EC Pulmonology and Respiratory Medicine

Background: Extra medullary plasmacytoma comprises 3 to 5% of all plasma cell tumors. Solitary plasmacytoma presented as solitary lung mass or nodule and diffuse alveolar consolidation is very rare. Expression of CD138 is highly specific for diagnosis of plasmacytoma. Treatment of choice is surgical resection alone or followed by radiation.

Case Study: A 70 Year female presented with complaints of breathlessness for 2 months, chest pain and bilateral shoulder pain for 1 month. CT scan thorax revealed massive left side pleural effusion and peripheral left lung mass with bony erosions. CT Thorax guided transthoracic biopsy and histopathological examination was done and tissue showed sheets of atypical plasma cells separated by fibrous septa and these findings supported the diagnosis of plasmacytoma of lung which is rare.

Discussion: Etiology of plasmacytoma is not well understood but viral pathogenesis and chronic irritation are probable contributary factors. Histopathological examination shows dense plasma cells and different level of diffuse proliferation and infiltration with mature nucleus which are round and ovoid are of same size with spoke shaped chromatin cells have less cytoplasm with peripheral nucleus surrounded by perinuclear hallows.

Conclusion: We presented and discussed a rare case of stage 3 Plasmacytoma of lung which presented as lung mass and pleural effusion of left side, with lytic lesions on bones with no lymph node involvement. Bone marrow and other parameters, did not suggest or support any alternative diagnosis. Histopathology of tissue establishes the diagnosis of Plasmacytoma.

Keywords: Plasmacytoma; Extramedullary; Lytic Lesions

1. Piero Galieni., et al. “Extramedullary Plasmacytoma”. Haematologica 85 (2000): 47-51.
2. Sang Heon Kim., et al. “Primary Pulmonary Plasmacytoma Presenting as Multiple Lung Nodules”. The Korean Journal of Internal Medicine1 (2012): 111-113.
3. DM Fletcher C. Diagnostic Histopathology of Tumors, Churchill Livingstone, London, UK, 3^rd edition (2007).
4. Rao MG and Venkatesh R. “Radiological evaluation of extramedullary plasmacytoma”. Kansas Journal of Medicine 95 (1994): 94-95.
5. Zohreh Mohammad Taheri., et al. “Primary pulmonary plasmacytoma with diffuse alveolar consolidation: a case report”. Pathology Research International (2010): 463465.
6. T Horiuchi., et al. “Diffuse pulmonary infiltrates as a roentgenographic manifestation of primary pulmonary plasmacytoma”. American Journal of Medicine 1 (1998): 72-74.
7. Maqsood U., et al. “Primary pulmonary plasmacytoma mimicking lung cancer diagnosed on endobronchial ultrasound (EBUS)-guided biopsy”. BMJ Case Reports (2016): bcr2016215785.
8. Si Nie., et al. “Primary pulmonary plasmacytoma: a case report introduction”. World Journal of Surgical Oncology 14 (2016): 205.
9. Lomeo PE and McDonald JE. “Extramedullary plasmacytoma of nasal sinus cavities”. American Journal of Otolaryngology 28 (2007): 50.
10. Wile A Olinger G., et al. “Solitary intraparenchymal pulmonary plasmacytoma associated with production of an M-protein”. Cancer 37 (1976): 2338-2342.