase-antiperoxidase method) of a case of truly non producing plasmacytoma, interesting because of the presence of a small polyclonal plasma cell population within the neoplastic clone. Several possible explanations are considered.
Previous studies have shown that uptake of several alkylating agents occurs by independent transport mechanisms. Uptake of one of these agents, the phenylalanine derivative of nitrogen mustard (melphalan), has been investigated in LPC-1 plasmacytoma cells in vitro. Evidence suggesting that melphalan uptake is an active process is that uptake of free intact melphalan proceeds "uphill" against a concentration gradient, is temperature- and sodium-dependent, and is inhibited by several metabolic antagonists. Other findings supporting the concept that melphalan uptake is carrier-mediated is that uptake follows biphasic Michaelis-Menten kinetics, is chemically specific, and is mediated by at least two separate amino acid transport systems. Uptake by one system was sensitive to DL-beta-2-aminobicyclo[2,2,1]-heptane-2-carboxylic acid, was sodium-independent, and appeared to be mediated by system L. The second unassigned system was characterized by sodium dependence, insensitivity to 2-aminoisobutyric acid and 2-(methylamino)isobutyric acid, and was inhibited by alanine, serine, cysteine, and other amino acids.
The early events following the ligation of interleukin-4 (IL-4) to the plasmacytoma cell line RPMI-8226 were analysed as a model of action for this interleukin on differentiated cells of the B lymphocyte lineage. The addition of recombinant IL-4 to these cells resulted in an increase of the intracytoplasmic free calcium concentration [Ca2+]i, but in contrast to normal B cells, this increase was mostly due to a calcium influx rather than to a mobilization from endoplasmic reticulum stores. IL-4 was also found to trigger cAMP accumulation in RPMI-8226 cells, with kinetics similar to that which has been described for normal resting human B lymphocytes. However, in contrast to normal B cells, IL-4 did not increase CD23 membrane expression on RPMI-8226 cells. But after incubation with high concentrations of IL-4, soluble CD23 (sCD23/IgE-BF) could be detected in the supernatant of these cells. In addition, the proliferation of RPMI-8226 cells was only moderately affected by IL-4. The expression of the receptors for IL-6, a growth factor for plasma cells, was not modified upon incubation of these cells with IL-4. These results therefore suggest that terminally differentiating B cells, such as the RPMI-8226 cell line, share common pathways of activation by IL-4 with mature resting B lymphocytes, but differ in some respects.
A 55-year-old alcoholic man with chronic atypical mycobacterial lung disease developed multiple plasmacytomas in the skin over a 6-month period. There was no evidence of either multiple myeloma or plasma cell leukemia at the time of diagnosis; however, evidence of multiple myeloma became apparent about 7 months later, and the man died, despite therapy for this condition, about 22 months after the initial diagnosis of his plasma cell disorder. Despite the apparent rarity of this clinical presentation, the available evidence suggests it is a harbinger of a relatively aggressive B-immunocytic malignancy.
A 69-year-old male presented with fever, ascites and leg edema in February, 1994. He had a pathological fracture of cervical supine in October. Pathological findings at operation showed plasmacytoma. Bone marrow aspiration showed 16.2% myeloma cells. So he was diagnosed as multiple myeloma presenting biclonal gammopathy of IgA-L and IgD-K. Ascites was massive and drainage of 2 to 4 liter per week was required. Ascites was supposed to be related to multiple myeloma, because the IL-6 level in the ascites was increased (2,440 pg/ml), although repeated cytologic studies were negative. After the operation, he developed hyperammonemic drowsiness. It was also suggested that hyperammonemia was associated with multiple myeloma. In addition to radiation therapy for the cervical lesion, MP therapy, Interferon-alpha, VAD therapy and intraperitoneal cyclophosphamide infusion were administered. But no improvement of ascites or hyperammonemia were noticed. Here we described a case of multiple myeloma with very notable clinical features.
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