Myelomatous pleural effusion with plasmablastic morphology and high genetic complexity as isolated extramedullary relaps
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LETTER TO THE EDITOR
Myelomatous pleural effusion with plasmablastic morphology and high genetic complexity as isolated extramedullary relapse Fernando Martín-Moro 1 María J Blanchard 1
&
Andrés Roncancio 2 & Amparo Benito 3 & María Talavera 4 & Jesús Villarrubia 1 &
Received: 20 April 2020 / Accepted: 28 April 2020 # Springer-Verlag GmbH Germany, part of Springer Nature 2020
Dear Editor, A 68-year-old Caucasian male with a history of multiple myeloma (MM) IgA kappa with several right thoracic and paravertebral plasmacytomas attended the emergency room due to fever, dyspnoea and cough. Moderate amount of right pleural effusion (PE) was demonstrated by imaging. Serosanguineous pleural fluid was exudative, with negative microbiological tests. Cytomorphological assessment of the PE showed a 55% infiltration by plasma cells with plasmablastic features (Fig. 1a, b). Malignant plasma cell population at PE was demonstrated by flow cytometry analysis (Fig. 1c): CD38bright, CD138+, CD56+ (homogeneous), CD19 − , CD20 − , CD45 − , CD27 − , CD28 d i m , CD81 − , CD117dim, kappa restricted and high side scatter. After malignant PE (MPE) plasma cell purification, karyotype and FISH analysis were performed, demonstrating hyperploid and highly complex cellularity with several chromosomal markers (Fig. 1d) and 1q21 gain. Pleural fluid electrophoresis was not performed. Blood tests were normal, and abnormal serum protein electrophoresis and immunofixation were negative. Bone marrow assessment did not find MM infiltration. No plasmacytomas were found by PET. Histologic examination of the oral mucosa and pleural biopsies ruled out amyloid deposition. The patient was managed with PE drainage,
* Fernando Martín-Moro [email protected] 1
Department of Haematology, Ramón y Cajal University Hospital, M-607, km. 9, 100, Madrid 28034, Spain
2
Department of Immunology, Ramón y Cajal University Hospital, M-607, km. 9, 100, Madrid 28034, Spain
3
Department of Pathology, Ramón y Cajal University Hospital, M-607, km. 9, 100, Madrid 28034, Spain
4
Department of Genetics, Ramón y Cajal University Hospital, M-607, km. 9, 100, Madrid 28034, Spain
pleurodesis by bleomycin instillation, local radiation and systemic therapy for MM (pomalidomide, cyclophosphamide and dexamethasone standard protocol every 28 days). After 3 months, symptoms and myelomatous PE had disappeared. Nine months later, the patient presented his second MPE episode, also managed with local and systemic treatment. The patient died 18 months after the first MPE episode; the cause of death was MM progression. Patients with MM occasionally present PE during follow-up; some causes are infections, renal failure, hypoalbuminemia, pulmonary embolism or heart failure due to amyloidosis. Effusion due to pleural myelomatous involvement is rare, occurring in less than 1% of cases [1]. Most cases are MM IgA type and occur in the left side of the chest [2]. MPE due to MM is related to pleural involvement secondary to extension of a chest wall plasmacytoma or an adjacent skeletal le
