Abstract: We report a case of plasmacytoma in a middle – aged man who subsequently developed multiple myeloma. The pathophysiology, diagnosis and treatment of this condition are briefly reviewed.
Introduction:
Plasma cell disorders are either generalized or localized. Generalized plasma cell proliferation with ostelytic bone lesion and monoclonal component of protein in serum electorphoresis is commonly known as multiple myeloma (M.M.). But 10% of all plasma cell disorders can present as localized plasmacytoma. Plasmacytoma may be two types:
1. Solitary osseous plasmacytoma (SOP)
2. Extramedullary plasmacytoma (EMP)
Usually they present at the age of 50 years, about 20yr before the average of presentation of multiple myeloma2. Though majority of SOP and about 50% EMP can progress to M.M. in long course, but their early detection is very important for the treatment point of view. Local radio therapy with or without chemotherapy can cure these patients.
Case Report:
A 55 yr male was admitted on 25.06.03 with the complaints of swelling over sternal region, noted for last 6 months. It was gradually increasing in size and became painful for last 4 months. He was also complaining of left shoulder pain. For last few days low back pain also started. This pain was nagging in character and increased with movement. His urine output normal, mild wt loss was also associated with it he was mildly anemic and his cardiovascular; CNS and respiratory system had no abnormality. Hepatosplenomegally was absent. His BP was 120/80 and pulse 80/min.
Sternal swelling was firm, mildly tender, nonpulsatile, measuring = 5cm x 9cm x 1.2cm.
On the day of admission FNAC of swelling was done and it reveled plasmacytoma. Serum and urine were sent for M band and Bence Jonce proteins respectively, but both of them were negative. But skull X-ray and Chest X-ray revealed punch out lesions and bone marrow from Rt iliac crest detected plasma cell infiltration (>85%). Hb% was 9.6gm. Urea 18mg% creatinine 1.2mg%. liver function test normal and sedimentation rate 60mm in 1st hr.
Two days after admission, patient fell down in bathroom and the shaft of the humerus and femur were fractured. Plaster cast was done on next day.
Five days after admission, chemotherapy was started with cyclophosphamide 200mg/m2 and predinisolone 80mg/m2 for 54 days along with supportive therapy.
Except mild pain abdomen and chest pain no other complication developed. On follow up after 4 weeks, swellin gover sternum regressed and sternal depression developed at that place due to destruction of mass along withribs instability. No radiotherapy was given.
Discussion
Solitary plasmacytoma is comparatively an uncommon entity. When the above mentioned patient presented with sternal swelling it gives the suspicion of mediastinal pathology. But firm nature and ultimate FNAC report disclosed it as a plasmacytoma. Early age of presentation (55yrs) and few days H/O of low back pain also point out towards psasmacytoma. But as every patient with plasmacytoma should be a suspected of multiple myeloma, B.M. examination and X-ray skull were done. This led to the diagnosis of the patient as a case of MM. M band negativity in this case tells about non –secretory nature of the tumor,which is more aggressive. This can explain why a patient develops pathological fracture so early. 2 Micro globulin can indicate about the prognosis of the patients, but not in this case due to lack of facility. As this case converted to M.M6, systemic chemotherapy was given instead of local irradiation.
This is a case of plasmacytoma,is rare, it should be considered for any abnormal bony shelling and they should be further followed up to know their progression to multiple myeloma.
REFERENCE
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