Diffuse skeletal muscle extramedullary plasmacytomas: a rare case and review of the literature
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CASE REPORT
Diffuse skeletal muscle extramedullary plasmacytomas: a rare case and review of the literature Robert D. Moore 1 & Steve M. Nelson 2 & Nathan D. Cecava 3,4,5 Received: 3 May 2020 / Revised: 6 June 2020 / Accepted: 9 June 2020 # This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply
2020
Abstract Extramedullary plasmacytomas are rare neoplasms arising from proliferations of monoclonal plasma cells. In primary form, these malignancies occur without other sites of plasma cell disease. Secondary extramedullary plasmacytomas occur in association with multiple myeloma and may be discovered during initial intramedullary disease or may occur during multiple myeloma relapse. In very rare instances, secondary extramedullary plasmacytomas have multifocal skeletal muscle involvement. We present a case of multifocal skeletal muscle plasmacytomas in a 58-year-old man with shoulder-reduced range of motion, pain, and a history of previously treated multiple myeloma. To our knowledge, the patient’s unique relapse presentation of torso and shoulder soft tissue masses and the vast extent of skeletal muscle involvement are unique to cases in the current literature. This case also has MRI findings of a muscular plasmacytoma with internal hemorrhage which has not been previously reported. This case report will review imaging features and clinical presentations of intramuscular extramedullary plasmacytomas. Since imaging surveillance for multiple myeloma relapse is commonly performed, radiologists should be aware of these uncommon relapsing features including multifocal intramuscular masses which may contain internal hemorrhage. Keywords Plasmacytoma . Extramedullary plasmacytoma . Skeletal muscle plasmacytoma . Soft tissue mass . Multiple myeloma
Introduction Plasmacytomas are solitary neoplastic proliferations of monoclonal plasma cells. Primary plasmacytomas are differentiated clinically from multiple myeloma (MM) by the absence of anemia, hypercalcemia, renal insufficiency, and skeletal * Nathan D. Cecava [email protected] Robert D. Moore [email protected] Steve M. Nelson [email protected] 1
San Antonio Uniformed Services Health Education Consortium, 3551 Roger Brooke Dr., Fort Sam Houston, TX 78234, USA
2
Department of Neuroradiology, University of Texas Southwestern, Dallas, TX, USA
3
Wilford Hall Ambulatory Surgical Center, 1100 Wilford Hall Loop, BLDG 4554, Lackland AFB, TX 78236, USA
4
Uniformed Services University of Health Sciences, 4301 Jones Bridge Rd, Bethesda, MD 20814, USA
5
Texas A&M School of Medicine, 8447 Riverside Pkwy, Bryan, TX 77807, USA
survey bone lesions. Patients with isolated plasmacytomas will have serum/urine paraprotein levels less than 2 g/dL [1]. These neoplasms are classified by location as intramedullary (bone) or extramedullary (soft tissue). Overall, extramedullary plasmacytomas (EMPs) are rare, representing only 4% of all plasma cell neoplasms [1]. EMPs are most commonly primary tumors, pres
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