대한흉부영상의학회 Weekly Chest Cases

Case No : 1416 Date 2024-12-09

Courtesy of Sunjin Ryu, Sowon Jang / Seoul National University Bundang Hospital
Age/Sex 73 / M
Chief ComplaintProstate cancer w/u

Figure 1
Figure 2

Diagnosis With Brief Discussion

Diagnosis: Pleural plasmacytoma
Radiologic Findings: Fig 1. Chest CT scan shows a pleural-based soft tissue mass measuring 9.0 x 1.8 cm involving the right 3rd and 4th intercostal spaces. The lesion shows enhancement.
Fig 2. PET/CT scan shows FDG uptake in the right pleural-based mass.
Brief Review: Plasmacytoma is a rare neoplastic proliferation of plasma cells. The three main subtypes are multiple myeloma (MM), solitary plasmacytoma, and extramedullary plasmacytoma. A plasmacytoma develops in bone or soft tissue and represents an intermediate phase between monoclonal gammopathy of undetermined significance and MM. It typically presents as a localized disease involving bone or extramedullary sites, without systemic involvement.

Extramedullary plasmacytoma can sometimes be the initial manifestation or occur during relapse in MM patients. In rare cases, it may involve the pleura (pleural plasmacytoma), resulting in nodular pleural thickening, with or without pleural effusion.
CT and magnetic resonance imaging (MRI) are useful for assessing the local extent and severity of extramedullary plasmacytomas. Fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) allows for a whole-body evaluation and helps identify active disease by targeting the specific cellular properties of neoplastic plasma cells.
Histologically, extramedullary plasmacytoma typically shows a homogenous infiltrate of monoclonal plasma cells. Immunohistochemical markers such as CD138 and CD38 are characteristic. After diagnosing plasmacytoma, tests such as complete blood count (CBC), serum calcium, renal function tests, serum protein electrophoresis (SPEP), urine protein electrophoresis (UPEP), skeletal survey, and bone marrow biopsy are performed to confirm or rule out MM.
References: 1. Al-Ataby, Harith, et al. "Pleural plasmacytomas in a patient with multiple myeloma relapse." Respiratory Medicine Case Reports 40 (2022): 101777.
2. Shin, Mack, et al. "A Case of Multiple Myeloma with Extramedullary Plasmacytoma Involving the Testis and Pleura at the Time of Initial Diagnosis." Journal of the Korean Society of Radiology 71.1 (2014): 49-53.
Keywords

No. of Applicants : 58

▶ Correct Answer : 3/58, 5.2%

- McGill University Health Center , Canada ALEXANDRE SEMIONOV
- Seoul Medical Center , Korea (South) HYUK GI HONG
- University of Yamanashi , Japan KOJIRO ONOHARA

▶ Correct Answer as Differential Diagnosis : 6/58, 10.3%

- Vita Hospital , Brazil DIOGO LAGO PINHEIRO
- University of Yamanashi , Japan TAKAAKI HASHIMOTO
- Osaka Metropolitan University Hospital , Japan SHU MATSUSHITA
- Shiga General Hospital , Japan YUSAKU MORIBATA
- Kyoto University , Japan SHO KOYASU
- Matsunami General Hospital , Japan TARO TAKEDA

▶ Semi-Correct Answer : 9/58, 15.5%

- Saitama-Sekishinkai Hosptal , Japan MIHOKO YAMAZAKI
- , Japan SUZUNE TSUKAMOTO
- Shiga University of Medical Science , Japan AKITOSHI INOUE
- The University of Tokyo Hospital , Japan TOSHIHIRO FURUTA
- , Japan YOSHIKI ISHII
- University of Yamanashi , Japan HIROAKI WATANABE
- Other , Korea (South) CHAEHUN LIM
- Mie university , Japan SHIKO OKABE
- Yonsei University,Severance Hospital , Korea (South) SEO BUM CHO

대한흉부영상의학회 Korean Society of Thoracic Radiology

Archive of Old Cases

Case No : 1416 Date 2024-12-09

Discussion

No. of Applicants : 58