Tuberc Respir Dis.  2015 Jul;78(3):262-266. 10.4046/trd.2015.78.3.262.

A Case of Posterior Mediastinal Plasmacytoma Confounded by Community-Acquired Pneumonia

• Heo D
• Boo KY
• Jwa H
• Lee HY
• Kim J
• Kim ST
• Seo HM
• Han SH
• Maeng YH
• Lee JH

• KMID: 2320653
• DOI: http://doi.org/10.4046/trd.2015.78.3.262

Abstract

Plasmacytomas are extramedullary accumulations of plasma cells originating from soft tissue. Mediastinal plasmacytoma is a rare presentation. A 67-year-old man recovered after antibiotic treatment for community-acquired pneumonia. However, on convalescent chest radiography after 3 months, mass like lesion at the right lower lung field was newly detected. Follow-up chest computed tomography (CT) revealed an increase in the extent of the right posterior mediastinal mass that we had considered to be pneumonic consolidations on previous CT scans. Through percutaneous needle biopsy, we diagnosed IgG kappa type extramedullary plasmacytoma of the posterior mediastinum.

Keyword

Plasmacytoma; Hematopoiesis, Extramedullary; Pneumonia; Diagnosis

MeSH Terms

Aged
Biopsy, Needle
Diagnosis
Follow-Up Studies
Hematopoiesis, Extramedullary
Humans
Immunoglobulin G
Lung
Mediastinum
Plasma Cells
Plasmacytoma*
Pneumonia*
Radiography
Thorax
Tomography, X-Ray Computed
Immunoglobulin G

Figure

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  Figure 1 Chest radiography images of the patient. (A) Initial chest radiography showing multiple pulmonary consolidations. (B) A mass-like lesion without the loss of right cardiac borders on a routine follow-up chest radiography after 3 months.

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  Figure 2 Computed tomography (CT) scan images of the chest. (A, B) Initial chest CT scan showing multiple pulmonary consolidations at both lung fields. (C, D) Follow-up chest CT scan revealing an increased mass in the right posterior mediastinum with improvements in other pneumonic consolidations at other lung fields.

• 

  Figure 3 (A, B) Contrast-enhanced computed tomography (CT) scan images of the chest after treatment of pneumonia. Chest CT scan revealing oval and elongated mass (arrow) with mild enhancement of soft tissue density without any bone destruction.

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  Figure 4 (A) Microscopic examination showing diffuse infiltrates of plasma cells with large and eccentric nuclei with prominent nucleoli and abundant cytoplasm (H&E stain, ×200). (B) Immunohistochemistry showing tumor cells with diffuse reactivity to cytoplasmic monoclonal kappa-light chain reactivity (×200).

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