Hans Huang1, Fateh Bazerbachi1, Hector Mesa2, Pankaj Gupta3. 1. Department of Medicine, University of Minnesota, Minneapolis, MN ; These authors contributed equally to this work. 2. Department of Pathology and Laboratory Medicine, Minneapolis VA Health Care System, Minneapolis, MN. 3. Division of Hematology/Oncology, Minneapolis VA Health Care System, Minneapolis, MN.
Abstract
BACKGROUND: Plasma cell myeloma is the most common primary bone malignancy in adults. However, liver involvement in the form of an initial and asymptomatic nodular plasmacytoma is exceedingly rare. CASE REPORT: A 64-year-old male was found to have a right hepatic lobe nodule on a routine abdominal ultrasound prior to bariatric surgery. Liver biopsy revealed a plasma cell neoplasm that, given the location of the lesion, was favored to represent a lymphoma with prominent plasmacytic differentiation. Positron emission tomography (PET) demonstrated a hypermetabolic hepatic mass and identified multiple destructive bony lesions. Biopsy of a clavicular lesion revealed sheets of plasma cells and confirmed the diagnosis of multiple myeloma. The patient underwent 6 cycles of chemotherapy with cyclophosphamide, bortezomib, and dexamethasone before transitioning to lenalidomide and dexamethasone because of early disease progression. Although the patient had International Staging System I (low-risk) disease, his disease demonstrated an aggressive clinical course and resistance to multiple lines of therapy. CONCLUSION: Extramedullary nodular hepatic plasmacytoma is exceedingly rare. Nevertheless, extramedullary plasmacytomas should be included in the differential diagnosis of patients with indistinct hepatic lesions visualized on computed tomography scan, especially if PET scans show associated bony lesions. In general, extramedullary plasmacytomas are a poor prognostic sign and a harbinger of an aggressive clinical course in the context of multiple myeloma.
BACKGROUND: Plasma cell myeloma is the most common primary bone malignancy in adults. However, liver involvement in the form of an initial and asymptomatic nodular plasmacytoma is exceedingly rare. CASE REPORT: A 64-year-old male was found to have a right hepatic lobe nodule on a routine abdominal ultrasound prior to bariatric surgery. Liver biopsy revealed a plasma cell neoplasm that, given the location of the lesion, was favored to represent a lymphoma with prominent plasmacytic differentiation. Positron emission tomography (PET) demonstrated a hypermetabolic hepatic mass and identified multiple destructive bony lesions. Biopsy of a clavicular lesion revealed sheets of plasma cells and confirmed the diagnosis of multiple myeloma. The patient underwent 6 cycles of chemotherapy with cyclophosphamide, bortezomib, and dexamethasone before transitioning to lenalidomide and dexamethasone because of early disease progression. Although the patient had International Staging System I (low-risk) disease, his disease demonstrated an aggressive clinical course and resistance to multiple lines of therapy. CONCLUSION: Extramedullary nodular hepatic plasmacytoma is exceedingly rare. Nevertheless, extramedullary plasmacytomas should be included in the differential diagnosis of patients with indistinct hepatic lesions visualized on computed tomography scan, especially if PET scans show associated bony lesions. In general, extramedullary plasmacytomas are a poor prognostic sign and a harbinger of an aggressive clinical course in the context of multiple myeloma.
Authors: Meaghan L Khan; Craig B Reeder; Shaji K Kumar; Marthy Q Lacy; Donna E Reece; Angela Dispenzieri; Morie A Gertz; Phillip Greipp; Suzanne Hayman; Steven Zeldenhurst; David Dingli; John Lust; Stephen Russell; Kristina M Laumann; Joseph R Mikhael; P Leif Bergsagel; Rafael Fonseca; S Vincent Rajkumar; A Keith Stewart Journal: Br J Haematol Date: 2011-11-23 Impact factor: 6.998
Authors: T Kato; E Tsukamoto; T Nishioka; A Yamazaki; H Shirato; S Kobayashi; M Asaka; M Imamura; N Tamaki Journal: Clin Nucl Med Date: 2000-11 Impact factor: 7.794