Skip Navigation LinksHome > May 2012 - Volume 7 - Issue 5 > Pulmonary Plasmacytoma
Journal of Thoracic Oncology:
doi: 10.1097/JTO.0b013e31824cbb2f
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Pulmonary Plasmacytoma

Shah, Binay Kumar MD*; Shrestha, Anup MD

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*Department of Hematology and Medical Oncology, Lewiston ID

St. Joseph Regional Medical Center, Lewiston ID

Disclosure: The authors declare no conflict of interest.

Address for correspondence: Binay Kumar Shah, MD, St. Joseph Regional Cancer Center, 1250 Idaho Street, Lewiston ID 83501. E-mail: binay.shah@gmail.com

A 64-year-old man presented with gradually worsening pain in his upper back for 1 year. Systemic examination was unrevealing. Computed tomography (CT) scan of chest (Fig. 1) showed a right-sided apical mass of 11 × 6 cm size and lesions on the second right rib and vertebrae T7-L1. CT-guided biopsy of the lung mass showed plasmacytoma. Serum protein electrophoresis revealed M-protein. Serum immunofixation showed elevated IgG lambda (3 gm/dl). Blood work showed normal complete blood count and kidney function. Calcium level was 10.7 mg/dl. Bone-marrow aspiration and biopsy revealed 52% plasma cells. Diagnosis of multiple myeloma with pulmonary plasmacytoma was made. The patient was treated with bortezomib and dexamethasone. After four cycles of chemotherapy, CT scan of chest (Fig. 2) showed complete resolution of the mass. On the basis of blood tests and bone-marrow studies, thepatient is currently in stringent complete remission.

Figure 1
Figure 1
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Figure 2
Figure 2
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Although extramedullary plasmacytomas are found in 4% patients with multiple myeloma,1 pulmonary plasmacytoma is rare.2 Thalidomide is not effective in extramedullary plasmacytoma.3 Similar to a previous case series,4 our patient had excellent response to bortezomib.

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REFERENCES

1. Soesan M, Paccagnella A, Chiarion-Sileni V, et al. Extramedullary plasmacytoma: clinical behaviour and response to treatment. Ann Oncol. 1992;3:51–57

2. O’Sullivan P,, Müller NL. Pulmonary and nodal multiple myeloma mimicking lymphoma. Br J Radiol. 2006;79:e25–e27

3. Rosiñol L, Cibeira MT, Bladé J, et al. Extramedullary multiple myeloma escapes the effect of thalidomide. Haematologica. 2004;89:832–836

4. Laura R, Cibeira MT, Uriburu C, et al. Bortezomib: an effective agent in extramedullary disease in multiple myeloma. Eur J Haematol. 2006;76:405–408

© 2012International Association for the Study of Lung Cancer

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