Multiple myeloma swollen glands-A Case of Primary Plasmacytoma of Lymph Nodes

Cancer can start any place in the body. Multiple myeloma is a type of cancer that starts in plasma cells, which are in the bone marrow — the soft, inner part of some bones. Normal plasma cells are a type of white blood cell that fight off infections by making antibodies that spot and attack germs. When plasma cells grow out of control and become cancer cells, they can form a tumor, usually in a bone. If there is only one plasma cell tumor, it is called a solitary plasmacytoma.

Multiple myeloma swollen glands

Multiple myeloma swollen glands

Multiple myeloma swollen glands

Multiple myeloma swollen glands

Multiple myeloma swollen glands

Blood chemistry tests: Tests might be done to check how well your kidney is working and how much calcium, potassium, and sodium and other Multiple myeloma swollen glands are in your blood. Find articles by Su Kyoung Park. However, the diagnosis is often made quite late because the disease has multiple modes of presentation. The sample is then tested for cancer cells. Information on current clinical trials for multiple myeloma gands posted on the Internet at www. My brother nipples hot wet thigh buildup of amyloid in certain organs can enlarge them and affect the way they work. The stage of multiple myeloma is based on the results of x-rays and swwollen blood or urine tests. Very rarely, primary lymph node plasmacytoma as associated with focal amyloid depositions 8. If affected individuals experience involvement of the kidneys, fluids may need to myelpma administered to avoid dehydration.

Italian puberty rites. Lymphoma & Leukemia Information

Many Cleopatra strap heels costume today's standard treatments for cancer are based on earlier clinical trials. Such individuals, and individuals with similar conditions like smoldering multiple myeloma and MGUS, may not require treatment. This can lead to problems swallowing and problems breathing during sleep sleep Multiple myeloma swollen glands. If so, did you push for more biopsies or see an Infectious Disease Specialist my ENT suggested that be the next route if this comes back negative? Accessed April 23, Sonographic diagnosis of a tracheal extramedullary plasmacytoma. Need help? The plasma cells make antibodies to fight bacteria and viruses, to stop infection and disease. I have mutliple swollen lymph nodes and the biopsy of some of the nodes shows that they are infiltrated with plasma cells. A different treatment than treatment already given, for patients whose tumor kept growing during treatment. Figure 2.

Multiple Myeloma is a cancer of the blood.

  • Remember Me?
  • Multiple myeloma is a cancer that forms in a type of white blood cell called a plasma cell.
  • Multiple myeloma is a rare form of cancer characterized by excessive production proliferation and improper function of certain cells plasma cells found in the bone marrow.

Multiple myeloma, a disease allied to malignancy of reticuloendothelial cells, is not an uncommon condition. However, the diagnosis is often made quite late because the disease has multiple modes of presentation. We are reporting a case of multiple myeloma in a year-old male who presented with multiple cystic swellings on the chest. Multiple myeloma is a relatively rare cancer that occurs predominantly in patients over 60 years of age. Occasional involvement of the extraosseous organ systems is known.

Isolated cystic swelling as the initial presentation of multiple myeloma is very rare. Few case reports are available about solitary plasmacytoma and extramedullary plasmacytoma of the paranasal sinuses and soft palate. There is no case report available. A year-old male presented in the medicine outpatient department with complaints of multiple swellings on the chest wall since 2 months.

There was no history of trauma, Ischemic heart disease, hypertension or diabetes. On examination, there were three cystic swellings on the anterior chest.

The swelling was small to start with and increased up to 6. It was firm, cystic and variegated in consistency and nontender on palpation. The liver was enlarged by 2 cm. Other examinations were unremarkable. The hemoglobin was 9. The erythrocyte sedimentation rate was mm 1st hour Westergren. Bence-Jones proteins was absent in the urine.

Serum electophoresis shows a very thick Beta band. Serum proteins were 8. Blood urea and blood sugar were normal. Serum calcium, phosphorus and alkaline phosphatase were Serum bilirubin was 0. Electrocardiogram was normal. Fine needle aspiration cytology cytology of the swelling shows plasmacytoma. The cells bear characteristic morphologic features of plasma cells, round or oval cells with an eccentric nucleus composed of coarsely clumped chromatin, and a densely basophilic cytoplasm.

Binucleate and multinucleate malignant plasma cells can be seen [ Figure 2 ]. X-ray skull showed multiple punched-out osteolytic lesions [ Figure 3 ]. Bone marrow biopsy revealed myeloma cells and was diagnostic of multiple myeloma. The patient was started on thalidomide and corticosteroids. He also received radiotherapy for the local swelling, which was reduced on the subsequent day. He is doing well on follow-up. The cells bear characteristic morphologic features of plasma cells, round or oval cells with an eccentric nucleus composed of coarsely clumped chromatin and a densely basophilic cytoplasm.

Binucleate and multinucleate malignant plasma cells are seen. Bony lesions in multiple myeloma. Multiple myeloma is the most common of the plasma cell neoplasms, which also includes monoclonal gammopathies of unknown significance, plasmacytomas and plasma cell leukemia. Whereas multiple myelomas represent systemic disease without the potential for cure, plasmacytomas represent local forms of plasma cell neoplasms.

Rare cases of primary EMP have been described in the skull base, larynx, hypopharynx, parotid gland, submandibular gland, thyroid, mandibular region, trachea, esophagus, cervical lymph nodes, middle ear, orbit, scalp, forehead, palate, tongue and mastoid.

The potential for malignant systemic progression is higher for solitary plasmacytomas of the bone than for extramedullary plasmacytomas.

When extramedullary plasmacytoma with multiple myeloma is diagnosed, local treatment of the plasmacytoma should be followed by the systemic combination chemotherapy. The prognosis of extramedullary plasmacytoma with multiple myeloma is poor and most patients die within 2 years of their diagnosis. Source of Support: Nil. Conflict of Interest: None declared. National Center for Biotechnology Information , U. Indian J Med Paediatr Oncol.

Sunil Kumar , A. Jain , and Swati Waghmare. Author information Copyright and License information Disclaimer. Address for correspondence: Dr. E-mail: moc. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC. Abstract Multiple myeloma, a disease allied to malignancy of reticuloendothelial cells, is not an uncommon condition. Keywords: Cystic swelling , multiple myeloma , plasmacytoma. Open in a separate window. Figure 1. Figure 2. Figure 3. Neurology and the bone marrow. J Neurol Neurosurg Psychiatry. Solitary plasmacytoma and extramedullary plasmacytoma of the paranasal sinuses and soft palate.

J Laryngol Otol. Skull base plasmacytoma in a patient with light chain myeloma. Skull Base. Solitary plasmacytoma of bone and soft tissue. Head and neck manifestations of plasma cell neoplasms. Sonographic diagnosis of a tracheal extramedullary plasmacytoma. J Ultrasound Med. Head and Neck Imaging. Louis: Mosby; Tumors and tumor-like conditions; pp. Support Center Support Center.

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Feeling very tired. Serum bilirubin was 0. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. If only a single tumor is present, the term solitary plasmacytoma is used. Re: Multiple myeloma in lymph nodes? When extramedullary plasmacytoma with multiple myeloma is diagnosed, local treatment of the plasmacytoma should be followed by the systemic combination chemotherapy.

Multiple myeloma swollen glands

Multiple myeloma swollen glands

Multiple myeloma swollen glands

Multiple myeloma swollen glands

Multiple myeloma swollen glands

Multiple myeloma swollen glands. Bone problems

The Light chain amyloidosis AL form of the disorder occurs most often, but not always, in association with an increased number of plasma cells in the bone marrow. Kidney or cardiac involvement may result in renal or congestive heart failure, respectively. Smoldering multiple myeloma SMM is characterized by abnormally high levels of atypical plasma cells in the bone marrow without evidence of symptomatic disease.

Many affected individuals exhibit M-proteins in the urine and blood but have no other evidence of the symptoms of multiple myeloma such as anemia, bone lesions or kidney failure. Individuals with smoldering multiple myeloma may eventually develop multiple myeloma. Plasma cell leukemia is characterized by the presence of excessive amounts of plasma cells in the blood. Non-secretory myeloma exists when an individual with multiple myeloma does not produce M-protein in either the urine or blood serum.

Individuals with non-secretory myeloma make up only one percent of individuals with myeloma. Osteosclerotic myeloma is a variant of multiple myeloma. Major symptoms may include weakness, numbness in the legs, skin changes, hormonal abnormalities, and lung problems. In osteosclerotic myeloma, there is an association with osteosclerosis, a condition marked by hardening and abnormal density of bone. A common symptom of osteosclerotic myeloma is peripheral neuropathy. The exact cause of osteosclerotic myeloma is not known.

Solitary plasmacytoma of bone is characterized by only one plasma cell tumor plasmacytoma of the bone. Diagnosis relies on cell examination, and no evidence of multiple myeloma in the bone marrow. Extramedullary plasmacytoma occurs when plasma cell tumors arise outside the bone marrow. The upper respiratory tract, which includes the nasal cavity and sinuses, nasopharynx, and larynx, is the most frequent site of involvement.

However, extramedullary plasmacytomas have been found in virtually every organ of the body. A diagnosis of multiple myeloma is made based upon a thorough clinical evaluation, a detailed patient history, and a variety of specialized tests. Such tests may include removal and microscopic examination of small samples of bone marrow biopsy or aspiration , blood tests to detect low levels of red and white blood cells, and various x-ray techniques including magnetic resonance imaging MRI , computed tomography CT , and positron emission tomography PET scanning that may reveal characteristic changes to bones.

A test that uses electric currents to sort proteins in the blood or urine electrophoresis may be used to detect elevated levels of M-proteins. An immunoglobulin free light chain assay of blood is considered a standard of evaluation.

Some affected individuals may have a slow developing form of multiple myeloma that progresses over many years, often without symptoms asymptomatic. Such individuals, and individuals with similar conditions like smoldering multiple myeloma and MGUS, may not require treatment.

However, these individuals should be routinely monitored so that treatment can begin if symptoms appear. The treatment of multiple myeloma usually involves chemotherapy to reduce the numbers of abnormal plasma cells, drugs to help fight infection e.

Additional treatment may include the use of high energy x-rays radiation therapy to destroy cancer cells and reduce bone masses that may develop. The use of new biologic drugs may also be recommended. If affected individuals experience involvement of the kidneys, fluids may need to be administered to avoid dehydration. The following link provides information from the National Cancer Institute about medications that have been approved by the U. Stem-cell transplantation along with high-dose chemotherapy is regularly used for the treatment of multiple myeloma.

Information on current clinical trials for multiple myeloma is posted on the Internet at www. All studies receiving U. For information about clinical trials sponsored by private sources, contact: www. Recombinant erythropoietin may be used as a treatment for anemia in some individuals with multiple myeloma. Recombinant erythropoietin is an artificial synthetic version of a natural hormone that stimulates the growth of red blood cells. Zoledronic Acid infusions monthly to quarterly are considered standard to reduce the risks of skeletal events.

Denosumab is also used to reduce the risk of skeletal events in myeloma. There are multiple effective therapies for the management of multiple myeloma the specific regimen needs to be individualized based on patient factors. Many clinical trials offer the opportunity to participate in cutting edge therapies for this disorder. Contact for additional information about Multiple Myeloma:. Morie A. Rochester, MN RareConnect offers a safe patient-hosted online community for patients and caregivers affected by this rare disease.

Mayo Clin Proc. Mateos MV, et al. Dougall W, Chaisson M. Clin Calcium. Body JJ, et al. Clin Cancer Res. Berenson JR. Semin Oncol. Kneller A, et al. Therapy with thalidomide in refractory multiple myeloma patients — the revival of an old drug.

Br J Haematol. Kyle RA, et al. Monoclonal gammopathy of undetermined significance. Hematol Oncol Clin North Am. Brigden ML. The search for meaning in monoclonal protein. Is it multiple myeloma or monoclonal gammopathy of undetermined significance? Postgrad Med. Singhal S, et al. Antitumor activity of thalidomide in refractory multiple myeloma. N Engl J Med. Attal M, et al. A prospective, randomized trial of autologous bone marrow transplantation and chemotherapy in multiple myeloma.

N Eng J Med. Berenson JR, et al. Efficacy of pamidronate in reducing skeletal events in patients with advanced multiple myeloma. Wahlin A, et al. Effects of plasmapheresis on the plasma concentration of proteins used to monitor the disease process in multiple myeloma.

Acta Med Scand. Costanzi JJ, et al. The use of interferon in the treatment of multiple myeloma. Mayo Foundation for Medical Education and Research. Multiple Myeloma. Last Updated: August 16, The content of the website and databases of the National Organization for Rare Disorders NORD is copyrighted and may not be reproduced, copied, downloaded or disseminated, in any way, for any commercial or public purpose, without prior written authorization and approval from NORD.

NORD strives to open new assistance programs as funding allows. If we don't have a program for you now, please continue to check back with us. About News Events Contact. Synonyms of Multiple Myeloma Kahler disease myelomatosis plasma cell myeloma.

Subdivisions of Multiple Myeloma extramedullary plasmacytoma nonsecretory myeloma osteosclerotic myeloma plasma cell leukemia smoldering myeloma solitary plasmacytoma of bone. General Discussion Multiple myeloma is a rare form of cancer characterized by excessive production proliferation and improper function of certain cells plasma cells found in the bone marrow. Causes The exact cause of multiple myeloma is not known.

Affected Populations Multiple myeloma is a rare cancer that is slightly more common in males than females. Related Disorders Symptoms of the following disorders can be similar to those of multiple myeloma.

Comparisons may be useful for a differential diagnosis: Waldenstrom macroglobulinemia is a lymph and blood cell disorder. The following disorders may be considered variants of multiple myeloma: Smoldering multiple myeloma SMM is characterized by abnormally high levels of atypical plasma cells in the bone marrow without evidence of symptomatic disease.

Diagnosis A diagnosis of multiple myeloma is made based upon a thorough clinical evaluation, a detailed patient history, and a variety of specialized tests. Other treatment is symptomatic and supportive. Investigational Therapies Information on current clinical trials for multiple myeloma is posted on the Internet at www. Contact for additional information about Multiple Myeloma: Morie A.

Resources RareConnect offers a safe patient-hosted online community for patients and caregivers affected by this rare disease. Patients may want to think about taking part in a clinical trial. Some clinical trials are open only to patients who have not started treatment. Chemotherapy is a cancer treatment that uses drugs to stop the growth of cancer cells, either by killing the cells or by stopping them from dividing.

When chemotherapy is taken by mouth or injected into a vein or muscle, the drugs enter the bloodstream and can reach cancer cells throughout the body systemic chemotherapy. When chemotherapy is placed directly into the cerebrospinal fluid, an organ, or a body cavity such as the abdomen, the drugs mainly affect cancer cells in those areas regional chemotherapy. The way the chemotherapy is given depends on the type and stage of the cancer being treated. Corticosteroids are steroids that have antitumor effects in multiple myeloma.

Targeted therapy is a treatment that uses drugs or other substances to identify and attack specific cancer cells without harming normal cells. Several types of targeted therapy may be used to treat multiple myeloma and other plasma cell neoplasms. Proteasome inhibitor therapy is a type of targeted therapy that blocks the action of proteasomes in cancer cells and may prevent the growth of tumors.

Bortezomib, carfilzomib, and ixazomib are proteasome inhibitors used in the treatment of multiple myeloma and other plasma cell neoplasms. Monoclonal antibody therapy is a cancer treatment that uses antibodies made in the laboratory, from a single type of immune system cell.

These antibodies can identify substances on cancer cells or normal substances that may help cancer cells grow. The antibodies attach to the substances and kill the cancer cells, block their growth, or keep them from spreading. Monoclonal antibodies are given by infusion.

They may be used alone or to carry drugs, toxins, or radioactive material directly to cancer cells. Daratumumab and elotuzumab are monoclonal antibodies used in the treatment of multiple myeloma and other plasma cell neoplasms. Histone deacetylase HDAC inhibitor therapy is a type of targeted therapy that blocks enzymes needed for cell division and may stop the growth of cancer cells.

Panobinostat is an HDAC inhibitor used in the treatment of multiple myeloma and other plasma cell neoplasms. This treatment is a way of giving high doses of chemotherapy and replacing blood -forming cells destroyed by the cancer treatment. Stem cells immature blood cells are removed from the blood or bone marrow of the patient autologous transplant or a donor allogeneic transplant and are frozen and stored.

After the chemotherapy is completed, the stored stem cells are thawed and given back to the patient through an infusion. These reinfused stem cells grow into and restore the body's blood cells. Biologic therapy is a treatment that uses the patient's immune system to fight cancer. Substances made by the body or made in a laboratory are used to boost, direct, or restore the body's natural defenses against cancer.

This type of cancer treatment is also called biotherapy or immunotherapy. Immunomodulators are a type of biologic therapy. Thalidomide, lenalidomide, and pomalidomide are immunomodulators used to treat multiple myeloma and other plasma cell neoplasms.

Interferon is a type of biologic therapy. It affects the division of cancer cells and can slow tumor growth. Radiation therapy is a cancer treatment that uses high-energy x-rays or other types of radiation to kill cancer cells or keep them from growing. There are two types of radiation therapy:.

The way the radiation therapy is given depends on the type and stage of the cancer being treated. External radiation therapy is used to treat plasma cell neoplasms. Surgery to remove the tumor may be done and is usually followed by radiation therapy. Treatment given after the surgery, to lower the risk that the cancer will come back, is called adjuvant therapy.

This summary section describes treatments that are being studied in clinical trials. It may not mention every new treatment being studied. Clinical trials are studying different combinations of biologic therapy, chemotherapy, steroid therapy, and drugs. New treatment regimens using thalidomide or lenalidomide are also being studied.

This therapy controls problems or side effects caused by the disease or its treatment, and improves quality of life. Supportive care is given to treat problems caused by multiple myeloma and other plasma cell neoplasms.

For some patients, taking part in a clinical trial may be the best treatment choice. Clinical trials are part of the cancer research process. Clinical trials are done to find out if new cancer treatments are safe and effective or better than the standard treatment. Many of today's standard treatments for cancer are based on earlier clinical trials. Patients who take part in a clinical trial may receive the standard treatment or be among the first to receive a new treatment.

Patients who take part in clinical trials also help improve the way cancer will be treated in the future. Even when clinical trials do not lead to effective new treatments, they often answer important questions and help move research forward. Some clinical trials only include patients who have not yet received treatment. Other trials test treatments for patients whose cancer has not gotten better.

There are also clinical trials that test new ways to stop cancer from recurring coming back or reduce the side effects of cancer treatment.

Some of the tests that were done to diagnose the cancer or to find out the stage of the cancer may be repeated. Some tests will be repeated in order to see how well the treatment is working. Decisions about whether to continue, change, or stop treatment may be based on the results of these tests. Some of the tests will continue to be done from time to time after treatment has ended. The results of these tests can show if your condition has changed or if the cancer has recurred come back.

These tests are sometimes called follow-up tests or check-ups. Treatment of monoclonal gammopathy of undetermined significance MGUS is usually watchful waiting. Regular blood tests to check the level of M protein in the blood and physical exams to check for signs or symptoms of cancer will be done. Patients without signs or symptoms may not need treatment.

When signs or symptoms appear, the treatment of multiple myeloma may be done in phases:. Induction therapy : This is the first phase of treatment.

Its goal is to reduce the amount of disease, and may include one or more of the following:. Consolidation chemotherapy : This is the second phase of treatment. Treatment in the consolidation phase is to kill any remaining cancer cells. High-dose chemotherapy is followed by either:.

Maintenance therapy : After the initial treatment, maintenance therapy is often given to help keep the disease in remission for a longer time. Several types of treatment are being studied for this use, including the following:. Cleveland Clinic is a non-profit academic medical center. Advertising on our site helps support our mission. We do not endorse non-Cleveland Clinic products or services.

Multiple Myeloma. Cancer Answer Line Multiple myeloma and other plasma cell neoplasms are diseases in which the body makes too many plasma cells. Plasma cell neoplasms can be benign not cancer or malignant cancer. There are several types of plasma cell neoplasms. Monoclonal gammopathy of undetermined significance MGUS. Multiple myeloma Multiple myeloma and other plasma cell neoplasms may cause a condition called amyloidosis. Age can affect the risk of plasma cell neoplasms.

Tests that examine the blood, bone marrow, and urine are used to detect find and diagnose multiple myeloma and other plasma cell neoplasms. Certain factors affect prognosis chance of recovery and treatment options. Plasma cell neoplasms are diseases in which the body makes too many plasma cells. The following types of plasma cell neoplasms are cancer: Lymphoplasmacytic lymphoma. Multiple myeloma.

Plasmacytoma In this type of plasma cell neoplasm, the abnormal plasma cells myeloma cells are in one place and form one tumor, called a plasmacytoma. Plasmacytoma of the bone often becomes multiple myeloma.

In extramedullary plasmacytoma, one plasma cell tumor is found in soft tissue but not in the bone or the bone marrow. Extramedullary plasmacytomas commonly form in tissues of the throat, tonsil, and paranasal sinuses. Signs and symptoms depend on where the tumor is. In bone, the plasmacytoma may cause pain or broken bones.

Multiple myeloma In multiple myeloma, abnormal plasma cells myeloma cells build up in the bone marrow and form tumors in many bones of the body. Normally, the bone marrow makes stem cells immature cells that become three types of mature blood cells: Red blood cells that carry oxygen and other substances to all tissues of the body.

White blood cells that fight infection and disease. Platelets that form blood clots to help prevent bleeding. Check with your doctor if you have any of the following: Bone pain, especially in the back or ribs.

Bones that break easily. Fever for no known reason or frequent infections. Easy bruising or bleeding. Trouble breathing. Weakness of the arms or legs. Feeling very tired. Hypercalcemia may cause the following signs and symptoms: Loss of appetite.

Nausea or vomiting. Feeling thirsty. Frequent urination. Muscle weakness. Confusion or trouble thinking. Multiple myeloma and other plasma cell neoplasms may cause a condition called amyloidosis. Amyloidosis may cause the following signs and symptoms: Feeling very tired. Purple spots on the skin. Enlarged tongue. Swelling caused by fluid in your body's tissues. Tingling or numbness in your legs and feet. For multiple myeloma and plasmacytoma, other risk factors include the following: Being black.

Being male. Having a personal history of MGUS or plasmacytoma. Being exposed to radiation or certain chemicals. The following tests and procedures may be used: Physical exam and history : An exam of the body to check general signs of health, including checking for signs of disease, such as lumps or anything else that seems unusual. Blood and urine immunoglobulin studies: A procedure in which a blood or urine sample is checked to measure the amounts of certain antibodies immunoglobulins.

For multiple myeloma, betamicroglobulin, M protein, free light chains, and other proteins made by the myeloma cells are measured. A higher-than-normal amount of these substances can be a sign of disease.

Bone marrow aspiration and biopsy : The removal of bone marrow, blood, and a small piece of bone by inserting a hollow needle into the hipbone or breastbone. A pathologist views the bone marrow, blood, and bone under a microscope to look for abnormal cells. The following test may be done on the sample of tissue removed during the bone marrow aspiration and biopsy: Complete blood count CBC with differential : A procedure in which a sample of blood is drawn and checked for the following: The number of red blood cells and platelets.

The number and type of white blood cells. The amount of hemoglobin the protein that carries oxygen in the red blood cells The portion of the blood sample made up of red blood cells. Blood chemistry studies : A procedure in which a blood sample is checked to measure the amounts of certain substances, such as calcium or albumin, released into the blood by organs and tissues in the body.

An unusual higher or lower than normal amount of a substance can be a sign of disease. Twenty-four-hour urine test: A test in which urine is collected for 24 hours to measure the amounts of certain substances.

If You Have Multiple Myeloma

Extramedullary plasmacytoma may originate in any organ, either as a primary tumor or as a facet of systemic multiple myeloma. These solid lesions most commonly affect the upper respiratory tract, gastrointestinal and urogenital tract, skin, and lung. Primary plasmacytoma of the lymph node is a rare hematologic neoplasm, which usually manifests as an enlargement of the cervical lymph nodes with no evidence of any other plasma cell dyscrasia.

A year-old man was admitted, due to the presence of multiple palpable masses in the right cervical and submandibular areas. Surgical resection revealed plasmacytoma of the lymph nodes. According to our full work-up, no evidence of the systemic involvement of plasma cell dyscrasia was discovered and thus, the diagnosis of primary plasmacytoma of the lymph node was made. Extramedullary plasmacytoma is a rare form of plasma cell dyscrasia, and represents 1.

Extramedullary manifestations of plasma cell dyscrasias may be initially observed in any organ, either as a primary tumor or as a facet of systemic multiple myeloma. Most lymph node plasmacytomas are attributable to metastasis from multiple myeloma, or other extramedullary plasmacytomas. There have been fewer than 20 reported cases worldwide 6.

There have been no case reports as yet in Korea. We report a case of primary lymph node plasmacytoma, and include a brief review of the literature. A year-old man was admitted to the otorhinolaryngology department, complaining of multiple palpable masses in the right cervical and submandibular areas, which slowly progressed in size during the past 8 years. The patient had neither any remarkable past medical history, nor a family history relevant to such a complaint.

On physical examination, no palpable lymph nodes or masses in any other area of the body were noted. Initial laboratory values revealed mild anemia Hb Blood urea nitrogen BUN , creatinine, calcium, inorganic phosphate, aspartate aminotransferase AST , alanine aminotransferase ALT , and serum electrolyte levels were found to be normal.

Serum albumin was 3. There were no abnormalities on the routine urine analysis. Neck and paranasal sinus computed tomography CT scans were conducted as part of an evaluation for surgical resection. The largest of these measured about 6. The tonsil, salivary gland, paranasal sinus, and nasal cavity yielded no abnormal findings Figure 1. The patient underwent surgery for the removal of the masses, but some small remnant masses persisted. Upon the gross examination of the removed lymph nodes, multiple grayish-white masses were seen, ranging from 2.

Upon sectioning of the lymph nodes, the cut surfaces were grayish-white with focal hemorrhaging Figure 2. Histologically, the masses were composed of dense and diffuse infiltrations of atypical plasma cells, with a few residual atrophic lymphoid follicles. After the operation, the patient was transferred to the hemato-oncologic department, for further evaluation and treatment.

A full work-up was conducted in order to ascertain whether there was any other evidence of plasma cell dyscrasia. Rouleux formations were seen on the peripheral blood smear. However, bone marrow aspiration and biopsy from the iliac crest revealed trilineage elements of normal hematopoiesis, as well as no evidence of plasma cell dyscrasia.

Accordingly, the patient was diagnosed with primary lymph node plasmacytoma, and was treated via radiotherapy total dose of 50 Gy in 25 fractions. Neck and PNS CT scans reveal that numerous enlarged lymph nodes had conglomerated in the right submental and submandibular areas, and that the right internal jugular vein was severely compressed by multiple enlarged lymph nodes. Most patients with plasma cell neoplasia exhibit a generalized disease upon diagnosis.

Primary plasmacytoma of the lymph nodes is quite rare. In order to diagnose primary plasmacytoma of the lymph nodes, there must be no evidence of plasma cell proliferation elsewhere, and also no associated malignant lymphoma components 7. The case reported here was a patient who exhibited a neck mass which revealed, histologically, monoclonal plasma cells in the lymph nodes.

However, bone marrow aspiration and biopsies and skeletal studies revealed no evidence of plasma cell proliferation. Also, no evidence of plasma cell dyscrasia involving the upper respiratory tract with the paranasal sinus was detected on the paranasal sinus CT scan.

Histologically, primary lymph node plasmacytoma needs to be differentiated from MALT mucosa-associated lymphoid tissue type low-grade lymphoma 8. MALT type low-grade lymphoma is characterized by the benign reactive proliferation of lymphoid follicles around malignant cells, and is also distinguished by its characteristic lymphoepithelial lesions.

In this case, the fact that there were no such findings, and that the lymph node, histologically, revealed only immature or plasmablastic plasma cells, made it possible to differentiate it from MALT type low-grade lymphoma.

Primary lymph node plasmacytoma is a rare hematologic neoplasm, which normally manifests as an enlargement of the cervical lymph nodes. Also, the lymph node is normally replaced by mature plasma cells 8.

Due to the small number of patient cases and low local failure rates associated with this condition, the dose-response relationship remains unclear. However, the optimal radiation dose appears to be somewhere within in the range of Gy 7. Tumors of less than 5 cm in diameter have an excellent chance of being locally controlled with doses of radiation in the region of 40 Gy in 20 fractions, whereas there is a higher risk of local failure when dealing with tumors greater than 5 cm in diameter, which require a higher dose, somewhere in the region of 50 Gy in 25 fractions 7 , 11 - Surgery is not generally required for diagnosis.

Radical surgery is not normally indicated for curative therapy, as the tumors are generally highly radiosensitive, and the majority of patients can be cured by radiotherapy 7. In our patient, the tumor size was greater than 5 cm. Therefore, we removed the masses surgically, both for cosmetic reasons and histological diagnosis.

After surgically removing the bulky masses, we administered 50 Gy of radiation in 25 fractions for curative therapy. Very rarely, primary lymph node plasmacytoma as associated with focal amyloid depositions 8. Primary lymph node plasmacytoma may present as disseminated lymphadenopathy, but does not progress to multiple myeloma.

The survival time associated with this condition is significantly longer than that of patients with multiple myeloma 8. However, in our case, the patient's tumor was composed of multiple, bulky masses, and continuous follow-up remains necessary.

National Center for Biotechnology Information , U. Korean J Intern Med. Published online Jun Young Hyo Lim , M. Find articles by Young Hyo Lim.

Find articles by Su Kyoung Park. Find articles by Ho Suk Oh. Find articles by Jung Hye Choi. Find articles by Myung Ju Ahn. Find articles by Young Yul Lee. Find articles by In Soon Kim. Author information Article notes Copyright and License information Disclaimer. Corresponding author. Correspondence to: In Soon Kim, M. Tel: , Fax: , rk. Received Nov 24; Accepted Dec This article has been cited by other articles in PMC.

Abstract Extramedullary plasmacytoma may originate in any organ, either as a primary tumor or as a facet of systemic multiple myeloma. Keywords: Plasmacytoma, Lymph nodes, Paraproteinemias. CASE REPORT A year-old man was admitted to the otorhinolaryngology department, complaining of multiple palpable masses in the right cervical and submandibular areas, which slowly progressed in size during the past 8 years. Open in a separate window. Figure 1. Figure 2.

The cut surface of the masses were grayish white with focal hemorrhaging. Figure 3. Figure 4. References 1. Solitary plasmacytoma: I. Extramedullary plasmacytoma: report of two cases with uncommon presentation. Ann Hematol. Extramedullary plasmacytoma: tumor occurrence and therapeutic concepts. Wiltshaw E. The natural history of extramedullary plasmacytoma and its relation to solitary myeloma of bone and myelomatosis.

Clinical outcome of extramedullary plasmacytoma. Primary plasmacytoma of lymph nodes. Hum Pathol. Guidelines on the diagnosis and management of solitary plasmacytoma of bone and solitary extramedullary plasmacytoma.

Br J Haematol. Primary lymph node plasmacytomas plasmacytic lymphomas Am J Clin Pathol. The role of radiation therapy in the treatment of solitary plasmacytomas. Radiother Oncol. Solitary plasmacytoma of bone and soft tissue.

Radiotherapy in the treatment of solitary plasmacytoma. Br J Radiol.

Multiple myeloma swollen glands

Multiple myeloma swollen glands

Multiple myeloma swollen glands