Plasma cell myeloma presenting with diffuse pleural involvement: a hitherto unreported pattern of a new mesothelioma mimicker

Our plain-English summary of Plasma cell myeloma presenting with diffuse pleural involvement: a hitherto unreported pattern of a new mesothelioma mimicker, by A. Colonna, G. Gualco, C.E. Bacchi, et al (Annals of Diagnostic Pathology, 2010).

The study

• Authors: A. Colonna, G. Gualco, C.E. Bacchi, M.A. Leite, M. Rocco, G. DeMaglio, S. Pizzolitto, G. Falconieri
• Journal: Annals of Diagnostic Pathology
• Published: 2010;14(1):30-5
• Type of article: Case report
• Cited by: 10 articles, as counted by NIH iCite
• Read it: PubMed · Publisher

Abstract

We described 2 cases of plasmacytoma presenting with a preponderant involvement of the pleural membranes simulating clinically, radiologically, and on gross pathologic inspection a primary mesothelioma. The patients were an 80-year-old man and a 45-year-old woman. In both cases, the clinical presentation was that of a serosal tumor, including effusions and pleural thickening. In the former, the serosal infiltration raised the suspicion of mesothelioma reinforced by history of occupational exposure to asbestos. Patient general condition deteriorated rapidly. Postmortem examination revealed unilateral encasing of the lung within a thick, irregular neoplastic rind. In addition, tumoral involvement was seen in the homolateral third rib and the clavicle. Histologic examination of pleural masses demonstrated diffuse infiltration by highly atypical, pleomorphic plasma cells with kappa chain restriction. In the second case, clinical presentation was also suspicious of mesothelioma. Nonetheless, a pleural biopsy specimen showed irregular sheets of plasma cells showing kappa light chain restriction. A bone marrow aspirate was also positive for abnormal plasma cell infiltrates. Despite chemotherapy, the patient died 4 months after presentation. Although rarely, it seems that plasmacytoma may present with an exclusive or preponderant pleural involvement; and it may therefore be added to the list of pseudomesotheliomatous tumors.

2010 Elsevier Inc. All rights reserved.

In plain English

This article reported two patients whose plasma cell myeloma (also called plasmacytoma) mainly involved the pleura, the lining around the lungs, and resembled pleural mesothelioma. The first, an 80-year-old man, had worked in a naval shipyard, had proven asbestos exposure, and had known myeloma for one year. A CT scan showed left pleural masses thought suspicious of mesothelioma. He died of multiorgan failure 4 months after first presenting. At autopsy, tumor encased the lung and reached the clavicle and neck soft tissues. Pleural plaques were present on both sides, and lung tissue contained 122 000 asbestos bodies per gram of dry tissue. Microscopic and staining studies identified plasma cell tumor, not mesothelioma. The second, a 45-year-old woman, denied asbestos exposure. Her pleural biopsy and bone marrow showed plasma cell tumor. The case history reported that she died of infections 10 months after her first chemotherapy cycle; the abstract instead gave 4 months after presentation. The authors concluded that plasmacytoma may rarely present mainly in the pleura and could be added to the list of mesothelioma mimickers.

We wrote this plain-English summary from the full article with the help of AI, and a second AI model checked each sentence against the article. It is not the authors' wording; the abstract and the article are their own account.

What the study did and found

• Design: case report of 2 patients
• Who was studied: Two patients with plasma cell myeloma: an 80-year-old man (case 1) and a 45-year-old woman (case 2). The authors are from hospitals in Italy and Brazil; where and when each patient was seen is not stated.
• Exposure: Case 1 had naval shipyard employment with proven asbestos exposure; no fiber type is named. Case 2 denied any asbestos exposure.
• Main results:
  • Case 1: a CT scan showed multinodular masses over the left pleural surface that were thought suspicious of mesothelioma.
  • Case 1: treated with chemotherapy for plasma cell tumor, with poor response; progressive decline and multiorgan failure 4 months after first presentation.
  • Case 1 autopsy: tumor diffusely infiltrated the peripheral lung and pleura and encased the lung, with tumor in the clavicle and neck soft tissues continuous with the pleural tumor. Bilateral pleural plaques were found.
  • Case 1: tumor cells were positive for the plasma cell marker CD138 with kappa light chain restriction. Stains for cytokeratins and calretinin (markers used for mesothelioma) and other stains were negative.
  • Case 1: digestion analysis of nonneoplastic lung tissue found asbestos bodies at 122 000 per gram of dry lung tissue.
  • Case 2: CT showed a large left pleural effusion with significant thickening of the left posterior and inferior pleura, considered highly suspicious of malignant pleural mesothelioma.
  • Case 2: the pleural biopsy was negative for calretinin and cytokeratins and positive for CD138 with kappa light chain restriction. Bone marrow plasma cell infiltrate was estimated at more than 30%.
  • Case 2 (case history): multimodality chemotherapy produced no response, and the patient died of infectious complications 10 months after the first cycle.
  • Case 2 (article abstract): the abstract instead states that the second patient died 4 months after presentation despite chemotherapy, which conflicts with the case history.
• The authors' conclusion: The authors concluded that plasmacytoma may, although rarely, present with exclusive or predominant pleural involvement and may be added to the list of tumors that mimic mesothelioma. They also stated that any malignant lesion reaching the pleura is a potential mesothelioma simulator.
• Limitations the authors state:
  • In case 1, pleural fluid cytology could not be further categorized because the smears were of suboptimal quality.
  • In case 1, further investigations were not performed because of the patient's critical condition.
  • In case 2, immunofixation testing was not available.

Topics

The National Library of Medicine indexes this study under subjects our site covers: Mesothelioma.

Medical terms in this study, explained in our Lexicon: Myeloma, Mesothelioma, Pleural Thickening, Occupational Exposure, Pleomorphic, Pleural Biopsy, Aspirate, Chemotherapy.

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• Lymphoid and plasma cell malignancies: asbestos-related disorders of long latency — E. Kagan, R.J. Jacobson (1983)
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