Tuberc Respir Dis.  2010 Aug;69(2):129-133.

A Case of Multiple Pulmonary Plasmacytomas after Complete Remission of Multiple Myeloma

• Sung PS
• Song JH
• Park CW

Abstract

Extramedullary plasmacytoma (EMP) is a rare disorder that typically occurs in the upper airway. Although the condition rarely arises in the lungs, a few cases have been reported. Here, we report a case of pulmonary plasmacytoma in 66-year-old man, who had been treated with VAD (vincrestine, adriamycin, dexamethasone) chemotherapy for multiple myeloma. The patient had been declared clear of multiple myeloma after 4 cycles of chemotherapy. Three months later, the patient had multiple masses visible on computed tomography (CT) and on positron emission tomography-computed tomography (PET-CT) with hot uptake. Subsequent studies using CT-guided needle biopsy and immunohistochemical stain showed pulmonary plasmacytoma. Bone marrow biopsy, serum, and urine M protein tests were repeated, showing no evidence of multiple myeloma. Pulmonary plasmacytomas, as extramedullary plasmacytomas, were considered an isolated manifestation of multiple myeloma recurrence. We treated the patient with concurrent chemoradiotherapy and the pulmonary plasmacytomas regressed dramatically.

Keyword

Multiple Myeloma; Plasmacytoma; Lung

MeSH Terms

Aged
Biopsy
Biopsy, Needle
Bone Marrow
Chemoradiotherapy
Doxorubicin
Electrons
Humans
Lung
Multiple Myeloma
Plasmacytoma
Recurrence
Doxorubicin

Figure

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  Figure 1 (A) Chest radiograph on admission showed multifocal mass-like consolidations in left lung field. (B) Follow-up of chest radiograph obtained after chemoradiotherapy showed marked shrinkage of multiple masses in left lung filed.

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  Figure 2 (A) Initial chest CT scan displayed three nodules up to 4 cm were in left lung, and multiple disseminated small nodules were in both lung fields. (B) Chest CT scan after chemoradiotherapy showed much regression of previous lung masses.

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  Figure 3 PET CT showed multiple hot uptakes (SUV, 6.4~7.2) in both lung fields.

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  Figure 4 (A) Photomicrograph of the lung biopsy demonstrated many aggregates of plasma cells, suggestive of plasmacytoma (H&E stain, ×400). (B) Immunohistochemical staining of kappa light chain (H&E stain, ×200).

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