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Carmen E. González, Maria T. Cruz-Carreras, Nandita Guha-Thakurta, Ninotchka Brydges, Patrick S. Chaftari
(Department of Emergency Medicine, The University of Texas, MD Anderson Cancer Center, Houston, TX, USA)
Med Sci Case Rep 2017; 4:19-23
Multiple myeloma, the second most common hematological malignancy in the U.S. after non-Hodgkin’s lymphoma, is a cancer of plasma cells. With cellularity similar to that of multiple myeloma, plasmacytoma is a discrete malignant plasma cell mass with several variants. The skeletal variant, which can be solitary or multiple, typically manifests as lytic lesions of the axial skeleton. An extramedullary or non-skeletal form compromises any soft tissue, but most commonly soft tissue of the upper respiratory tract.
CASE REPORT: We report the case of a 72-year-old man with a long history of multiple myeloma who presented to the Emergency Department (ED) on day 1 with urinary retention. He returned 24 h later with lower-extremity paresis. His physical examination suggested spinal cord compression. Spinal magnetic resonance imaging (MRI) confirmed a right cervico-thoracic pleural-based mass involving the paravertebral region, an epidural tumor compromising the thoracic spine and causing cord compression, and edema. The final pathology report from pleural fluid was consistent with extramedullary plasmacytoma. This represents an unusual cause of spinal cord compression by a plasmacytoma originating in the pleura of the lung, which is an extramedullary manifestation of multiple myeloma.
CONCLUSIONS: We present a case of extramedullary plasmacytoma of the pleura in a patient with multiple myeloma with an extension to the spine causing cord compression, which are 2 rare clinical manifestations of multiple myeloma. To the best of our knowledge, this is the first report of a patient presenting with cord compression secondary to a pleural plasmacytoma.