Extramedullary plasmacytoma of the testis is extremely rare and usually associated with multiple myeloma. A 59-year-old man presented with painless enlargement of his left scrotal content. The initial clinical diagnosis was left testicular tumor. Left radical orchiectomy was performed immediately and histopathology showed plasmacytoma. Extensive investigations including skull series, bone C-T, bone biopsy and immunoelectrophoresis revealed multiple myeloma which had bone involvements and immunoglobulin abnormalities. Chemotherapy was done with melphalan and prednisolone. The presenlalion, evaluation and management of this extremely unusual tumor are reviewed.
Biopsy ; Diagnosis ; Drug Therapy ; Humans ; Immunoelectrophoresis ; Immunoglobulins ; Melphalan ; Middle Aged ; Multiple Myeloma* ; Orchiectomy ; Plasmacytoma* ; Prednisolone ; Skull ; Testis*

Extramedullary plasmacytoma is a rare presentation of plasma cell dyscrasia. Most such tumors arise on the upper aerodigestive tract and renal plasmacytoma is very rare. The patient was 44 years old female presented with a 3 month-history of palpable mass in the right flank. There was a past history of complete remission after a chemotherapy for multiple myeloma (6 cycles of VAD chemotherapy) for the two years following the first diagnosis. After surgical resection, histologic and immunofluorescence studies of resected specimens revealed that the renal parenchyma was destroyed by sheets of mature plasma cells producing monoclonal protein (IgG-lambda) and by deposits of amorphous eosinophilic substance stained with anti-lambda antisera. Treatment with chemotherapy of Hyper-CVAD and local irradiation was done. The patient has been disease-free for 3 months after treatment. We report a case of relapsed renal plasmacytoma after complete remission of multiple myeloma.
Adult ; Diagnosis ; Drug Therapy ; Eosinophils ; Female ; Fluorescent Antibody Technique ; Humans ; Immune Sera ; Multiple Myeloma* ; Paraproteinemias ; Plasma Cells ; Plasmacytoma*

Plasmacytoma in patients with multiple myeloma usually develops in the advanced stage of the disease. We report herein an atypical case of extramedullary relapse of multiple myeloma that presented as mechanical obstruction of the small bowel in a patient who had achieved complete remission after chemotherapy. A 75-year-old man was diagnosed with multiple myeloma 25 months previously and treated with a bortezomib-containing chemotherapy regimen. He presented for evaluation of abdominal pain. A circumferential mass resulting in mechanical ileus was observed by abdominal computed tomography. Biopsy after surgical resection confirmed the diagnosis of plasmacytoma. The patient was subsequently treated with thalidomide-containing chemotherapy, but he died of disease progression after 6 months. We suggest careful observation of unusual relapses of multiple myeloma in patients who have achieved complete remission after antimyeloma therapy.
Abdominal Pain ; Aged ; Biopsy ; Diagnosis ; Disease Progression ; Drug Therapy ; Humans ; Ileus ; Intestinal Obstruction ; Multiple Myeloma* ; Plasmacytoma ; Recurrence*

No abstract available.
Adult ; Antineoplastic Combined Chemotherapy Protocols/therapeutic use ; Biopsy ; Female ; Humans ; Immunohistochemistry ; Lung Neoplasms/*diagnosis/drug therapy ; Multiple Pulmonary Nodules/*diagnosis/drug therapy ; Plasmacytoma/*diagnosis/drug therapy ; Tomography, X-Ray Computed

Plasmacytoma refers to malignant plasma cell tumor, which consists of abnormal proliferation of plasma cells. It can be classified into several types, multiple myeloma, solitary medullary plasmacytoma and extramedullary plasmacytoma according to clinical and histological aspects of the tumor. Multiple myeloma is the most common plasmacytoma and its main feature is the infiltration of plasma cells into the bone marrow. Over 10% of plasma cell count among the nuclear cells in the bone marrow biopsy allows diagnosis of multiple myeloma. This involves multiple organs and extramedullary sites including the spleen, liver, lymph nodes and kidney; however, the involvement of nasal cavity and paranasal sinus is rare. Recently, we experienced a case of multiple myeloma, which was present in both nasal cavities and paranasal sinuses. The case was treated with chemotherapy and radiotherapy followed by autologous bone marrow transplantation. We report on it with literature review.
Biopsy ; Bone Marrow ; Bone Marrow Transplantation ; Diagnosis ; Drug Therapy ; Kidney ; Liver ; Lymph Nodes ; Multiple Myeloma* ; Nasal Cavity ; Paranasal Sinuses* ; Plasma Cells ; Plasmacytoma ; Radiotherapy ; Spleen

BACKGROUND: Kaposi's sarcoma-associated herpesvirus (KSHV) been shown to be associated with human diseases including Kaposi's sarcoma, pleural effusion lymphoma, multicentric Castleman's disease. The IL-6 may both stimulate myeloma growth and prevent apoptosis of malignant plasma cells. Interestingly, viral IL-6(vIL-6), homolog to human interleukin-6(IL-6) in KSHV genome retains biologic activity. Thus, oncogenic role of the KSHV has been proposed as a pathogenesis of the multiple myeloma. We used ISH to determine the frequency of patients with multiple myeloma and plasmacytosis associated with KSHV-infected BM cells in fresh core biopsies and to determine the correlation between KSHV infection and clinical characteristics. METHODS: Bone marrow(BM) biopsy samples from 16 cases of multiple myeloma, 2 cases of monoclonal gammopathy of undetermined significance(MGUS) were obtained from the pathology division of Soon Chun Hyang University Hospital, Seoul, Korea. Biopsy sample of Kaposi's sarcoma for positive control and BM biopsy samples of myelodysplastic syndrome(MDS) and malignant lymphoma for negative control were obtained. Bitinylated probe to KSHV were prepared with the following sequences: 5' to 3' TGCAGCAGCTGTTGGTGTACCACATATCT. and in situ hybridization (ISH) was performed. RESULTS: Among the 18 patients. Two patients were MGUS and among 16 patients with multiple myeloma, 1 in stage IB disease, 1 stage IIB disease, 8 stage IIIA disease, 4 stage IIIB diseases and 2 in variant of multiple myeloma, extramedullary plasmacytoma. Strong positive signal was detected in nuclei and cytoplasm of the malignant cells of biopsy sample from 1 cases of Kaposi's sarcoma by ISH(positive control). Signal was not detected in BM biopsy samples of 7 cases from MDS and malignant lymphoma(negative control). Among 16 patients with multiple myeloma, 15 demonstrated viral positive cells and 2 cases with MGUS also showed viral positive cells by ISH. Signal was detected in nuclei and cytoplasm of stromal cells. Signal was strongly detected in MGUS than multiple myeloma. Positivity of the KSHV was not related with stage of the patients with multiple myeloma. One patients with multiple myeloma was studied at diagnosis and after chemotherapy. After chemotherapy KSHV was not detected. CONCLUSION: In MGUS and multiple myeloma, KSHV infects the stromal cells of BM rather than malignant plasma cells. On the basis of these data, we have supposed KSHV to play a role in transformation from MGUS to multiple myeloma. Particularly, due to the fact that signal of ISH was strongly detected in MGUS and was not detected in one case with multiple myeloma, it was presumed that KSHV was not major role in already advanced multiple myeloma but statistic significance was not demonstrated because of small numbers of cases. Further studies to reveal the correlation of KSHV and pathogenesis of multiple myeloma are needed.
Apoptosis ; Biopsy ; Cytoplasm ; Diagnosis ; Drug Therapy ; Genome ; Giant Lymph Node Hyperplasia ; Herpesvirus 8, Human ; Humans ; In Situ Hybridization ; Interleukin-6 ; Korea ; Lymphoma ; Multiple Myeloma* ; Paraproteinemias ; Pathology ; Plasma Cells ; Plasmacytoma ; Pleural Effusion ; Sarcoma, Kaposi ; Seoul ; Stromal Cells

Extramedullary plasmacytoma (EMP) is a common plasma cell tumor often involving the upper aerodigestive tract. Although extremely rare, mediastinal involvement is possible. An 81-year-old man was presented to our emergency department with chest and back pain with weakness in both legs. Chest X-ray showed a large mass in the upper right mediastinum; subsequently, computed tomography and magnetic resonance imaging evaluated the mass. He was diagnosed with mediastinal EMP, which progressed to spinal cord compression. The patient was treated with radiotherapy and chemotherapy. Spinal cord compression, due to metastatic tumor, is an emergency clinical situation that requires prompt diagnosis and treatment. Emergency medicine physicians should be aware of the clinical presentation and complications associated with EMP.
Aged, 80 and over ; Back Pain ; Diagnosis ; Drug Therapy ; Emergencies ; Emergency Medicine ; Emergency Service, Hospital ; Humans ; Leg ; Magnetic Resonance Imaging ; Mediastinum ; Multiple Myeloma ; Plasmacytoma* ; Radiotherapy ; Spinal Cord Compression* ; Spinal Cord* ; Thorax

Aged ; Antineoplastic Combined Chemotherapy Protocols ; therapeutic use ; CD4 Antigens ; metabolism ; CD56 Antigen ; metabolism ; Cyclophosphamide ; therapeutic use ; Dendritic Cells ; pathology ; Diagnosis, Differential ; Doxorubicin ; therapeutic use ; Female ; Humans ; Leukemia, Myeloid ; metabolism ; pathology ; Lymphoma, Extranodal NK-T-Cell ; metabolism ; pathology ; Plasmacytoma ; drug therapy ; metabolism ; pathology ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; metabolism ; pathology ; Prednisone ; therapeutic use ; Skin Neoplasms ; drug therapy ; metabolism ; pathology ; Vincristine ; therapeutic use